Madison Medical Center

All Charges

Charge

Type

Setting

Price

NEOSTIGMINE 5MG VIAL 10ML

Facility

$382.00

Service Code	HCPCS J2710
Hospital Charge Code	2058046
Hospital Revenue Code	370
Rate for Payer: Cash Price	$343.80

NEO SUCKER CURVED-ORAL & NASAL SUCTION

Facility

$8.00

Service Code	CPT A4648
Hospital Charge Code	2819395
Hospital Revenue Code	271
Rate for Payer: Cash Price	$7.20

NEO SUCKER CURVED-ORAL & NASAL SUCTION

Facility

$8.00

Service Code	CPT A4648
Hospital Charge Code	2819395
Hospital Revenue Code	271
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$5.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.71
Rate for Payer: Cash Price	$7.20
Rate for Payer: UnitedHealthcare Commercial	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.88

NEPHRITIS AND NEPHROSIS

Facility

$6,788.33

Service Code	APR-DRG 4621
Min. Negotiated Rate	$6,788.33
Max. Negotiated Rate	$6,788.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,788.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,788.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,788.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,788.33

NEPHRITIS AND NEPHROSIS

Facility

$11,280.37

Service Code	APR-DRG 4622
Min. Negotiated Rate	$11,280.37
Max. Negotiated Rate	$11,280.37
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,280.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,280.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,280.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,280.37

NEPHRITIS AND NEPHROSIS

Facility

$38,100.62

Service Code	APR-DRG 4624
Min. Negotiated Rate	$38,100.62
Max. Negotiated Rate	$38,100.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$38,100.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$38,100.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$38,100.62
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$38,100.62

NEPHRITIS AND NEPHROSIS

Facility

$22,850.20

Service Code	APR-DRG 4623
Min. Negotiated Rate	$22,850.20
Max. Negotiated Rate	$22,850.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,850.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,850.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,850.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,850.20

NERVE BLOCK NEEDLE

Facility

$80.00

Hospital Charge Code	2824478
Hospital Revenue Code	270
Rate for Payer: Cash Price	$72.00

NERVE BLOCK NEEDLE

Facility

$80.00

Hospital Charge Code	2824478
Hospital Revenue Code	270
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$57.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: UnitedHealthcare Commercial	$53.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.80

NERVE BLOCK OCCIPITAL

Professional

Both

$500.00

Service Code	CPT 64405
Hospital Charge Code	4164405
Hospital Revenue Code	975
Min. Negotiated Rate	$44.76
Max. Negotiated Rate	$175.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$44.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$63.04
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cigna Commercial HMO & PPO	$44.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$63.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.34
Rate for Payer: Home State Health Plan Medicare Advantage	$44.76
Rate for Payer: Optum Medicare Advantage	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$63.04

NERVE BLOCK TRIGEMINAL NERVE ANY BRANCH

Professional

Both

$480.00

Service Code	CPT 64400
Hospital Charge Code	4164400
Hospital Revenue Code	975
Min. Negotiated Rate	$45.03
Max. Negotiated Rate	$168.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$45.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$85.89
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cigna Commercial HMO & PPO	$45.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$85.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$94.48
Rate for Payer: Home State Health Plan Medicare Advantage	$45.03
Rate for Payer: Optum Medicare Advantage	$168.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$85.89

NERVE ELECTRODE

Facility

$39.00

Hospital Charge Code	2814286
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

NERVE ELECTRODE

Facility

$39.00

Hospital Charge Code	2814286
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

NERVOUS SYSTEM MALIGNANCY

Facility

$13,926.03

Service Code	APR-DRG 0413
Min. Negotiated Rate	$13,926.03
Max. Negotiated Rate	$13,926.03
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,926.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,926.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,926.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,926.03

NERVOUS SYSTEM MALIGNANCY

Facility

$9,047.34

Service Code	APR-DRG 0411
Min. Negotiated Rate	$9,047.34
Max. Negotiated Rate	$9,047.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,047.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,047.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,047.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,047.34

NERVOUS SYSTEM MALIGNANCY

Facility

$21,107.69

Service Code	APR-DRG 0414
Min. Negotiated Rate	$21,107.69
Max. Negotiated Rate	$21,107.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$21,107.69
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21,107.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21,107.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21,107.69

NERVOUS SYSTEM MALIGNANCY

Facility

$11,112.72

Service Code	APR-DRG 0412
Min. Negotiated Rate	$11,112.72
Max. Negotiated Rate	$11,112.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,112.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,112.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,112.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,112.72

NERVOUS SYSTEM NEOPLASMS WITH MCC

Facility

$27,546.30

Service Code	MSDRG 054
Min. Negotiated Rate	$13,773.15
Max. Negotiated Rate	$27,546.30
Rate for Payer: Aetna Medicare Advantage	$13,773.15
Rate for Payer: Cigna Commercial HMO & PPO	$13,773.15
Rate for Payer: Home State Health Plan Medicare Advantage	$13,773.15
Rate for Payer: Humana Commercial	$27,546.30
Rate for Payer: Humana Medicare Advantage	$13,773.15

NERVOUS SYSTEM NEOPLASMS WITHOUT MCC

Facility

$19,600.62

Service Code	MSDRG 055
Min. Negotiated Rate	$9,800.31
Max. Negotiated Rate	$19,600.62
Rate for Payer: Aetna Medicare Advantage	$9,800.31
Rate for Payer: Cigna Commercial HMO & PPO	$9,800.31
Rate for Payer: Home State Health Plan Medicare Advantage	$9,800.31
Rate for Payer: Humana Commercial	$19,600.62
Rate for Payer: Humana Medicare Advantage	$9,800.31

NEUROLOGICAL EYE DISORDERS

Facility

$16,142.10

Service Code	MSDRG 123
Min. Negotiated Rate	$8,071.05
Max. Negotiated Rate	$16,142.10
Rate for Payer: Aetna Medicare Advantage	$8,071.05
Rate for Payer: Cigna Commercial HMO & PPO	$8,071.05
Rate for Payer: Home State Health Plan Medicare Advantage	$8,071.05
Rate for Payer: Humana Commercial	$16,142.10
Rate for Payer: Humana Medicare Advantage	$8,071.05

NEUROMYELITIS AUTOANTIBODY IGG

Facility

$922.00

Service Code	CPT 83516
Hospital Charge Code	2203516
Hospital Revenue Code	302
Rate for Payer: Cash Price	$829.80

NEUROMYELITIS AUTOANTIBODY IGG

Facility

$922.00

Service Code	CPT 83516
Hospital Charge Code	2203516
Hospital Revenue Code	302
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$658.31
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$545.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$658.31
Rate for Payer: Cash Price	$829.80
Rate for Payer: Cash Price	$829.80
Rate for Payer: Cash Price	$829.80
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$331.92

NEUROPLASTY AND OR TRANSPOSITION CTS MED

Facility

$2,450.00

Service Code	CPT 64721
Hospital Charge Code	9164721
Hospital Revenue Code	525
Rate for Payer: Cash Price	$2,205.00

NEUROPLASTY AND OR TRANSPOSITION CTS MED

Facility

$2,450.00

Service Code	CPT 64721
Hospital Charge Code	9164721
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$3,990.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,760.28
Rate for Payer: Aetna Medicare Advantage	$1,995.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,450.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,749.30
Rate for Payer: Cash Price	$2,205.00
Rate for Payer: Cash Price	$2,205.00
Rate for Payer: Cash Price	$2,205.00
Rate for Payer: Cash Price	$2,205.00
Rate for Payer: Cigna Commercial HMO & PPO	$1,995.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,584.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,883.50
Rate for Payer: Home State Health Plan Medicare Advantage	$1,995.02
Rate for Payer: Humana Commercial	$3,990.04
Rate for Payer: Humana Medicare Advantage	$1,995.02
Rate for Payer: UnitedHealthcare Commercial	$1,634.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,760.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NEUROPLASTY MEDIAN NERVE AT CARPAL TUNNE

Professional

Both

$2,600.00

Service Code	CPT 64721
Hospital Charge Code	9364721
Hospital Revenue Code	975
Min. Negotiated Rate	$335.75
Max. Negotiated Rate	$910.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$390.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$335.75
Rate for Payer: Cash Price	$2,340.00
Rate for Payer: Cash Price	$2,340.00
Rate for Payer: Cigna Commercial HMO & PPO	$390.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$335.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$369.32
Rate for Payer: Home State Health Plan Medicare Advantage	$390.85
Rate for Payer: Optum Medicare Advantage	$910.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$335.75

Know your out-of-pocket cost for care.

All Charges