Madison Medical Center

All Charges

Charge

Type

Setting

Price

ESTROGEN CONJ 0.3MG TAB

Facility

$10.00

Service Code	NDC 46110081
Hospital Charge Code	2627289
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

ESTROGEN TOTAL

Facility

$247.00

Service Code	CPT 82672
Hospital Charge Code	225259
Hospital Revenue Code	301
Rate for Payer: Cash Price	$222.30

ESTROGEN TOTAL

Facility

$247.00

Service Code	CPT 82672
Hospital Charge Code	225259
Hospital Revenue Code	301
Min. Negotiated Rate	$19.53
Max. Negotiated Rate	$176.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.53
Rate for Payer: Aetna Medicare Advantage	$21.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$146.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$176.36
Rate for Payer: Cash Price	$222.30
Rate for Payer: Cash Price	$222.30
Rate for Payer: Cash Price	$222.30
Rate for Payer: Cigna Commercial HMO & PPO	$21.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.90
Rate for Payer: Home State Health Plan Medicare Advantage	$21.70
Rate for Payer: Humana Commercial	$43.40
Rate for Payer: Humana Medicare Advantage	$21.70
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$88.92

ESTRONE

Facility

$183.00

Service Code	CPT 82679
Hospital Charge Code	2282679
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$130.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$22.46
Rate for Payer: Aetna Medicare Advantage	$24.95
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	$24.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24.03
Rate for Payer: Home State Health Plan Medicare Advantage	$24.95
Rate for Payer: Humana Commercial	$49.90
Rate for Payer: Humana Medicare Advantage	$24.95
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.88

ESTRONE

Facility

$183.00

Service Code	CPT 82679
Hospital Charge Code	2282679
Hospital Revenue Code	305
Rate for Payer: Cash Price	$164.70

E S U CLEANING PAD

Facility

$20.00

Hospital Charge Code	127794
Hospital Revenue Code	271
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

E S U CLEANING PAD

Facility

$20.00

Hospital Charge Code	127794
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

ESU EXTENDER 6 COATED ELECTRODE BLADECS

Facility

$196.00

Hospital Charge Code	124368
Hospital Revenue Code	271
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

ESU EXTENDER 6 COATED ELECTRODE BLADECS

Facility

$196.00

Hospital Charge Code	124368
Hospital Revenue Code	271
Rate for Payer: Cash Price	$176.40

ESZOPICLONE (LUNESTA) 1MG TAB EMP C4

Facility

$18.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2625778
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

ESZOPICLONE (LUNESTA) 1MG TAB EMP C4

Facility

$18.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2625778
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

ESZOPICLONE (LUNESTA) 2MG TAB EMP C4

Facility

$18.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2624244
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

ESZOPICLONE (LUNESTA) 2MG TAB EMP C4

Facility

$18.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2624244
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

ESZOPICLONE (LUNESTA) 3MG TAB EMP C4

Facility

$18.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2626901
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

ESZOPICLONE (LUNESTA) 3MG TAB EMP C4

Facility

$18.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2626901
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

ETCO 2

Facility

$125.00

Hospital Charge Code	2024476
Hospital Revenue Code	271
Rate for Payer: Cash Price	$112.50

ETCO 2

Facility

$125.00

Hospital Charge Code	2024476
Hospital Revenue Code	271
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$89.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: UnitedHealthcare Commercial	$83.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

ETCO2 CANNULA (SURGERY)

Facility

$57.00

Hospital Charge Code	1800344
Hospital Revenue Code	271
Min. Negotiated Rate	$20.52
Max. Negotiated Rate	$40.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$33.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$40.70
Rate for Payer: Cash Price	$51.30
Rate for Payer: UnitedHealthcare Commercial	$38.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.52

ETCO2 CANNULA (SURGERY)

Facility

$57.00

Hospital Charge Code	1800344
Hospital Revenue Code	271
Rate for Payer: Cash Price	$51.30

ETHAMBUTOL 400MG TAB (MYAMBUTOL)

Facility

$20.00

Service Code	NDC 1E+11
Hospital Charge Code	2619506
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

ETHAMBUTOL 400MG TAB (MYAMBUTOL)

Facility

$20.00

Service Code	NDC 1E+11
Hospital Charge Code	2619506
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

.ETHANOL REFLEX CONFIRMATION

Facility

$110.00

Service Code	CPT 80321
Hospital Charge Code	221751
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

.ETHANOL REFLEX CONFIRMATION

Facility

$110.00

Service Code	CPT 80321
Hospital Charge Code	221751
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$78.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

E.T HOLDER

Facility

$112.00

Hospital Charge Code	4500347
Hospital Revenue Code	271
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$79.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: UnitedHealthcare Commercial	$74.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

E.T HOLDER

Facility

$112.00

Hospital Charge Code	4500347
Hospital Revenue Code	271
Rate for Payer: Cash Price	$100.80

Know your out-of-pocket cost for care.

All Charges