Madison Medical Center

All Charges

Charge

Type

Setting

Price

EYE INFECTIONS AND OTHER EYE DISORDERS

Facility

$4,838.01

Service Code	APR-DRG 0821
Min. Negotiated Rate	$4,838.01
Max. Negotiated Rate	$4,838.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,838.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,838.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,838.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,838.01

EYE PAD

Facility

$15.00

Hospital Charge Code	1269100
Hospital Revenue Code	271
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

EYE PAD

Facility

$15.00

Hospital Charge Code	1269100
Hospital Revenue Code	271
Rate for Payer: Cash Price	$13.50

EYE PADS

Facility

$16.00

Hospital Charge Code	285225
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

EYE PADS

Facility

$16.00

Hospital Charge Code	285225
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

EYE SHIELD

Facility

$16.00

Hospital Charge Code	285003
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

EYE SHIELD

Facility

$16.00

Hospital Charge Code	285003
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

EYE TOOL (ALGERBRUSH)

Facility

$447.00

Hospital Charge Code	284019
Hospital Revenue Code	271
Min. Negotiated Rate	$160.92
Max. Negotiated Rate	$319.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$264.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$319.16
Rate for Payer: Cash Price	$402.30
Rate for Payer: UnitedHealthcare Commercial	$298.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$160.92

EYE TOOL (ALGERBRUSH)

Facility

$447.00

Hospital Charge Code	284019
Hospital Revenue Code	271
Rate for Payer: Cash Price	$402.30

EYE TRAY

Facility

$60.00

Hospital Charge Code	285001
Hospital Revenue Code	271
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

EYE TRAY

Facility

$60.00

Hospital Charge Code	285001
Hospital Revenue Code	271
Rate for Payer: Cash Price	$54.00

EYE-VITE (OCUVITE) TAB

Facility

$9.00

Service Code	NDC 536509008
Hospital Charge Code	2626607
Hospital Revenue Code	250
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$6.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$6.43
Rate for Payer: Cash Price	$8.10
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.24

EYE-VITE (OCUVITE) TAB

Facility

$9.00

Service Code	NDC 536509008
Hospital Charge Code	2626607
Hospital Revenue Code	250
Rate for Payer: Cash Price	$8.10

EYE WASH OPTH IRRIGATION SOL 118ML

Facility

$81.00

Service Code	NDC 65053001
Hospital Charge Code	2684668
Hospital Revenue Code	250
Rate for Payer: Cash Price	$72.90

EYE WASH OPTH IRRIGATION SOL 118ML

Facility

$81.00

Service Code	NDC 65053001
Hospital Charge Code	2684668
Hospital Revenue Code	250
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$57.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

EZETIMIBE/SIMVAST 10/20 TAB EMP

Facility

$43.00

Service Code	NDC 6.2559E+10
Hospital Charge Code	2622210
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

EZETIMIBE/SIMVAST 10/20 TAB EMP

Facility

$43.00

Service Code	NDC 6.2559E+10
Hospital Charge Code	2622210
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

EZETIMIBE (ZETIA) 10MG TAB

Facility

$43.00

Service Code	NDC 6.6582E+10
Hospital Charge Code	2626487
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

EZETIMIBE (ZETIA) 10MG TAB

Facility

$43.00

Service Code	NDC 6.6582E+10
Hospital Charge Code	2626487
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

EZETIMIBE (ZETIA) 10MG TAB EMP

Facility

$43.00

Service Code	NDC 4.9884E+10
Hospital Charge Code	2622084
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

EZETIMIBE (ZETIA) 10MG TAB EMP

Facility

$43.00

Service Code	NDC 4.9884E+10
Hospital Charge Code	2622084
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

EZ I/O DRILL

Facility

$208.00

Hospital Charge Code	129118
Hospital Revenue Code	360
Min. Negotiated Rate	$74.88
Max. Negotiated Rate	$138.74
Rate for Payer: Cash Price	$187.20
Rate for Payer: UnitedHealthcare Commercial	$138.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$74.88

EZ I/O DRILL

Facility

$208.00

Hospital Charge Code	129118
Hospital Revenue Code	360
Rate for Payer: Cash Price	$187.20

EZ-I/O STABILIZER

Facility

$32.00

Hospital Charge Code	283302
Hospital Revenue Code	271
Rate for Payer: Cash Price	$28.80

EZ-I/O STABILIZER

Facility

$32.00

Hospital Charge Code	283302
Hospital Revenue Code	271
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

Know your out-of-pocket cost for care.

All Charges