Madison Medical Center

All Charges

Charge

Type

Setting

Price

DISP. BOVIE TIP CHO5

Facility

$42.00

Hospital Charge Code	282221
Hospital Revenue Code	271
Rate for Payer: Cash Price	$37.80

DISP FLAT SHEETS EA.

Facility

$22.00

Hospital Charge Code	284782
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

DISP FLAT SHEETS EA.

Facility

$22.00

Hospital Charge Code	284782
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

DISPOSABLE BIOPSY PUNCH (ALL SIZES)

Facility

$20.00

Hospital Charge Code	4070800
Hospital Revenue Code	510
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

DISPOSABLE BIOPSY PUNCH (ALL SIZES)

Facility

$20.00

Hospital Charge Code	4070800
Hospital Revenue Code	510
Rate for Payer: Cash Price	$18.00

DISPOSABLE VAGINAL SPECULUM

Facility

$20.00

Hospital Charge Code	403023
Hospital Revenue Code	271
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

DISPOSABLE VAGINAL SPECULUM

Facility

$20.00

Hospital Charge Code	403023
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

DIS POZ-A-BAG

Facility

$43.00

Hospital Charge Code	284006
Hospital Revenue Code	271
Rate for Payer: Cash Price	$38.70

DIS POZ-A-BAG

Facility

$43.00

Hospital Charge Code	284006
Hospital Revenue Code	271
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

DISP PED PULSE OX PROBE

Facility

$118.00

Service Code	CPT 94760
Hospital Charge Code	4500445
Hospital Revenue Code	460
Rate for Payer: Cash Price	$106.20

DISP PED PULSE OX PROBE

Facility

$118.00

Service Code	CPT 94760
Hospital Charge Code	4500445
Hospital Revenue Code	460
Min. Negotiated Rate	$42.48
Max. Negotiated Rate	$84.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$69.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$84.25
Rate for Payer: Cash Price	$106.20
Rate for Payer: UnitedHealthcare Commercial	$78.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.48

DISP PILLOW CASE EA.

Facility

$15.00

Hospital Charge Code	284780
Hospital Revenue Code	271
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

DISP PILLOW CASE EA.

Facility

$15.00

Hospital Charge Code	284780
Hospital Revenue Code	271
Rate for Payer: Cash Price	$13.50

DIVALPROEX 125MG TAB EMP

Facility

$21.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2621088
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

DIVALPROEX 125MG TAB EMP

Facility

$21.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2621088
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

DIVALPROEX (DEPAKOTE) 125MG DR TAB

Facility

$21.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2626590
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

DIVALPROEX (DEPAKOTE) 125MG DR TAB

Facility

$21.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2626590
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

DIVALPROEX (DEPAKOTE) DR 250MG TAB

Facility

$21.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2657140
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

DIVALPROEX (DEPAKOTE) DR 250MG TAB

Facility

$21.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2657140
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$28,557.00

Service Code	APR-DRG 2444
Min. Negotiated Rate	$28,557.00
Max. Negotiated Rate	$28,557.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$28,557.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28,557.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28,557.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28,557.00

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$14,436.55

Service Code	APR-DRG 2443
Min. Negotiated Rate	$14,436.55
Max. Negotiated Rate	$14,436.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,436.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,436.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,436.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,436.55

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$6,634.51

Service Code	APR-DRG 2441
Min. Negotiated Rate	$6,634.51
Max. Negotiated Rate	$6,634.51
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,634.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,634.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,634.51
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,634.51

DIVERTICULITIS AND DIVERTICULOSIS

Facility

$9,237.21

Service Code	APR-DRG 2442
Min. Negotiated Rate	$9,237.21
Max. Negotiated Rate	$9,237.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,237.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,237.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,237.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,237.21

D L U 30V

Facility

$715.00

Hospital Charge Code	283974
Hospital Revenue Code	271
Rate for Payer: Cash Price	$643.50

D L U 30V

Facility

$715.00

Hospital Charge Code	283974
Hospital Revenue Code	271
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$510.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$423.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$510.51
Rate for Payer: Cash Price	$643.50
Rate for Payer: UnitedHealthcare Commercial	$476.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$257.40

Know your out-of-pocket cost for care.

All Charges