Madison Medical Center

All Charges

Charge

Type

Setting

Price

IRON L4H, URINE

Facility

$273.00

Service Code	CPT 83540
Hospital Charge Code	2283540
Hospital Revenue Code	301
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$194.92
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	$161.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$194.92
Rate for Payer: Cash Price	$245.70
Rate for Payer: Cash Price	$245.70
Rate for Payer: Cash Price	$245.70
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	$98.28

IRON L4H, URINE

Facility

$273.00

Service Code	CPT 83540
Hospital Charge Code	2283540
Hospital Revenue Code	301
Rate for Payer: Cash Price	$245.70

IRON SUCROSE (VENOFER) 100MG INJ 5ML

Facility

$465.00

Service Code	NDC 517234099
Hospital Charge Code	2626419
Hospital Revenue Code	250
Rate for Payer: Cash Price	$418.50

IRON SUCROSE (VENOFER) 100MG INJ 5ML

Facility

$465.00

Service Code	NDC 517234099
Hospital Charge Code	2626419
Hospital Revenue Code	250
Min. Negotiated Rate	$167.40
Max. Negotiated Rate	$332.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$275.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.01
Rate for Payer: Cash Price	$418.50
Rate for Payer: UnitedHealthcare Commercial	$310.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$167.40

IRRIG ACETIC SOL 1000ML

Facility

$48.00

Hospital Charge Code	289362
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

IRRIG ACETIC SOL 1000ML

Facility

$48.00

Hospital Charge Code	289362
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

IRRIG ACETIC SOL 250ML

Facility

$21.00

Hospital Charge Code	289360
Hospital Revenue Code	271
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

IRRIG ACETIC SOL 250ML

Facility

$21.00

Hospital Charge Code	289360
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

IRRIGATION TRAY W/ BULB SYRINGE

Facility

$65.00

Hospital Charge Code	289700
Hospital Revenue Code	271
Rate for Payer: Cash Price	$58.50

IRRIGATION TRAY W/ BULB SYRINGE

Facility

$65.00

Hospital Charge Code	289700
Hospital Revenue Code	271
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

IRRIGATION TRAY W/ PISTON SYRINGE

Facility

$48.00

Hospital Charge Code	289729
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

IRRIGATION TRAY W/ PISTON SYRINGE

Facility

$48.00

Hospital Charge Code	289729
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

IRRIG H2O 3000ML BAG

Facility

$7.00

Hospital Charge Code	123176
Hospital Revenue Code	271
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$5.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.00
Rate for Payer: Cash Price	$6.30
Rate for Payer: UnitedHealthcare Commercial	$4.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.52

IRRIG H2O 3000ML BAG

Facility

$7.00

Hospital Charge Code	123176
Hospital Revenue Code	271
Rate for Payer: Cash Price	$6.30

IRRIGO.9%SOD CHL1000

Facility

$58.00

Hospital Charge Code	289364
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

IRRIGO.9%SOD CHL1000

Facility

$58.00

Hospital Charge Code	289364
Hospital Revenue Code	271
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

IRRIG SALINE 1000 ML

Facility

$58.00

Hospital Charge Code	289363
Hospital Revenue Code	271
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

IRRIG SALINE 1000 ML

Facility

$58.00

Hospital Charge Code	289363
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

IRRIG SALINE 3000ML BAG

Facility

$7.00

Hospital Charge Code	123177
Hospital Revenue Code	271
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$5.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.00
Rate for Payer: Cash Price	$6.30
Rate for Payer: UnitedHealthcare Commercial	$4.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.52

IRRIG SALINE 3000ML BAG

Facility

$7.00

Hospital Charge Code	123177
Hospital Revenue Code	271
Rate for Payer: Cash Price	$6.30

IRRIG SALINE 500CC

Facility

$39.00

Hospital Charge Code	289365
Hospital Revenue Code	271
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

IRRIG SALINE 500CC

Facility

$39.00

Hospital Charge Code	289365
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

IRRIG SALINE SOL 250ML

Facility

$21.00

Hospital Charge Code	289361
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

IRRIG SALINE SOL 250ML

Facility

$21.00

Hospital Charge Code	289361
Hospital Revenue Code	271
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC

Facility

$31,174.40

Service Code	MSDRG 062
Min. Negotiated Rate	$15,587.20
Max. Negotiated Rate	$31,174.40
Rate for Payer: Aetna Medicare Advantage	$15,587.20
Rate for Payer: Cigna Commercial HMO & PPO	$15,587.20
Rate for Payer: Home State Health Plan Medicare Advantage	$15,587.20
Rate for Payer: Humana Commercial	$31,174.40
Rate for Payer: Humana Medicare Advantage	$15,587.20

Know your out-of-pocket cost for care.

All Charges