Madison Medical Center

All Charges

Charge

Type

Setting

Price

CUROS STRIP

Facility

$12.00

Hospital Charge Code	1299148
Hospital Revenue Code	271
Rate for Payer: Cash Price	$10.80

CUROS STRIP

Facility

$12.00

Hospital Charge Code	1299148
Hospital Revenue Code	271
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$8.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8.57
Rate for Payer: Cash Price	$10.80
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

CUTDOWN TRAY

Facility

$106.00

Hospital Charge Code	283806
Hospital Revenue Code	271
Rate for Payer: Cash Price	$95.40

CUTDOWN TRAY

Facility

$106.00

Hospital Charge Code	283806
Hospital Revenue Code	271
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$75.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: UnitedHealthcare Commercial	$70.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

CUTTING LOOP

Facility

$424.00

Hospital Charge Code	283810
Hospital Revenue Code	271
Rate for Payer: Cash Price	$381.60

CUTTING LOOP

Facility

$424.00

Hospital Charge Code	283810
Hospital Revenue Code	271
Min. Negotiated Rate	$152.64
Max. Negotiated Rate	$302.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$251.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$302.74
Rate for Payer: Cash Price	$381.60
Rate for Payer: UnitedHealthcare Commercial	$282.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$152.64

CUTTING LOOP ELECTRODE

Facility

$343.00

Hospital Charge Code	1216052
Hospital Revenue Code	271
Min. Negotiated Rate	$123.48
Max. Negotiated Rate	$244.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$203.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$244.90
Rate for Payer: Cash Price	$308.70
Rate for Payer: UnitedHealthcare Commercial	$228.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$123.48

CUTTING LOOP ELECTRODE

Facility

$343.00

Hospital Charge Code	1216052
Hospital Revenue Code	271
Rate for Payer: Cash Price	$308.70

CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION

Facility

$8,325.29

Service Code	APR-DRG 0452
Min. Negotiated Rate	$8,325.29
Max. Negotiated Rate	$8,325.29
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,325.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,325.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,325.29
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,325.29

CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION

Facility

$30,097.72

Service Code	APR-DRG 0454
Min. Negotiated Rate	$30,097.72
Max. Negotiated Rate	$30,097.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$30,097.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30,097.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$30,097.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$30,097.72

CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION

Facility

$14,320.80

Service Code	APR-DRG 0453
Min. Negotiated Rate	$14,320.80
Max. Negotiated Rate	$14,320.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,320.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,320.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,320.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,320.80

CVA AND PRECEREBRAL OCCLUSION WITH INFARCTION

Facility

$5,407.51

Service Code	APR-DRG 0451
Min. Negotiated Rate	$5,407.51
Max. Negotiated Rate	$5,407.51
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,407.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,407.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,407.51
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,407.51

CYANOCOBALAMIN 100MCG (VIT B-12)TAB

Facility

$17.00

Service Code	NDC 536354201
Hospital Charge Code	2697077
Hospital Revenue Code	250
Rate for Payer: Cash Price	$15.30

CYANOCOBALAMIN 100MCG (VIT B-12)TAB

Facility

$17.00

Service Code	NDC 536354201
Hospital Charge Code	2697077
Hospital Revenue Code	250
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$12.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.14
Rate for Payer: Cash Price	$15.30
Rate for Payer: UnitedHealthcare Commercial	$11.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.12

CYANOCOBALAMIN (VIT B-12) 1MG VL 1ML

Facility

$65.00

Service Code	HCPCS J3420
Hospital Charge Code	2654684
Hospital Revenue Code	250
Rate for Payer: Cash Price	$58.50

CYANOCOBALAMIN (VIT B-12) 1MG VL 1ML

Facility

$65.00

Service Code	HCPCS J3420
Hospital Charge Code	2654684
Hospital Revenue Code	250
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

CYANOCOBALAMIN (VIT B-12) 1MG VL 1ML EMP

Facility

$65.00

Service Code	HCPCS J3420
Hospital Charge Code	2622768
Hospital Revenue Code	250
Rate for Payer: Cash Price	$58.50

CYANOCOBALAMIN (VIT B-12) 1MG VL 1ML EMP

Facility

$65.00

Service Code	HCPCS J3420
Hospital Charge Code	2622768
Hospital Revenue Code	250
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

CYANOCOBAL (VIT B-12) 1000 MCG TAB

Facility

$15.00

Service Code	NDC 1.0135E+10
Hospital Charge Code	2697076
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

CYANOCOBAL (VIT B-12) 1000 MCG TAB

Facility

$15.00

Service Code	NDC 1.0135E+10
Hospital Charge Code	2697076
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

CYANOCOBAL (VIT B-12) 1MG/ML INJ 10ML

Facility

$52.00

Service Code	HCPCS J3420
Hospital Charge Code	2697046
Hospital Revenue Code	250
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$37.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.13
Rate for Payer: Cash Price	$46.80
Rate for Payer: UnitedHealthcare Commercial	$34.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.72

CYANOCOBAL (VIT B-12) 1MG/ML INJ 10ML

Facility

$52.00

Service Code	HCPCS J3420
Hospital Charge Code	2697046
Hospital Revenue Code	250
Rate for Payer: Cash Price	$46.80

CYCLIC AMP

Facility

$391.00

Service Code	CPT 82030
Hospital Charge Code	2282030
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$279.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$23.22
Rate for Payer: Aetna Medicare Advantage	$25.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$231.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$279.17
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cigna Commercial HMO & PPO	$25.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24.85
Rate for Payer: Home State Health Plan Medicare Advantage	$25.80
Rate for Payer: Humana Commercial	$51.60
Rate for Payer: Humana Medicare Advantage	$25.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$140.76

CYCLIC AMP

Facility

$391.00

Service Code	CPT 82030
Hospital Charge Code	2282030
Hospital Revenue Code	301
Rate for Payer: Cash Price	$351.90

CYCLOBENZAPRINE 10MG TAB EMP

Facility

$22.00

Service Code	NDC 5.9746E+10
Hospital Charge Code	2619906
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

Know your out-of-pocket cost for care.

All Charges