Madison Medical Center

All Charges

Charge

Type

Setting

Price

DELIVERY (VAGINAL)

Facility

$1,153.00

Service Code	CPT 59409
Hospital Charge Code	5259409
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,037.70

DELIVERY, VAGINAL

Facility

$5,151.00

Service Code	CPT 59409
Hospital Charge Code	1859409
Hospital Revenue Code	450
Min. Negotiated Rate	$1,854.36
Max. Negotiated Rate	$6,614.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,918.10
Rate for Payer: Aetna Medicare Advantage	$3,307.24
Rate for Payer: Cash Price	$4,635.90
Rate for Payer: Cash Price	$4,635.90
Rate for Payer: Cash Price	$4,635.90
Rate for Payer: Cigna Commercial HMO & PPO	$3,307.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,918.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,122.37
Rate for Payer: Home State Health Plan Medicare Advantage	$3,307.24
Rate for Payer: Humana Commercial	$6,614.48
Rate for Payer: Humana Medicare Advantage	$3,307.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,918.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,854.36

DELIVERY, VAGINAL

Facility

$5,151.00

Service Code	CPT 59409
Hospital Charge Code	1859409
Hospital Revenue Code	450
Rate for Payer: Cash Price	$4,635.90

DEMERAL (MEPERIDINE)

Facility

$234.00

Service Code	CPT 83925
Hospital Charge Code	2283925
Hospital Revenue Code	301
Rate for Payer: Cash Price	$210.60

DEMERAL (MEPERIDINE)

Facility

$234.00

Service Code	CPT 83925
Hospital Charge Code	2283925
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$167.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$138.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.08
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.24

DEMONSTRATION EDUCATION

Facility

$151.00

Service Code	CPT 94664
Hospital Charge Code	4600512
Hospital Revenue Code	460
Rate for Payer: Cash Price	$135.90

DEMONSTRATION EDUCATION

Facility

$151.00

Service Code	CPT 94664
Hospital Charge Code	4600512
Hospital Revenue Code	460
Min. Negotiated Rate	$54.36
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.81
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$100.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.36

DENAVIR 1% CRM 5GM EMP

Facility

$423.00

Service Code	NDC 378972055
Hospital Charge Code	2623538
Hospital Revenue Code	250
Rate for Payer: Cash Price	$380.70

DENAVIR 1% CRM 5GM EMP

Facility

$423.00

Service Code	NDC 378972055
Hospital Charge Code	2623538
Hospital Revenue Code	250
Min. Negotiated Rate	$152.28
Max. Negotiated Rate	$302.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$250.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$302.02
Rate for Payer: Cash Price	$380.70
Rate for Payer: UnitedHealthcare Commercial	$282.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$152.28

DENOSUMAB (PROLIA) 60MG/ML SC INJ

Facility

$6,454.00

Service Code	HCPCS J0897
Hospital Charge Code	2626529
Hospital Revenue Code	250
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$4,608.16
Rate for Payer: Aetna Medicare Advantage	$30.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$3,820.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$4,608.16
Rate for Payer: Cash Price	$5,808.60
Rate for Payer: Cash Price	$5,808.60
Rate for Payer: Cigna Commercial HMO & PPO	$30.10
Rate for Payer: Home State Health Plan Medicare Advantage	$30.10
Rate for Payer: Humana Commercial	$60.20
Rate for Payer: Humana Medicare Advantage	$30.10
Rate for Payer: UnitedHealthcare Commercial	$4,304.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,323.44

DENOSUMAB (PROLIA) 60MG/ML SC INJ

Facility

$6,454.00

Service Code	HCPCS J0897
Hospital Charge Code	2626529
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5,808.60

DENOSUMAB (XGEVA) 120MG INJ

Facility

$11,383.00

Service Code	NDC 5.5513E+10
Hospital Charge Code	2697229
Hospital Revenue Code	250
Min. Negotiated Rate	$4,097.88
Max. Negotiated Rate	$8,127.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$6,738.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8,127.46
Rate for Payer: Cash Price	$10,244.70
Rate for Payer: UnitedHealthcare Commercial	$7,592.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$4,097.88

DENOSUMAB (XGEVA) 120MG INJ

Facility

$11,383.00

Service Code	NDC 5.5513E+10
Hospital Charge Code	2697229
Hospital Revenue Code	250
Rate for Payer: Cash Price	$10,244.70

DENTAL AND ORAL DISEASES WITH CC

Facility

$17,882.32

Service Code	MSDRG 158
Min. Negotiated Rate	$8,941.16
Max. Negotiated Rate	$17,882.32
Rate for Payer: Aetna Medicare Advantage	$8,941.16
Rate for Payer: Cigna Commercial HMO & PPO	$8,941.16
Rate for Payer: Home State Health Plan Medicare Advantage	$8,941.16
Rate for Payer: Humana Commercial	$17,882.32
Rate for Payer: Humana Medicare Advantage	$8,941.16

DENTAL AND ORAL DISEASES WITH MCC

Facility

$30,537.96

Service Code	MSDRG 157
Min. Negotiated Rate	$15,268.98
Max. Negotiated Rate	$30,537.96
Rate for Payer: Aetna Medicare Advantage	$15,268.98
Rate for Payer: Cigna Commercial HMO & PPO	$15,268.98
Rate for Payer: Home State Health Plan Medicare Advantage	$15,268.98
Rate for Payer: Humana Commercial	$30,537.96
Rate for Payer: Humana Medicare Advantage	$15,268.98

DENTAL AND ORAL DISEASES WITHOUT CC/MCC

Facility

$14,734.10

Service Code	MSDRG 159
Min. Negotiated Rate	$7,367.05
Max. Negotiated Rate	$14,734.10
Rate for Payer: Aetna Medicare Advantage	$7,367.05
Rate for Payer: Cigna Commercial HMO & PPO	$7,367.05
Rate for Payer: Home State Health Plan Medicare Advantage	$7,367.05
Rate for Payer: Humana Commercial	$14,734.10
Rate for Payer: Humana Medicare Advantage	$7,367.05

DENTAL DISEASES AND DISORDERS

Facility

$11,925.37

Service Code	APR-DRG 1143
Min. Negotiated Rate	$11,925.37
Max. Negotiated Rate	$11,925.37
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,925.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,925.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,925.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,925.37

DENTAL DISEASES AND DISORDERS

Facility

$4,402.56

Service Code	APR-DRG 1142
Min. Negotiated Rate	$4,402.56
Max. Negotiated Rate	$4,402.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,402.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,402.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,402.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,402.56

DENTAL DISEASES AND DISORDERS

Facility

$3,739.68

Service Code	APR-DRG 1141
Min. Negotiated Rate	$3,739.68
Max. Negotiated Rate	$3,739.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$3,739.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3,739.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,739.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3,739.68

DENTAL DISEASES AND DISORDERS

Facility

$21,883.36

Service Code	APR-DRG 1144
Min. Negotiated Rate	$21,883.36
Max. Negotiated Rate	$21,883.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$21,883.36
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21,883.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21,883.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21,883.36

DEPOESTROGEN 1CC

Facility

$150.00

Service Code	CPT J1000
Hospital Charge Code	4101000
Hospital Revenue Code	636
Min. Negotiated Rate	$100.05
Max. Negotiated Rate	$100.05
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05

DEPOESTROGEN 1CC

Facility

$150.00

Service Code	HCPCS J1000
Hospital Charge Code	9601000
Hospital Revenue Code	636
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$107.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.00

DEPOESTROGEN 1CC

Facility

$150.00

Service Code	CPT J1000
Hospital Charge Code	4101000
Hospital Revenue Code	636
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$107.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.00

DEPOESTROGEN 1CC

Facility

$150.00

Service Code	HCPCS J1000
Hospital Charge Code	9601000
Hospital Revenue Code	636
Min. Negotiated Rate	$100.05
Max. Negotiated Rate	$100.05
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05

DEPO MEDROL 1 MG

Facility

$60.00

Service Code	HCPCS J1010
Hospital Charge Code	9601030
Hospital Revenue Code	636
Min. Negotiated Rate	$40.02
Max. Negotiated Rate	$40.02
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02

Know your out-of-pocket cost for care.

All Charges