Madison Medical Center

All Charges

Charge

Type

Setting

Price

FERRIC CARBOXYMALTOSE INJ 750MG 15ML

Facility

$5,532.00

Service Code	NDC 517065001
Hospital Charge Code	2621299
Hospital Revenue Code	250
Min. Negotiated Rate	$1,991.52
Max. Negotiated Rate	$3,949.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$3,274.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3,949.85
Rate for Payer: Cash Price	$4,978.80
Rate for Payer: UnitedHealthcare Commercial	$3,689.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,991.52

FERRIC CARBOXYMALTOSE INJ 750MG 15ML

Facility

$5,532.00

Service Code	NDC 517065001
Hospital Charge Code	2621299
Hospital Revenue Code	250
Rate for Payer: Cash Price	$4,978.80

FERRIC SULFATE SOL BASIC PURIFIED 480ML

Facility

$234.00

Service Code	NDC 1E+11
Hospital Charge Code	2619422
Hospital Revenue Code	250
Rate for Payer: Cash Price	$210.60

FERRIC SULFATE SOL BASIC PURIFIED 480ML

Facility

$234.00

Service Code	NDC 1E+11
Hospital Charge Code	2619422
Hospital Revenue Code	250
Min. Negotiated Rate	$84.24
Max. Negotiated Rate	$167.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$138.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.08
Rate for Payer: Cash Price	$210.60
Rate for Payer: UnitedHealthcare Commercial	$156.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.24

FERRITIN

Facility

$234.00

Service Code	CPT 82728
Hospital Charge Code	226400
Hospital Revenue Code	301
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$167.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.27
Rate for Payer: Aetna Medicare Advantage	$13.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$138.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.08
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cigna Commercial HMO & PPO	$13.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.13
Rate for Payer: Home State Health Plan Medicare Advantage	$13.63
Rate for Payer: Humana Commercial	$27.26
Rate for Payer: Humana Medicare Advantage	$13.63
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.24

FERRITIN

Facility

$234.00

Service Code	CPT 82728
Hospital Charge Code	226400
Hospital Revenue Code	301
Rate for Payer: Cash Price	$210.60

FERRITIN (LABCORP)

Facility

$234.00

Service Code	CPT 82728
Hospital Charge Code	226401
Hospital Revenue Code	301
Rate for Payer: Cash Price	$210.60

FERRITIN (LABCORP)

Facility

$234.00

Service Code	CPT 82728
Hospital Charge Code	226401
Hospital Revenue Code	301
Min. Negotiated Rate	$12.27
Max. Negotiated Rate	$167.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.27
Rate for Payer: Aetna Medicare Advantage	$13.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$138.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.08
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cigna Commercial HMO & PPO	$13.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.13
Rate for Payer: Home State Health Plan Medicare Advantage	$13.63
Rate for Payer: Humana Commercial	$27.26
Rate for Payer: Humana Medicare Advantage	$13.63
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.24

FERROUS SULFATE (FEOSOL) 324MG TAB

Facility

$20.00

Service Code	NDC 574060811
Hospital Charge Code	2655020
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

FERROUS SULFATE (FEOSOL) 324MG TAB

Facility

$20.00

Service Code	NDC 574060811
Hospital Charge Code	2655020
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

FERROUS SULFATE ORAL SOL 220MG 5ML

Facility

$20.00

Service Code	NDC 121053005
Hospital Charge Code	2697067
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

FERROUS SULFATE ORAL SOL 220MG 5ML

Facility

$20.00

Service Code	NDC 121053005
Hospital Charge Code	2697067
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

FERUMOXYTOL (FERAHEME) 510MG VIAL

Facility

$5,033.00

Service Code	NDC 5.9338E+10
Hospital Charge Code	2626551
Hospital Revenue Code	250
Rate for Payer: Cash Price	$4,529.70

FERUMOXYTOL (FERAHEME) 510MG VIAL

Facility

$5,033.00

Service Code	NDC 5.9338E+10
Hospital Charge Code	2626551
Hospital Revenue Code	250
Min. Negotiated Rate	$1,811.88
Max. Negotiated Rate	$3,593.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,979.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3,593.56
Rate for Payer: Cash Price	$4,529.70
Rate for Payer: UnitedHealthcare Commercial	$3,357.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,811.88

FETAL CK&RM SVS EXT

Facility

$445.00

Service Code	CPT 59025
Hospital Charge Code	1869009
Hospital Revenue Code	761
Rate for Payer: Cash Price	$400.50

FETAL CK&RM SVS EXT

Facility

$445.00

Service Code	CPT 59025
Hospital Charge Code	1869009
Hospital Revenue Code	761
Min. Negotiated Rate	$160.20
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$182.25
Rate for Payer: Aetna Medicare Advantage	$206.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$263.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$317.73
Rate for Payer: Cash Price	$400.50
Rate for Payer: Cash Price	$400.50
Rate for Payer: Cash Price	$400.50
Rate for Payer: Cigna Commercial HMO & PPO	$206.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$182.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$195.01
Rate for Payer: Home State Health Plan Medicare Advantage	$206.55
Rate for Payer: Humana Commercial	$413.10
Rate for Payer: Humana Medicare Advantage	$206.55
Rate for Payer: UnitedHealthcare Commercial	$296.81
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$182.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$160.20

FETAL MONITOR

Facility

$240.00

Hospital Charge Code	282036
Hospital Revenue Code	721
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$171.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$142.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$171.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: UnitedHealthcare Commercial	$160.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$86.40

FETAL MONITOR

Facility

$240.00

Hospital Charge Code	282036
Hospital Revenue Code	721
Rate for Payer: Cash Price	$216.00

FETZIMA ER 120MG CAP EMP

Facility

$20.00

Service Code	NDC 456221230
Hospital Charge Code	2624288
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

FETZIMA ER 120MG CAP EMP

Facility

$20.00

Service Code	NDC 456221230
Hospital Charge Code	2624288
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

FETZIMA ER 20MG CAP EMP

Facility

$20.00

Service Code	NDC 456222030
Hospital Charge Code	2623264
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

FETZIMA ER 20MG CAP EMP

Facility

$20.00

Service Code	NDC 456222030
Hospital Charge Code	2623264
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

FETZIMA ER 40MG CAP EMP

Facility

$20.00

Service Code	NDC 456224030
Hospital Charge Code	2623569
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

FETZIMA ER 40MG CAP EMP

Facility

$20.00

Service Code	NDC 456224030
Hospital Charge Code	2623569
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

FETZIMA ER 80MG CAP EMP

Facility

$20.00

Service Code	NDC 456228030
Hospital Charge Code	2624236
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

Know your out-of-pocket cost for care.

All Charges