Madison Medical Center

All Charges

Charge

Type

Setting

Price

CIPROFLOXACIN (CIPRO) 3% OP SOL 2.5ML

Facility

$127.00

Service Code	NDC 6.9315E+10
Hospital Charge Code	2623602
Hospital Revenue Code	250
Rate for Payer: Cash Price	$114.30

CIPROFLOXACIN (CIPRO) 3% OP SOL 5ML

Facility

$127.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2626393
Hospital Revenue Code	250
Min. Negotiated Rate	$45.72
Max. Negotiated Rate	$90.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$90.68
Rate for Payer: Cash Price	$114.30
Rate for Payer: UnitedHealthcare Commercial	$84.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

CIPROFLOXACIN (CIPRO) 3% OP SOL 5ML

Facility

$127.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2626393
Hospital Revenue Code	250
Rate for Payer: Cash Price	$114.30

CIPROFLOXACIN (CIPRO) 3% OP SOL 5ML EMP

Facility

$127.00

Service Code	NDC 6.1314E+10
Hospital Charge Code	2624309
Hospital Revenue Code	250
Rate for Payer: Cash Price	$114.30

CIPROFLOXACIN (CIPRO) 3% OP SOL 5ML EMP

Facility

$127.00

Service Code	NDC 6.1314E+10
Hospital Charge Code	2624309
Hospital Revenue Code	250
Min. Negotiated Rate	$45.72
Max. Negotiated Rate	$90.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$90.68
Rate for Payer: Cash Price	$114.30
Rate for Payer: UnitedHealthcare Commercial	$84.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

CIPROFLOXACIN (CIPRO) 500MG TAB UD

Facility

$55.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2657138
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

CIPROFLOXACIN (CIPRO) 500MG TAB UD

Facility

$55.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2657138
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

CIPROFLOXIN 400MG PREMIX 200ML

Facility

$107.00

Service Code	HCPCS J0744
Hospital Charge Code	2603954
Hospital Revenue Code	250
Rate for Payer: Cash Price	$96.30

CIPROFLOXIN 400MG PREMIX 200ML

Facility

$107.00

Service Code	HCPCS J0744
Hospital Charge Code	2603954
Hospital Revenue Code	250
Min. Negotiated Rate	$38.52
Max. Negotiated Rate	$76.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: UnitedHealthcare Commercial	$71.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

CIPROFLOXIN 400MG VIAL 40ML

Facility

$107.00

Service Code	HCPCS J0744
Hospital Charge Code	2619772
Hospital Revenue Code	250
Rate for Payer: Cash Price	$96.30

CIPROFLOXIN 400MG VIAL 40ML

Facility

$107.00

Service Code	HCPCS J0744
Hospital Charge Code	2619772
Hospital Revenue Code	250
Min. Negotiated Rate	$38.52
Max. Negotiated Rate	$76.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: UnitedHealthcare Commercial	$71.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC

Facility

$38,351.82

Service Code	MSDRG 286
Min. Negotiated Rate	$19,175.91
Max. Negotiated Rate	$38,351.82
Rate for Payer: Aetna Medicare Advantage	$19,175.91
Rate for Payer: Cigna Commercial HMO & PPO	$19,175.91
Rate for Payer: Home State Health Plan Medicare Advantage	$19,175.91
Rate for Payer: Humana Commercial	$38,351.82
Rate for Payer: Humana Medicare Advantage	$19,175.91

CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC

Facility

$20,390.92

Service Code	MSDRG 287
Min. Negotiated Rate	$10,195.46
Max. Negotiated Rate	$20,390.92
Rate for Payer: Aetna Medicare Advantage	$10,195.46
Rate for Payer: Cigna Commercial HMO & PPO	$10,195.46
Rate for Payer: Home State Health Plan Medicare Advantage	$10,195.46
Rate for Payer: Humana Commercial	$20,390.92
Rate for Payer: Humana Medicare Advantage	$10,195.46

CIRCUMCISIAM/NEWBORN

Facility

$146.00

Service Code	CPT 54150
Hospital Charge Code	4254150
Hospital Revenue Code	521
Rate for Payer: Cash Price	$131.40

CIRCUMCISIAM/NEWBORN

Facility

$146.00

Service Code	CPT 54150
Hospital Charge Code	4254150
Hospital Revenue Code	521
Min. Negotiated Rate	$86.43
Max. Negotiated Rate	$4,271.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,884.38
Rate for Payer: Aetna Medicare Advantage	$2,135.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$86.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$104.24
Rate for Payer: Cash Price	$131.40
Rate for Payer: Cash Price	$131.40
Rate for Payer: Cash Price	$131.40
Rate for Payer: Cash Price	$131.40
Rate for Payer: Cigna Commercial HMO & PPO	$2,135.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,695.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2,016.29
Rate for Payer: Home State Health Plan Medicare Advantage	$2,135.66
Rate for Payer: Humana Commercial	$4,271.32
Rate for Payer: Humana Medicare Advantage	$2,135.66
Rate for Payer: UnitedHealthcare Commercial	$97.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,884.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CIRCUMCISION

Facility

$665.00

Service Code	CPT 54161
Hospital Charge Code	4154161
Hospital Revenue Code	521
Rate for Payer: Cash Price	$598.50

CIRCUMCISION

Facility

$665.00

Service Code	CPT 54161
Hospital Charge Code	4154161
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$4,271.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,884.38
Rate for Payer: Aetna Medicare Advantage	$2,135.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$393.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$474.81
Rate for Payer: Cash Price	$598.50
Rate for Payer: Cash Price	$598.50
Rate for Payer: Cash Price	$598.50
Rate for Payer: Cash Price	$598.50
Rate for Payer: Cigna Commercial HMO & PPO	$2,135.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,695.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2,016.29
Rate for Payer: Home State Health Plan Medicare Advantage	$2,135.66
Rate for Payer: Humana Commercial	$4,271.32
Rate for Payer: Humana Medicare Advantage	$2,135.66
Rate for Payer: UnitedHealthcare Commercial	$443.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,884.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CIRCUMCISION EXCEPT NEWBORN OTHER THAN C

Professional

Both

$945.00

Service Code	CPT 54161
Hospital Charge Code	5454161
Hospital Revenue Code	975
Min. Negotiated Rate	$147.59
Max. Negotiated Rate	$330.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$172.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$147.59
Rate for Payer: Cash Price	$850.50
Rate for Payer: Cash Price	$850.50
Rate for Payer: Cigna Commercial HMO & PPO	$172.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$147.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$162.35
Rate for Payer: Home State Health Plan Medicare Advantage	$172.56
Rate for Payer: Optum Medicare Advantage	$330.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$147.59

CIRCUMCISION NEWBORN

Facility

$174.00

Service Code	CPT 54150
Hospital Charge Code	5254150
Hospital Revenue Code	521
Min. Negotiated Rate	$103.01
Max. Negotiated Rate	$4,271.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,884.38
Rate for Payer: Aetna Medicare Advantage	$2,135.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$103.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$124.24
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cigna Commercial HMO & PPO	$2,135.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,695.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2,016.29
Rate for Payer: Home State Health Plan Medicare Advantage	$2,135.66
Rate for Payer: Humana Commercial	$4,271.32
Rate for Payer: Humana Medicare Advantage	$2,135.66
Rate for Payer: UnitedHealthcare Commercial	$116.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,884.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CIRCUMCISION NEWBORN

Facility

$174.00

Service Code	CPT 54150
Hospital Charge Code	5254150
Hospital Revenue Code	521
Rate for Payer: Cash Price	$156.60

CIRCUMCISION REPAIR

Professional

Both

$683.00

Service Code	CPT 54163
Hospital Charge Code	5454163
Hospital Revenue Code	975
Min. Negotiated Rate	$163.04
Max. Negotiated Rate	$239.05
Rate for Payer: Aetna Commercial/Medicare Advantage	$195.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$163.04
Rate for Payer: Cash Price	$614.70
Rate for Payer: Cash Price	$614.70
Rate for Payer: Cigna Commercial HMO & PPO	$195.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$163.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$179.34
Rate for Payer: Home State Health Plan Medicare Advantage	$195.01
Rate for Payer: Optum Medicare Advantage	$239.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$163.04

CIRCUMCISUM

Professional

Both

$185.00

Service Code	CPT 54150
Hospital Charge Code	4154150
Hospital Revenue Code	975
Min. Negotiated Rate	$64.75
Max. Negotiated Rate	$133.96
Rate for Payer: Aetna Commercial/Medicare Advantage	$81.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$121.78
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cigna Commercial HMO & PPO	$81.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$121.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$133.96
Rate for Payer: Home State Health Plan Medicare Advantage	$81.98
Rate for Payer: Optum Medicare Advantage	$64.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$121.78

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC

Facility

$20,173.36

Service Code	MSDRG 433
Min. Negotiated Rate	$10,086.68
Max. Negotiated Rate	$20,173.36
Rate for Payer: Aetna Medicare Advantage	$10,086.68
Rate for Payer: Cigna Commercial HMO & PPO	$10,086.68
Rate for Payer: Home State Health Plan Medicare Advantage	$10,086.68
Rate for Payer: Humana Commercial	$20,173.36
Rate for Payer: Humana Medicare Advantage	$10,086.68

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC

Facility

$34,498.46

Service Code	MSDRG 432
Min. Negotiated Rate	$17,249.23
Max. Negotiated Rate	$34,498.46
Rate for Payer: Aetna Medicare Advantage	$17,249.23
Rate for Payer: Cigna Commercial HMO & PPO	$17,249.23
Rate for Payer: Home State Health Plan Medicare Advantage	$17,249.23
Rate for Payer: Humana Commercial	$34,498.46
Rate for Payer: Humana Medicare Advantage	$17,249.23

CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC

Facility

$14,796.40

Service Code	MSDRG 434
Min. Negotiated Rate	$7,398.20
Max. Negotiated Rate	$14,796.40
Rate for Payer: Aetna Medicare Advantage	$7,398.20
Rate for Payer: Cigna Commercial HMO & PPO	$7,398.20
Rate for Payer: Home State Health Plan Medicare Advantage	$7,398.20
Rate for Payer: Humana Commercial	$14,796.40
Rate for Payer: Humana Medicare Advantage	$7,398.20

Know your out-of-pocket cost for care.

All Charges