Madison Medical Center

All Charges

Charge

Type

Setting

Price

IPRATROP BR 0.5MG/2.5ML NEB EMP 60V

Facility

$39.00

Service Code	HCPCS J7608
Hospital Charge Code	2623582
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

IPRATROPIUM 0.03% NAS SPRAY 30ML EMP

Facility

$149.00

Service Code	NDC 2.4208E+10
Hospital Charge Code	2619347
Hospital Revenue Code	250
Rate for Payer: Cash Price	$134.10

IPRATROPIUM 0.03% NAS SPRAY 30ML EMP

Facility

$149.00

Service Code	NDC 2.4208E+10
Hospital Charge Code	2619347
Hospital Revenue Code	250
Min. Negotiated Rate	$53.64
Max. Negotiated Rate	$106.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$106.39
Rate for Payer: Cash Price	$134.10
Rate for Payer: UnitedHealthcare Commercial	$99.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

IPRATROPIUM (ATROVENT)13GM HFA INH EMP

Facility

$112.00

Service Code	NDC 597008717
Hospital Charge Code	2625553
Hospital Revenue Code	250
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

IPRATROPIUM (ATROVENT)13GM HFA INH EMP

Facility

$112.00

Service Code	NDC 597008717
Hospital Charge Code	2625553
Hospital Revenue Code	250
Rate for Payer: Cash Price	$100.80

IPRATROPIUM (ATROVENT) NAS SPY 15ML EMP

Facility

$149.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2622983
Hospital Revenue Code	250
Min. Negotiated Rate	$53.64
Max. Negotiated Rate	$106.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$106.39
Rate for Payer: Cash Price	$134.10
Rate for Payer: UnitedHealthcare Commercial	$99.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

IPRATROPIUM (ATROVENT) NAS SPY 15ML EMP

Facility

$149.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2622983
Hospital Revenue Code	250
Rate for Payer: Cash Price	$134.10

IP SUBSEQ HOSP CARE BRIEF

Facility

$125.00

Service Code	CPT 99231
Hospital Charge Code	4299231
Rate for Payer: Cash Price	$112.50

IP SUBSEQ HOSP CARE EXTENDED

Facility

$282.00

Service Code	CPT 99233
Hospital Charge Code	4299233
Rate for Payer: Cash Price	$253.80

IP SUBSEQ HOSP CARE INTERMEDIATE

Facility

$195.00

Service Code	CPT 99232
Hospital Charge Code	4299232
Rate for Payer: Cash Price	$175.50

IP SUBSEQ VISIT EXTENDED

Facility

$295.00

Service Code	CPT 99233
Hospital Charge Code	9899233
Rate for Payer: Cash Price	$265.50

IP SUBSEQ VISIT INTERMEDIATE

Facility

$205.00

Service Code	CPT 99232
Hospital Charge Code	9899232
Rate for Payer: Cash Price	$184.50

IP SUSEQ VISIT BRIEF

Facility

$130.00

Service Code	CPT 99231
Hospital Charge Code	9899231
Rate for Payer: Cash Price	$117.00

IRBESARTAN 150MG TAB EMP

Facility

$39.00

Service Code	NDC 93746598
Hospital Charge Code	2697392
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

IRBESARTAN 150MG TAB EMP

Facility

$39.00

Service Code	NDC 93746598
Hospital Charge Code	2697392
Hospital Revenue Code	250
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

IRBESARTAN 300MG TAB EMP

Facility

$39.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2619232
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

IRBESARTAN 300MG TAB EMP

Facility

$39.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2619232
Hospital Revenue Code	250
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

IRBESARTAN/HCTZ 150MG/12.5MG TAB EMP

Facility

$39.00

Service Code	NDC 4.3547E+10
Hospital Charge Code	2627063
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

IRBESARTAN/HCTZ 150MG/12.5MG TAB EMP

Facility

$39.00

Service Code	NDC 4.3547E+10
Hospital Charge Code	2627063
Hospital Revenue Code	250
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

IRBESARTAN/HCTZ 300MG/12.5MG TAB EMP

Facility

$39.00

Service Code	NDC 24585630
Hospital Charge Code	2623272
Hospital Revenue Code	250
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

IRBESARTAN/HCTZ 300MG/12.5MG TAB EMP

Facility

$39.00

Service Code	NDC 24585630
Hospital Charge Code	2623272
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

IRON

Facility

$112.00

Service Code	CPT 83540
Hospital Charge Code	2219161
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

IRON

Facility

$112.00

Service Code	CPT 83540
Hospital Charge Code	2219161
Hospital Revenue Code	301
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.82
Rate for Payer: Aetna Medicare Advantage	$6.47
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: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$6.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.23
Rate for Payer: Home State Health Plan Medicare Advantage	$6.47
Rate for Payer: Humana Commercial	$12.94
Rate for Payer: Humana Medicare Advantage	$6.47
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

IRON DEXTRAN (INFED) 100MG INJ 2ML VIAL

Facility

$435.00

Hospital Charge Code	2698411
Hospital Revenue Code	250
Rate for Payer: Cash Price	$391.50

IRON DEXTRAN (INFED) 100MG INJ 2ML VIAL

Facility

$435.00

Hospital Charge Code	2698411
Hospital Revenue Code	250
Min. Negotiated Rate	$156.60
Max. Negotiated Rate	$310.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$257.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$310.59
Rate for Payer: Cash Price	$391.50
Rate for Payer: UnitedHealthcare Commercial	$290.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$156.60

Know your out-of-pocket cost for care.

All Charges