Madison Medical Center

All Charges

Charge

Type

Setting

Price

NF-TRAMADOL HCL TAB 50MG

Facility

$15.00

Service Code	NDC 5.4868E+10
Hospital Charge Code	2697198
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

NF-TRAMADOL HCL TAB 50MG

Facility

$15.00

Service Code	NDC 5.4868E+10
Hospital Charge Code	2697198
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

NH ADMISSION HIGH SEVERITY

Facility

$330.00

Service Code	CPT 99306
Hospital Charge Code	4499306
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$235.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$195.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$235.62
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: UnitedHealthcare Commercial	$220.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH ADMISSION HIGH SEVERITY

Facility

$285.00

Service Code	CPT 99306
Hospital Charge Code	5499306
Hospital Revenue Code	525
Rate for Payer: Cash Price	$256.50

NH ADMISSION HIGH SEVERITY

Facility

$330.00

Service Code	CPT 99306
Hospital Charge Code	9799306
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$235.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$195.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$235.62
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: UnitedHealthcare Commercial	$220.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH ADMISSION HIGH SEVERITY

Facility

$285.00

Service Code	CPT 99306
Hospital Charge Code	4299306
Hospital Revenue Code	525
Rate for Payer: Cash Price	$256.50

NH ADMISSION HIGH SEVERITY

Facility

$330.00

Service Code	CPT 99306
Hospital Charge Code	9799306
Hospital Revenue Code	521
Rate for Payer: Cash Price	$297.00

NH ADMISSION HIGH SEVERITY

Facility

$285.00

Service Code	CPT 99306
Hospital Charge Code	4299306
Hospital Revenue Code	525
Min. Negotiated Rate	$168.72
Max. Negotiated Rate	$203.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: UnitedHealthcare Commercial	$190.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH ADMISSION HIGH SEVERITY

Facility

$330.00

Service Code	CPT 99306
Hospital Charge Code	4499306
Hospital Revenue Code	525
Rate for Payer: Cash Price	$297.00

NH ADMISSION HIGH SEVERITY

Facility

$285.00

Service Code	CPT 99306
Hospital Charge Code	5499306
Hospital Revenue Code	525
Min. Negotiated Rate	$168.72
Max. Negotiated Rate	$203.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: UnitedHealthcare Commercial	$190.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH ADMISSION LOW SEVERITY

Facility

$176.00

Service Code	CPT 99304
Hospital Charge Code	4299304
Hospital Revenue Code	525
Rate for Payer: Cash Price	$158.40

NH ADMISSION LOW SEVERITY

Facility

$176.00

Service Code	CPT 99304
Hospital Charge Code	4299304
Hospital Revenue Code	525
Min. Negotiated Rate	$104.19
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$104.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$125.66
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cash Price	$158.40
Rate for Payer: UnitedHealthcare Commercial	$117.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH ADMISSION MODERATE

Facility

$235.00

Service Code	CPT 99305
Hospital Charge Code	9799305
Hospital Revenue Code	521
Min. Negotiated Rate	$139.12
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.79
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: UnitedHealthcare Commercial	$156.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH ADMISSION MODERATE

Facility

$185.00

Service Code	CPT 99305
Hospital Charge Code	9799304
Hospital Revenue Code	521
Rate for Payer: Cash Price	$166.50

NH ADMISSION MODERATE

Facility

$185.00

Service Code	CPT 99305
Hospital Charge Code	9799304
Hospital Revenue Code	521
Min. Negotiated Rate	$109.52
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$109.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.09
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: UnitedHealthcare Commercial	$123.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH ADMISSION MODERATE

Facility

$235.00

Service Code	CPT 99305
Hospital Charge Code	9799305
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

NH ADMISSION MODERATE SEV

Facility

$250.00

Service Code	CPT 99305
Hospital Charge Code	4499305
Hospital Revenue Code	525
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$178.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH ADMISSION MODERATE SEV

Facility

$235.00

Service Code	CPT 99305
Hospital Charge Code	5499305
Hospital Revenue Code	525
Min. Negotiated Rate	$139.12
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.79
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: UnitedHealthcare Commercial	$156.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH ADMISSION MODERATE SEV

Facility

$235.00

Service Code	CPT 99305
Hospital Charge Code	5499305
Hospital Revenue Code	525
Rate for Payer: Cash Price	$211.50

NH ADMISSION MODERATE SEV

Facility

$250.00

Service Code	CPT 99305
Hospital Charge Code	4499305
Hospital Revenue Code	525
Rate for Payer: Cash Price	$225.00

NH ADMISSION MODERATE SEVERITY

Facility

$235.00

Service Code	CPT 99305
Hospital Charge Code	4299305
Hospital Revenue Code	525
Rate for Payer: Cash Price	$211.50

NH ADMISSION MODERATE SEVERITY

Facility

$235.00

Service Code	CPT 99305
Hospital Charge Code	4299305
Hospital Revenue Code	525
Min. Negotiated Rate	$139.12
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.79
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: UnitedHealthcare Commercial	$156.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH CARE PLAN OVERSIGHT HOME HEALTH

Facility

$173.00

Service Code	CPT 99374
Hospital Charge Code	9499374
Hospital Revenue Code	521
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$102.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$123.52
Rate for Payer: Cash Price	$155.70
Rate for Payer: Cash Price	$155.70
Rate for Payer: UnitedHealthcare Commercial	$115.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH CARE PLAN OVERSIGHT HOME HEALTH

Facility

$173.00

Service Code	CPT 99374
Hospital Charge Code	9499374
Hospital Revenue Code	521
Rate for Payer: Cash Price	$155.70

NH CARE PLAN OVERSIGHT HOME HEALTH L 2

Facility

$251.00

Service Code	CPT 99375
Hospital Charge Code	9499375
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.90

Know your out-of-pocket cost for care.

All Charges