Madison Medical Center

All Charges

Charge

Type

Setting

Price

EMPAGLIFLOZIN (JARDIANCE) 25MG TAB EMP

Facility

$77.00

Service Code	NDC 597015330
Hospital Charge Code	2622167
Hospital Revenue Code	250
Rate for Payer: Cash Price	$69.30

EMP RX-DUO NEB INH SOL (IPRAT/ALB)

Facility

$72.00

Service Code	HCPCS J7608
Hospital Charge Code	2697572
Hospital Revenue Code	250
Min. Negotiated Rate	$25.92
Max. Negotiated Rate	$51.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$51.41
Rate for Payer: Cash Price	$64.80
Rate for Payer: UnitedHealthcare Commercial	$48.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.92

EMP RX-DUO NEB INH SOL (IPRAT/ALB)

Facility

$72.00

Service Code	HCPCS J7608
Hospital Charge Code	2697572
Hospital Revenue Code	250
Rate for Payer: Cash Price	$64.80

ENALAPRIL 10MG TAB EMP

Facility

$17.00

Service Code	NDC 93002801
Hospital Charge Code	2697259
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

ENALAPRIL 10MG TAB EMP

Facility

$17.00

Service Code	NDC 93002801
Hospital Charge Code	2697259
Hospital Revenue Code	250
Rate for Payer: Cash Price	$15.30

ENALAPRIL 10MG TAB EMP

Facility

$21.00

Service Code	NDC 93002801
Hospital Charge Code	2619249
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

ENALAPRIL 10MG TAB EMP

Facility

$21.00

Service Code	NDC 93002801
Hospital Charge Code	2619249
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

ENALAPRIL 20MG TAB EMP

Facility

$21.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2619293
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

ENALAPRIL 20MG TAB EMP

Facility

$21.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2619293
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

ENALAPRILAT 2.5MG/2ML(VASOTEC)

Facility

$124.00

Service Code	HCPCS J3490
Hospital Charge Code	2697053
Hospital Revenue Code	250
Rate for Payer: Cash Price	$111.60

ENALAPRILAT 2.5MG/2ML(VASOTEC)

Facility

$124.00

Service Code	HCPCS J3490
Hospital Charge Code	2697053
Hospital Revenue Code	250
Min. Negotiated Rate	$44.64
Max. Negotiated Rate	$88.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: UnitedHealthcare Commercial	$82.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

ENALAPRIL (VASOTEC) 10MG TAB U/D

Facility

$21.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2654937
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

ENALAPRIL (VASOTEC) 10MG TAB U/D

Facility

$21.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2654937
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

ENALAPRIL (VASOTEC) 5MG TAB EMP

Facility

$22.00

Service Code	NDC 904550261
Hospital Charge Code	2657112
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

ENALAPRIL (VASOTEC) 5MG TAB EMP

Facility

$22.00

Service Code	NDC 904550261
Hospital Charge Code	2657112
Hospital Revenue Code	250
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

ENDOCERVICAL CURRETTAGE

Facility

$171.00

Service Code	CPT 57505
Hospital Charge Code	5257505
Hospital Revenue Code	521
Rate for Payer: Cash Price	$153.90

ENDOCERVICAL CURRETTAGE

Facility

$171.00

Service Code	CPT 57505
Hospital Charge Code	5257505
Hospital Revenue Code	521
Min. Negotiated Rate	$101.23
Max. Negotiated Rate	$1,882.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$830.28
Rate for Payer: Aetna Medicare Advantage	$941.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$101.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$122.09
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cigna Commercial HMO & PPO	$941.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$747.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$888.40
Rate for Payer: Home State Health Plan Medicare Advantage	$941.00
Rate for Payer: Humana Commercial	$1,882.00
Rate for Payer: Humana Medicare Advantage	$941.00
Rate for Payer: UnitedHealthcare Commercial	$114.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$830.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ENDOCLIP

Facility

$972.00

Hospital Charge Code	285340
Hospital Revenue Code	271
Min. Negotiated Rate	$349.92
Max. Negotiated Rate	$694.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$575.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$694.01
Rate for Payer: Cash Price	$874.80
Rate for Payer: UnitedHealthcare Commercial	$648.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$349.92

ENDOCLIP

Facility

$972.00

Hospital Charge Code	285340
Hospital Revenue Code	271
Rate for Payer: Cash Price	$874.80

ENDO CLOSED SUCTION 14F

Facility

$45.00

Hospital Charge Code	2819399
Hospital Revenue Code	271
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

ENDO CLOSED SUCTION 14F

Facility

$45.00

Hospital Charge Code	2819399
Hospital Revenue Code	271
Rate for Payer: Cash Price	$40.50

ENDOCRINE DISORDERS WITH CC

Facility

$19,685.12

Service Code	MSDRG 644
Min. Negotiated Rate	$9,842.56
Max. Negotiated Rate	$19,685.12
Rate for Payer: Aetna Medicare Advantage	$9,842.56
Rate for Payer: Cigna Commercial HMO & PPO	$9,842.56
Rate for Payer: Home State Health Plan Medicare Advantage	$9,842.56
Rate for Payer: Humana Commercial	$19,685.12
Rate for Payer: Humana Medicare Advantage	$9,842.56

ENDOCRINE DISORDERS WITH MCC

Facility

$29,424.16

Service Code	MSDRG 643
Min. Negotiated Rate	$14,712.08
Max. Negotiated Rate	$29,424.16
Rate for Payer: Aetna Medicare Advantage	$14,712.08
Rate for Payer: Cigna Commercial HMO & PPO	$14,712.08
Rate for Payer: Home State Health Plan Medicare Advantage	$14,712.08
Rate for Payer: Humana Commercial	$29,424.16
Rate for Payer: Humana Medicare Advantage	$14,712.08

ENDOCRINE DISORDERS WITHOUT CC/MCC

Facility

$15,667.96

Service Code	MSDRG 645
Min. Negotiated Rate	$7,833.98
Max. Negotiated Rate	$15,667.96
Rate for Payer: Aetna Medicare Advantage	$7,833.98
Rate for Payer: Cigna Commercial HMO & PPO	$7,833.98
Rate for Payer: Home State Health Plan Medicare Advantage	$7,833.98
Rate for Payer: Humana Commercial	$15,667.96
Rate for Payer: Humana Medicare Advantage	$7,833.98

ENDOCUFF LARGE GREEN

Facility

$158.00

Hospital Charge Code	125347
Hospital Revenue Code	271
Rate for Payer: Cash Price	$142.20

Know your out-of-pocket cost for care.

All Charges