Madison Medical Center

All Charges

Charge

Type

Setting

Price

INSULIN PEN NEEDLES #100

Facility

$12.00

Service Code	NDC 8214030726
Hospital Charge Code	2620513
Hospital Revenue Code	250
Rate for Payer: Cash Price	$10.80

INSULIN PEN NEEDLES 4MM 32G 50CT

Facility

$20.00

Service Code	NDC 8222095459
Hospital Charge Code	2697343
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

INSULIN PEN NEEDLES 4MM 32G 50CT

Facility

$20.00

Service Code	NDC 8222095459
Hospital Charge Code	2697343
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

INSULIN REGULAR 1UNIT INJECTION

Facility

$19.00

Service Code	HCPCS J1815
Hospital Charge Code	2626406
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

INSULIN REGULAR 1UNIT INJECTION

Facility

$19.00

Service Code	HCPCS J1815
Hospital Charge Code	2626406
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

INSULIN SYRINGE 1/2CC 31G SHORT

Facility

$20.00

Service Code	NDC 5.7515E+10
Hospital Charge Code	2697342
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

INSULIN SYRINGE 1/2CC 31G SHORT

Facility

$20.00

Service Code	NDC 5.7515E+10
Hospital Charge Code	2697342
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$9,997.79

Service Code	APR-DRG 8172
Min. Negotiated Rate	$9,997.79
Max. Negotiated Rate	$9,997.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,997.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,997.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,997.79
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,997.79

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$16,106.68

Service Code	APR-DRG 8173
Min. Negotiated Rate	$16,106.68
Max. Negotiated Rate	$16,106.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,106.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,106.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,106.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,106.68

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$5,677.73

Service Code	APR-DRG 8171
Min. Negotiated Rate	$5,677.73
Max. Negotiated Rate	$5,677.73
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,677.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,677.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,677.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,677.73

INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE

Facility

$33,260.99

Service Code	APR-DRG 8174
Min. Negotiated Rate	$33,260.99
Max. Negotiated Rate	$33,260.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$33,260.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33,260.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33,260.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33,260.99

INTERJECT NEEDLE

Facility

$326.00

Hospital Charge Code	1213039
Hospital Revenue Code	271
Min. Negotiated Rate	$117.36
Max. Negotiated Rate	$232.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.76
Rate for Payer: Cash Price	$293.40
Rate for Payer: UnitedHealthcare Commercial	$217.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$117.36

INTERJECT NEEDLE

Facility

$326.00

Hospital Charge Code	1213039
Hospital Revenue Code	271
Rate for Payer: Cash Price	$293.40

INTERLEUKIN 6

Facility

$615.00

Service Code	CPT 83520
Hospital Charge Code	2283523
Hospital Revenue Code	305
Rate for Payer: Cash Price	$553.50

INTERLEUKIN 6

Facility

$615.00

Service Code	CPT 83520
Hospital Charge Code	2283523
Hospital Revenue Code	305
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$439.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.54
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$364.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$439.11
Rate for Payer: Cash Price	$553.50
Rate for Payer: Cash Price	$553.50
Rate for Payer: Cash Price	$553.50
Rate for Payer: Cigna Commercial HMO & PPO	$17.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.63
Rate for Payer: Home State Health Plan Medicare Advantage	$17.27
Rate for Payer: Humana Commercial	$34.54
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$221.40

INTERLINK INSECTION SITE

Facility

$16.00

Hospital Charge Code	2823399
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

INTERLINK INSECTION SITE

Facility

$16.00

Hospital Charge Code	2823399
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

INTERMEDIATE JOINT INJ

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	4420605
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INTERMEDIATE JOINT INJ

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	4420605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

INTERMED JOINT INJ PERFORMED IN OR

Professional

Both

$285.00

Service Code	CPT 20605
Hospital Charge Code	41206050
Hospital Revenue Code	975
Min. Negotiated Rate	$30.98
Max. Negotiated Rate	$99.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$30.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$41.26
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cigna Commercial HMO & PPO	$30.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$41.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$45.39
Rate for Payer: Home State Health Plan Medicare Advantage	$30.98
Rate for Payer: Optum Medicare Advantage	$99.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$41.26

INTERNAL PACEMAKER

Facility

$347.00

Service Code	CPT 71090
Hospital Charge Code	323142
Hospital Revenue Code	320
Min. Negotiated Rate	$124.92
Max. Negotiated Rate	$247.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$205.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$247.76
Rate for Payer: Cash Price	$312.30
Rate for Payer: Cash Price	$312.30
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.92

INTERNAL PACEMAKER

Facility

$347.00

Service Code	CPT 71090
Hospital Charge Code	323142
Hospital Revenue Code	320
Rate for Payer: Cash Price	$312.30

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$11,814.47

Service Code	APR-DRG 1422
Min. Negotiated Rate	$11,814.47
Max. Negotiated Rate	$11,814.47
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,814.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,814.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,814.47
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,814.47

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$8,499.64

Service Code	APR-DRG 1421
Min. Negotiated Rate	$8,499.64
Max. Negotiated Rate	$8,499.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,499.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,499.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,499.64
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,499.64

INTERSTITIAL AND ALVEOLAR LUNG DISEASES

Facility

$28,893.69

Service Code	APR-DRG 1424
Min. Negotiated Rate	$28,893.69
Max. Negotiated Rate	$28,893.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$28,893.69
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28,893.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28,893.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28,893.69

Know your out-of-pocket cost for care.

All Charges