Madison Medical Center

All Charges

Charge

Type

Setting

Price

FEMALE SELF CATH

Facility

$22.00

Hospital Charge Code	286806
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

FEMALE SELF CATH

Facility

$22.00

Hospital Charge Code	286806
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

FEMUR XRAY LT

Facility

$529.00

Service Code	CPT 73552
Hospital Charge Code	326134
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$377.71
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$313.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$377.71
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$190.44

FEMUR XRAY LT

Facility

$529.00

Service Code	CPT 73552
Hospital Charge Code	326134
Hospital Revenue Code	320
Rate for Payer: Cash Price	$476.10

FEMUR XRAY RT

Facility

$529.00

Service Code	CPT 73552
Hospital Charge Code	326133
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$377.71
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$313.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$377.71
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$190.44

FEMUR XRAY RT

Facility

$529.00

Service Code	CPT 73552
Hospital Charge Code	326133
Hospital Revenue Code	320
Rate for Payer: Cash Price	$476.10

FEMYNOR 0.25/0.035MG 28 TAB PAK EMP

Facility

$113.00

Service Code	NDC 6.9238E+10
Hospital Charge Code	2622904
Hospital Revenue Code	250
Rate for Payer: Cash Price	$101.70

FEMYNOR 0.25/0.035MG 28 TAB PAK EMP

Facility

$113.00

Service Code	NDC 6.9238E+10
Hospital Charge Code	2622904
Hospital Revenue Code	250
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$80.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: UnitedHealthcare Commercial	$75.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

FENOFIBRATE (TRICOR) 145MG TAB

Facility

$44.00

Service Code	NDC 904716104
Hospital Charge Code	2626399
Hospital Revenue Code	250
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

FENOFIBRATE (TRICOR) 145MG TAB

Facility

$44.00

Service Code	NDC 904716104
Hospital Charge Code	2626399
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

FENOFIBRATE (TRICOR) 145MG TAB EMP

Facility

$44.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2624087
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

FENOFIBRATE (TRICOR) 145MG TAB EMP

Facility

$44.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2624087
Hospital Revenue Code	250
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

FENOFIBRATE (TRICOR) 160MG TAB

Facility

$37.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2626345
Hospital Revenue Code	250
Rate for Payer: Cash Price	$33.30

FENOFIBRATE (TRICOR) 160MG TAB

Facility

$37.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2626345
Hospital Revenue Code	250
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$26.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$26.42
Rate for Payer: Cash Price	$33.30
Rate for Payer: UnitedHealthcare Commercial	$24.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.32

FENOFIBRATE (TRICOR) 160MG TAB EMP

Facility

$1,242.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2622171
Hospital Revenue Code	250
Min. Negotiated Rate	$447.12
Max. Negotiated Rate	$886.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$735.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$886.79
Rate for Payer: Cash Price	$1,117.80
Rate for Payer: UnitedHealthcare Commercial	$828.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$447.12

FENOFIBRATE (TRICOR) 160MG TAB EMP

Facility

$1,242.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2622171
Hospital Revenue Code	250
Rate for Payer: Cash Price	$1,117.80

FENOFIBRATE (TRICOR) 43MG CAP EMP

Facility

$101.00

Service Code	NDC 6.3304E+10
Hospital Charge Code	2624466
Hospital Revenue Code	250
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

FENOFIBRATE (TRICOR) 43MG CAP EMP

Facility

$101.00

Service Code	NDC 6.3304E+10
Hospital Charge Code	2624466
Hospital Revenue Code	250
Rate for Payer: Cash Price	$90.90

FENOFIBRATE (TRICOR) 48MG TAB

Facility

$101.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2697150
Hospital Revenue Code	250
Rate for Payer: Cash Price	$90.90

FENOFIBRATE (TRICOR) 48MG TAB

Facility

$101.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2697150
Hospital Revenue Code	250
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

FENOFIBRATE (TRICOR) 48MG TAB EMP

Facility

$101.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2623451
Hospital Revenue Code	250
Rate for Payer: Cash Price	$90.90

FENOFIBRATE (TRICOR) 48MG TAB EMP

Facility

$101.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2623451
Hospital Revenue Code	250
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

FENOFIBRATE (TRICOR) 54MG TAB EMP

Facility

$101.00

Service Code	NDC 2.7241E+10
Hospital Charge Code	2623797
Hospital Revenue Code	250
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

FENOFIBRATE (TRICOR) 54MG TAB EMP

Facility

$101.00

Service Code	NDC 2.7241E+10
Hospital Charge Code	2623797
Hospital Revenue Code	250
Rate for Payer: Cash Price	$90.90

FENTANYL 100MCG PATCH C2

Facility

$402.00

Service Code	NDC 6.0506E+10
Hospital Charge Code	2621428
Hospital Revenue Code	250
Min. Negotiated Rate	$144.72
Max. Negotiated Rate	$287.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$237.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$287.03
Rate for Payer: Cash Price	$361.80
Rate for Payer: UnitedHealthcare Commercial	$268.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$144.72

Know your out-of-pocket cost for care.

All Charges