Madison Medical Center

All Charges

Charge

Type

Setting

Price

E/R VISIT-EXAM & HISTORY

Facility

$68.00

Service Code	CPT 99281
Hospital Charge Code	4199281
Hospital Revenue Code	521
Min. Negotiated Rate	$40.26
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$76.01
Rate for Payer: Aetna Medicare Advantage	$86.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$40.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$48.55
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cigna Commercial HMO & PPO	$86.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$68.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$81.33
Rate for Payer: Home State Health Plan Medicare Advantage	$86.15
Rate for Payer: Humana Commercial	$172.30
Rate for Payer: Humana Medicare Advantage	$86.15
Rate for Payer: UnitedHealthcare Commercial	$45.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$76.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

E/R VISIT-EXAM & HISTORY

Facility

$68.00

Service Code	CPT 99281
Hospital Charge Code	4199281
Hospital Revenue Code	521
Rate for Payer: Cash Price	$61.20

E/R VISIT-EXPANDED PROB. W/MOD.COMPLX

Facility

$141.00

Service Code	CPT 99283
Hospital Charge Code	4199283
Hospital Revenue Code	521
Min. Negotiated Rate	$83.47
Max. Negotiated Rate	$557.78
Rate for Payer: Aetna Better Health Medicaid/QHP	$246.07
Rate for Payer: Aetna Medicare Advantage	$278.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$83.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$100.67
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cigna Commercial HMO & PPO	$278.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$221.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$263.29
Rate for Payer: Home State Health Plan Medicare Advantage	$278.89
Rate for Payer: Humana Commercial	$557.78
Rate for Payer: Humana Medicare Advantage	$278.89
Rate for Payer: UnitedHealthcare Commercial	$94.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$246.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

E/R VISIT-EXPANDED PROB. W/MOD.COMPLX

Facility

$141.00

Service Code	CPT 99283
Hospital Charge Code	4199283
Hospital Revenue Code	521
Rate for Payer: Cash Price	$126.90

ERYTHROMYCIN 3.5GM OP OINT

Facility

$60.00

Service Code	NDC 574402435
Hospital Charge Code	2655000
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

ERYTHROMYCIN 3.5GM OP OINT

Facility

$60.00

Service Code	NDC 574402435
Hospital Charge Code	2655000
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

ERYTHROMYCIN LACTOBINATE 500MG VIAL

Facility

$196.00

Service Code	NDC 409647644
Hospital Charge Code	2654996
Hospital Revenue Code	250
Min. Negotiated Rate	$70.56
Max. Negotiated Rate	$139.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$116.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.94
Rate for Payer: Cash Price	$176.40
Rate for Payer: UnitedHealthcare Commercial	$130.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.56

ERYTHROMYCIN LACTOBINATE 500MG VIAL

Facility

$196.00

Service Code	NDC 409647644
Hospital Charge Code	2654996
Hospital Revenue Code	250
Rate for Payer: Cash Price	$176.40

ERYTHROPOIETIN

Facility

$183.00

Service Code	CPT 82668
Hospital Charge Code	2282668
Hospital Revenue Code	301
Min. Negotiated Rate	$16.91
Max. Negotiated Rate	$130.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.91
Rate for Payer: Aetna Medicare Advantage	$18.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$108.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$130.66
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cigna Commercial HMO & PPO	$18.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18.09
Rate for Payer: Home State Health Plan Medicare Advantage	$18.79
Rate for Payer: Humana Commercial	$37.58
Rate for Payer: Humana Medicare Advantage	$18.79
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.88

ERYTHROPOIETIN

Facility

$183.00

Service Code	CPT 82668
Hospital Charge Code	2282668
Hospital Revenue Code	301
Rate for Payer: Cash Price	$164.70

ESCITALOPRAM

Facility

$523.00

Service Code	CPT 80332
Hospital Charge Code	2280301
Hospital Revenue Code	301
Rate for Payer: Cash Price	$470.70

ESCITALOPRAM

Facility

$523.00

Service Code	CPT 80332
Hospital Charge Code	2280301
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$373.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$309.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$373.42
Rate for Payer: Cash Price	$470.70
Rate for Payer: Cash Price	$470.70
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$188.28

ESCITALOPRAM 10MG TAB EMP

Facility

$28.00

Service Code	NDC 6.9097E+10
Hospital Charge Code	2619292
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

ESCITALOPRAM 10MG TAB EMP

Facility

$28.00

Service Code	NDC 6.9097E+10
Hospital Charge Code	2619292
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

ESCITALOPRAM 20MG TAB EMP

Facility

$28.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2620339
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

ESCITALOPRAM 20MG TAB EMP

Facility

$28.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2620339
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

ESCITALOPRAM 5MG TAB EMP

Facility

$28.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2621850
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

ESCITALOPRAM 5MG TAB EMP

Facility

$28.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2621850
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

ESCITALOPRAM (LEXAPRO) 10MG TAB

Facility

$28.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626338
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

ESCITALOPRAM (LEXAPRO) 10MG TAB

Facility

$28.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626338
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

ESMARK

Facility

$102.00

Hospital Charge Code	1251111
Hospital Revenue Code	271
Rate for Payer: Cash Price	$91.80

ESMARK

Facility

$102.00

Hospital Charge Code	1251111
Hospital Revenue Code	271
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$72.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$60.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.83
Rate for Payer: Cash Price	$91.80
Rate for Payer: UnitedHealthcare Commercial	$68.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.72

ESOMEPRAZOLE 20MG CAP EMP

Facility

$10.00

Service Code	NDC 3.1722E+10
Hospital Charge Code	2624451
Hospital Revenue Code	250
Rate for Payer: Cash Price	$9.00

ESOMEPRAZOLE 20MG CAP EMP

Facility

$10.00

Service Code	NDC 3.1722E+10
Hospital Charge Code	2624451
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$7.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.14
Rate for Payer: Cash Price	$9.00
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

ESOMEPRAZOLE 40MG CAP EMP

Facility

$10.00

Service Code	NDC 93645198
Hospital Charge Code	2622125
Hospital Revenue Code	250
Rate for Payer: Cash Price	$9.00

Know your out-of-pocket cost for care.

All Charges