Madison Medical Center

All Charges

Charge

Type

Setting

Price

ENOXAPARIN (LOVENOX) 100MG INJ 1ML

Facility

$460.00

Service Code	HCPCS J1650
Hospital Charge Code	2626318
Hospital Revenue Code	250
Rate for Payer: Cash Price	$414.00

ENOXAPARIN (LOVENOX) 100MG INJ 1ML

Facility

$460.00

Service Code	HCPCS J1650
Hospital Charge Code	2626318
Hospital Revenue Code	250
Min. Negotiated Rate	$165.60
Max. Negotiated Rate	$328.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$272.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$328.44
Rate for Payer: Cash Price	$414.00
Rate for Payer: UnitedHealthcare Commercial	$306.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$165.60

ENOXAPARIN (LOVENOX) 30MG/0.3ML INJ

Facility

$153.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2626297
Hospital Revenue Code	250
Rate for Payer: Cash Price	$137.70

ENOXAPARIN (LOVENOX) 30MG/0.3ML INJ

Facility

$153.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2626297
Hospital Revenue Code	250
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$109.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: UnitedHealthcare Commercial	$102.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

ENOXAPARIN (LOVENOX) 30MG/0.3ML INJ EMP

Facility

$153.00

Service Code	NDC 75062430
Hospital Charge Code	2622847
Hospital Revenue Code	250
Rate for Payer: Cash Price	$137.70

ENOXAPARIN (LOVENOX) 30MG/0.3ML INJ EMP

Facility

$153.00

Service Code	NDC 75062430
Hospital Charge Code	2622847
Hospital Revenue Code	250
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$109.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: UnitedHealthcare Commercial	$102.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

ENOXAPARIN (LOVENOX) 40MG/0.4ML INJ

Facility

$185.00

Service Code	HCPCS J1650
Hospital Charge Code	2626309
Hospital Revenue Code	250
Rate for Payer: Cash Price	$166.50

ENOXAPARIN (LOVENOX) 40MG/0.4ML INJ

Facility

$185.00

Service Code	HCPCS J1650
Hospital Charge Code	2626309
Hospital Revenue Code	250
Min. Negotiated Rate	$66.60
Max. Negotiated Rate	$132.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$109.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.09
Rate for Payer: Cash Price	$166.50
Rate for Payer: UnitedHealthcare Commercial	$123.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.60

ENOXAPARIN (LOVENOX) 60MG/0.6ML INJ

Facility

$260.00

Service Code	HCPCS J1650
Hospital Charge Code	2626310
Hospital Revenue Code	250
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$185.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: UnitedHealthcare Commercial	$173.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$93.60

ENOXAPARIN (LOVENOX) 60MG/0.6ML INJ

Facility

$260.00

Service Code	HCPCS J1650
Hospital Charge Code	2626310
Hospital Revenue Code	250
Rate for Payer: Cash Price	$234.00

ENSKYCE 0.15/0.03MG 3X28 TAB PAK EMP

Facility

$403.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2623818
Hospital Revenue Code	250
Rate for Payer: Cash Price	$362.70

ENSKYCE 0.15/0.03MG 3X28 TAB PAK EMP

Facility

$403.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2623818
Hospital Revenue Code	250
Min. Negotiated Rate	$145.08
Max. Negotiated Rate	$287.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$238.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$287.74
Rate for Payer: Cash Price	$362.70
Rate for Payer: UnitedHealthcare Commercial	$268.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$145.08

*ENTACAPONE 200MG TAB

Facility

$7.00

Hospital Charge Code	260644
Hospital Revenue Code	250
Rate for Payer: Cash Price	$6.30

*ENTACAPONE 200MG TAB

Facility

$7.00

Hospital Charge Code	260644
Hospital Revenue Code	250
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$5.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.00
Rate for Payer: Cash Price	$6.30
Rate for Payer: UnitedHealthcare Commercial	$4.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.52

ENTACAPONE (COMTAN) 200MG TAB

Facility

$24.00

Service Code	NDC 378908001
Hospital Charge Code	2697071
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

ENTACAPONE (COMTAN) 200MG TAB

Facility

$24.00

Service Code	NDC 378908001
Hospital Charge Code	2697071
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

ENTERECTOMY,RESECTION SM INTES-SING/ANAS

Professional

Both

$2,871.00

Service Code	CPT 44120
Hospital Charge Code	4144120
Hospital Revenue Code	975
Min. Negotiated Rate	$922.85
Max. Negotiated Rate	$1,092.14
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,092.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$922.85
Rate for Payer: Cash Price	$2,583.90
Rate for Payer: Cash Price	$2,583.90
Rate for Payer: Cigna Commercial HMO & PPO	$1,092.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$922.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,015.13
Rate for Payer: Home State Health Plan Medicare Advantage	$1,092.14
Rate for Payer: Optum Medicare Advantage	$1,004.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$922.85

ENTEROLYSIS

Facility

$3,360.00

Service Code	CPT 44005
Hospital Charge Code	5444005
Rate for Payer: Cash Price	$3,024.00

ENTEROLYSIS-INCISION-INTESTINES

Professional

Both

$2,326.00

Service Code	CPT 44005
Hospital Charge Code	4144005
Hospital Revenue Code	975
Min. Negotiated Rate	$814.10
Max. Negotiated Rate	$979.53
Rate for Payer: Aetna Commercial/Medicare Advantage	$979.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$826.07
Rate for Payer: Cash Price	$2,093.40
Rate for Payer: Cash Price	$2,093.40
Rate for Payer: Cigna Commercial HMO & PPO	$979.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$826.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$908.68
Rate for Payer: Home State Health Plan Medicare Advantage	$979.53
Rate for Payer: Optum Medicare Advantage	$814.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$826.07

ENTERORRHAP

Professional

Both

$2,158.00

Service Code	CPT 44602
Hospital Charge Code	4144602
Hospital Revenue Code	975
Min. Negotiated Rate	$755.30
Max. Negotiated Rate	$1,245.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,245.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,062.39
Rate for Payer: Cash Price	$1,942.20
Rate for Payer: Cash Price	$1,942.20
Rate for Payer: Cigna Commercial HMO & PPO	$1,245.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,062.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,168.63
Rate for Payer: Home State Health Plan Medicare Advantage	$1,245.75
Rate for Payer: Optum Medicare Advantage	$755.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,062.39

ENTEROTOMY FOR EXPL BIOPSY OR F/B REMOV

Professional

Both

$2,528.00

Service Code	CPT 44020
Hospital Charge Code	4144020
Hospital Revenue Code	975
Min. Negotiated Rate	$738.36
Max. Negotiated Rate	$884.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$876.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$738.36
Rate for Payer: Cash Price	$2,275.20
Rate for Payer: Cash Price	$2,275.20
Rate for Payer: Cigna Commercial HMO & PPO	$876.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$738.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$812.20
Rate for Payer: Home State Health Plan Medicare Advantage	$876.84
Rate for Payer: Optum Medicare Advantage	$884.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$738.36

ENT KNIFE

Facility

$131.00

Hospital Charge Code	125351
Hospital Revenue Code	272
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$93.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$77.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$93.53
Rate for Payer: Cash Price	$117.90
Rate for Payer: UnitedHealthcare Commercial	$87.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.16

ENT KNIFE

Facility

$131.00

Hospital Charge Code	125351
Hospital Revenue Code	272
Rate for Payer: Cash Price	$117.90

ENUCLEATION OF HEMORRHOID

Facility

$217.00

Service Code	CPT 46320
Hospital Charge Code	4146320
Hospital Revenue Code	521
Rate for Payer: Cash Price	$195.30

ENUCLEATION OF HEMORRHOID

Facility

$217.00

Service Code	CPT 46320
Hospital Charge Code	4146320
Hospital Revenue Code	521
Min. Negotiated Rate	$128.46
Max. Negotiated Rate	$2,445.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,078.71
Rate for Payer: Aetna Medicare Advantage	$1,222.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$128.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$154.94
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cigna Commercial HMO & PPO	$1,222.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$970.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,154.22
Rate for Payer: Home State Health Plan Medicare Advantage	$1,222.56
Rate for Payer: Humana Commercial	$2,445.12
Rate for Payer: Humana Medicare Advantage	$1,222.56
Rate for Payer: UnitedHealthcare Commercial	$144.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,078.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges