Madison Medical Center

All Charges

Charge

Type

Setting

Price

EST PT PREVENTATIVE EXAM 40 - 64

Facility

$285.00

Service Code	CPT 99396
Hospital Charge Code	9899396
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

EST PT PREVENTATIVE EXAM 40 - 64

Facility

$285.00

Service Code	CPT 99396
Hospital Charge Code	9899396
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
Max. Negotiated Rate	$203.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: UnitedHealthcare Commercial	$190.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT PREVENTATIVE EXAM 65 AND OVER

Facility

$330.00

Service Code	CPT 99397
Hospital Charge Code	9899397
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$235.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$195.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$235.62
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: UnitedHealthcare Commercial	$220.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT PREVENTATIVE EXAM 65 AND OVER

Facility

$330.00

Service Code	CPT 99397
Hospital Charge Code	9899397
Hospital Revenue Code	521
Rate for Payer: Cash Price	$297.00

ESTRADIOL

Facility

$150.00

Service Code	HCPCS J1000
Hospital Charge Code	4201000
Hospital Revenue Code	636
Min. Negotiated Rate	$100.05
Max. Negotiated Rate	$100.05
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05

ESTRADIOL

Facility

$149.00

Service Code	CPT 82670
Hospital Charge Code	2282670
Hospital Revenue Code	301
Rate for Payer: Cash Price	$134.10

ESTRADIOL

Facility

$149.00

Service Code	CPT 82670
Hospital Charge Code	2282670
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$106.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$25.15
Rate for Payer: Aetna Medicare Advantage	$27.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$106.39
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cigna Commercial HMO & PPO	$27.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.91
Rate for Payer: Home State Health Plan Medicare Advantage	$27.94
Rate for Payer: Humana Commercial	$55.88
Rate for Payer: Humana Medicare Advantage	$27.94
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

ESTRADIOL

Facility

$86.00

Service Code	CPT 82670
Hospital Charge Code	4282670
Hospital Revenue Code	636
Min. Negotiated Rate	$25.15
Max. Negotiated Rate	$61.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$25.15
Rate for Payer: Aetna Medicare Advantage	$27.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$50.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$61.40
Rate for Payer: Cash Price	$77.40
Rate for Payer: Cash Price	$77.40
Rate for Payer: Cash Price	$77.40
Rate for Payer: Cigna Commercial HMO & PPO	$27.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.91
Rate for Payer: Home State Health Plan Medicare Advantage	$27.94
Rate for Payer: Humana Commercial	$55.88
Rate for Payer: Humana Medicare Advantage	$27.94
Rate for Payer: UnitedHealthcare Commercial	$27.94
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.96

ESTRADIOL

Facility

$86.00

Service Code	CPT 82670
Hospital Charge Code	4282670
Hospital Revenue Code	636
Min. Negotiated Rate	$57.36
Max. Negotiated Rate	$57.36
Rate for Payer: Cash Price	$77.40
Rate for Payer: UnitedHealthcare Commercial	$57.36

ESTRADIOL

Facility

$150.00

Service Code	HCPCS J1000
Hospital Charge Code	4201000
Hospital Revenue Code	636
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$107.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.00

ESTRADIOL 0.01% VAG CRM 42.5GM EMP

Facility

$272.00

Service Code	NDC 378877035
Hospital Charge Code	2623775
Hospital Revenue Code	250
Min. Negotiated Rate	$97.92
Max. Negotiated Rate	$194.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$161.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$194.21
Rate for Payer: Cash Price	$244.80
Rate for Payer: UnitedHealthcare Commercial	$181.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.92

ESTRADIOL 0.01% VAG CRM 42.5GM EMP

Facility

$272.00

Service Code	NDC 378877035
Hospital Charge Code	2623775
Hospital Revenue Code	250
Rate for Payer: Cash Price	$244.80

ESTRADIOL 0.5MG TAB EMP

Facility

$13.00

Service Code	NDC 555089902
Hospital Charge Code	2625408
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

ESTRADIOL 0.5MG TAB EMP

Facility

$13.00

Service Code	NDC 555089902
Hospital Charge Code	2625408
Hospital Revenue Code	250
Rate for Payer: Cash Price	$11.70

ESTRADIOL 10MCG TAB SUPP EMP

Facility

$77.00

Service Code	NDC 169517604
Hospital Charge Code	2623545
Hospital Revenue Code	250
Rate for Payer: Cash Price	$69.30

ESTRADIOL 10MCG TAB SUPP EMP

Facility

$77.00

Service Code	NDC 169517604
Hospital Charge Code	2623545
Hospital Revenue Code	250
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$54.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$45.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.98
Rate for Payer: Cash Price	$69.30
Rate for Payer: UnitedHealthcare Commercial	$51.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.72

ESTRADIOL 1MG TAB EMP

Facility

$13.00

Service Code	NDC 1E+11
Hospital Charge Code	2620108
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

ESTRADIOL 1MG TAB EMP

Facility

$13.00

Service Code	NDC 1E+11
Hospital Charge Code	2620108
Hospital Revenue Code	250
Rate for Payer: Cash Price	$11.70

ESTRADIOL CYP (DEPO-ESTRAD) 25MG VIAL

Facility

$479.00

Service Code	NDC 9027101
Hospital Charge Code	2697057
Hospital Revenue Code	250
Min. Negotiated Rate	$172.44
Max. Negotiated Rate	$342.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$283.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$342.01
Rate for Payer: Cash Price	$431.10
Rate for Payer: UnitedHealthcare Commercial	$319.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$172.44

ESTRADIOL CYP (DEPO-ESTRAD) 25MG VIAL

Facility

$479.00

Service Code	NDC 9027101
Hospital Charge Code	2697057
Hospital Revenue Code	250
Rate for Payer: Cash Price	$431.10

ESTRADIOL SENSITIVE

Facility

$118.00

Service Code	CPT 82670
Hospital Charge Code	2282671
Hospital Revenue Code	305
Rate for Payer: Cash Price	$106.20

ESTRADIOL SENSITIVE

Facility

$118.00

Service Code	CPT 82670
Hospital Charge Code	2282671
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$84.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$25.15
Rate for Payer: Aetna Medicare Advantage	$27.94
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: Cash Price	$106.20
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cigna Commercial HMO & PPO	$27.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.91
Rate for Payer: Home State Health Plan Medicare Advantage	$27.94
Rate for Payer: Humana Commercial	$55.88
Rate for Payer: Humana Medicare Advantage	$27.94
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.48

ESTRIOL SERUM

Facility

$185.00

Service Code	CPT 82677
Hospital Charge Code	2227044
Hospital Revenue Code	301
Rate for Payer: Cash Price	$166.50

ESTRIOL SERUM

Facility

$185.00

Service Code	CPT 82677
Hospital Charge Code	2227044
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$132.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.76
Rate for Payer: Aetna Medicare Advantage	$24.18
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: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cigna Commercial HMO & PPO	$24.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.28
Rate for Payer: Home State Health Plan Medicare Advantage	$24.18
Rate for Payer: Humana Commercial	$48.36
Rate for Payer: Humana Medicare Advantage	$24.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.60

ESTROGEN CONJ 0.3MG TAB

Facility

$10.00

Service Code	NDC 46110081
Hospital Charge Code	2627289
Hospital Revenue Code	250
Rate for Payer: Cash Price	$9.00

Know your out-of-pocket cost for care.

All Charges