Madison Medical Center

All Charges

Charge

Type

Setting

Price

DUTASTERIDE (AVODART) 0.5MG CAP EMP

Facility

$39.00

Service Code	NDC 3.1722E+10
Hospital Charge Code	2624848
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

DUTASTERIDE (AVODART) 0.5MG CAP EMP

Facility

$39.00

Service Code	NDC 3.1722E+10
Hospital Charge Code	2624848
Hospital Revenue Code	250
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

DYCLONINE SOLN.(190 DYCLONE)

Facility

$319.00

Hospital Charge Code	209222
Hospital Revenue Code	370
Rate for Payer: Cash Price	$287.10

DYCLONINE SOLN.(190 DYCLONE)

Facility

$319.00

Hospital Charge Code	209222
Hospital Revenue Code	370
Min. Negotiated Rate	$114.84
Max. Negotiated Rate	$227.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$188.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$227.77
Rate for Payer: Cash Price	$287.10
Rate for Payer: UnitedHealthcare Commercial	$212.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$114.84

DYMISTA NASAL SPRAY 23GM EMP

Facility

$282.00

Service Code	NDC 37024523
Hospital Charge Code	2622920
Hospital Revenue Code	250
Rate for Payer: Cash Price	$253.80

DYMISTA NASAL SPRAY 23GM EMP

Facility

$282.00

Service Code	NDC 37024523
Hospital Charge Code	2622920
Hospital Revenue Code	250
Min. Negotiated Rate	$101.52
Max. Negotiated Rate	$201.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$166.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$201.35
Rate for Payer: Cash Price	$253.80
Rate for Payer: UnitedHealthcare Commercial	$188.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$101.52

DYSEQUILIBRIUM

Facility

$15,406.60

Service Code	MSDRG 149
Min. Negotiated Rate	$7,703.30
Max. Negotiated Rate	$15,406.60
Rate for Payer: Aetna Medicare Advantage	$7,703.30
Rate for Payer: Cigna Commercial HMO & PPO	$7,703.30
Rate for Payer: Home State Health Plan Medicare Advantage	$7,703.30
Rate for Payer: Humana Commercial	$15,406.60
Rate for Payer: Humana Medicare Advantage	$7,703.30

EA ADD'L VACCINE ADMINISTRATION

Facility

$35.00

Service Code	CPT 90472
Hospital Charge Code	4290472
Hospital Revenue Code	636
Min. Negotiated Rate	$23.34
Max. Negotiated Rate	$23.34
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34

EA ADD'L VACCINE ADMINISTRATION

Facility

$35.00

Service Code	CPT 90472
Hospital Charge Code	4290472
Hospital Revenue Code	636
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC

Facility

$23,542.68

Service Code	MSDRG 147
Min. Negotiated Rate	$11,771.34
Max. Negotiated Rate	$23,542.68
Rate for Payer: Aetna Medicare Advantage	$11,771.34
Rate for Payer: Cigna Commercial HMO & PPO	$11,771.34
Rate for Payer: Home State Health Plan Medicare Advantage	$11,771.34
Rate for Payer: Humana Commercial	$23,542.68
Rate for Payer: Humana Medicare Advantage	$11,771.34

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC

Facility

$36,848.90

Service Code	MSDRG 146
Min. Negotiated Rate	$18,424.45
Max. Negotiated Rate	$36,848.90
Rate for Payer: Aetna Medicare Advantage	$18,424.45
Rate for Payer: Cigna Commercial HMO & PPO	$18,424.45
Rate for Payer: Home State Health Plan Medicare Advantage	$18,424.45
Rate for Payer: Humana Commercial	$36,848.90
Rate for Payer: Humana Medicare Advantage	$18,424.45

EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC

Facility

$16,118.64

Service Code	MSDRG 148
Min. Negotiated Rate	$8,059.32
Max. Negotiated Rate	$16,118.64
Rate for Payer: Aetna Medicare Advantage	$8,059.32
Rate for Payer: Cigna Commercial HMO & PPO	$8,059.32
Rate for Payer: Home State Health Plan Medicare Advantage	$8,059.32
Rate for Payer: Humana Commercial	$16,118.64
Rate for Payer: Humana Medicare Advantage	$8,059.32

EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES

Facility

$10,306.54

Service Code	APR-DRG 1102
Min. Negotiated Rate	$10,306.54
Max. Negotiated Rate	$10,306.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,306.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,306.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,306.54
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,306.54

EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES

Facility

$16,676.47

Service Code	APR-DRG 1103
Min. Negotiated Rate	$16,676.47
Max. Negotiated Rate	$16,676.47
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,676.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,676.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,676.47
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,676.47

EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES

Facility

$10,306.54

Service Code	APR-DRG 1101
Min. Negotiated Rate	$10,306.54
Max. Negotiated Rate	$10,306.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,306.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,306.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,306.54
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,306.54

EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL MALIGNANCIES

Facility

$25,268.95

Service Code	APR-DRG 1104
Min. Negotiated Rate	$25,268.95
Max. Negotiated Rate	$25,268.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$25,268.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25,268.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25,268.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25,268.95

EAR SYRINGE 3 OZ

Facility

$22.00

Hospital Charge Code	285202
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

EAR SYRINGE 3 OZ

Facility

$22.00

Hospital Charge Code	285202
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

EAR TRAY

Facility

$75.00

Hospital Charge Code	285005
Hospital Revenue Code	271
Rate for Payer: Cash Price	$67.50

EAR TRAY

Facility

$75.00

Hospital Charge Code	285005
Hospital Revenue Code	271
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

EAR WAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	4469210
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EAR WAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	4469210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9569210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	5469210
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EARWAX REMOVAL

Facility

$135.00

Service Code	CPT 69210
Hospital Charge Code	9769210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

Know your out-of-pocket cost for care.

All Charges