Madison Medical Center

All Charges

Charge

Type

Setting

Price

NH SUB VISIT LEVEL II

Facility

$150.00

Service Code	CPT 99308
Hospital Charge Code	9799308
Hospital Revenue Code	521
Rate for Payer: Cash Price	$135.00

NH SUB VISIT LEVEL III

Facility

$190.00

Service Code	CPT 99309
Hospital Charge Code	9799309
Hospital Revenue Code	521
Min. Negotiated Rate	$112.48
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: UnitedHealthcare Commercial	$126.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH SUB VISIT LEVEL III

Facility

$190.00

Service Code	CPT 99309
Hospital Charge Code	9799309
Hospital Revenue Code	521
Rate for Payer: Cash Price	$171.00

NH VISIT LEVEL 2

Facility

$165.00

Service Code	CPT 99305
Hospital Charge Code	9299305
Hospital Revenue Code	521
Min. Negotiated Rate	$97.68
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: UnitedHealthcare Commercial	$110.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH VISIT LEVEL 2

Facility

$165.00

Service Code	CPT 99305
Hospital Charge Code	9299305
Hospital Revenue Code	521
Rate for Payer: Cash Price	$148.50

NIACIN 500MG FLUSH FREE CAPS #60

Facility

$18.00

Service Code	NDC 1.1845E+10
Hospital Charge Code	2697320
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

NIACIN 500MG FLUSH FREE CAPS #60

Facility

$18.00

Service Code	NDC 1.1845E+10
Hospital Charge Code	2697320
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

NIACIN 500MG PLAIN TAB

Facility

$18.00

Service Code	NDC 904227260
Hospital Charge Code	2626495
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

NIACIN 500MG PLAIN TAB

Facility

$18.00

Service Code	NDC 904227260
Hospital Charge Code	2626495
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

NIACIN (VITAMIN B3)

Facility

$351.00

Service Code	CPT 84591
Hospital Charge Code	2284591
Hospital Revenue Code	301
Rate for Payer: Cash Price	$315.90

NIACIN (VITAMIN B3)

Facility

$351.00

Service Code	CPT 84591
Hospital Charge Code	2284591
Hospital Revenue Code	301
Min. Negotiated Rate	$15.35
Max. Negotiated Rate	$250.61
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.35
Rate for Payer: Aetna Medicare Advantage	$17.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$207.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$250.61
Rate for Payer: Cash Price	$315.90
Rate for Payer: Cash Price	$315.90
Rate for Payer: Cash Price	$315.90
Rate for Payer: Cigna Commercial HMO & PPO	$17.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.42
Rate for Payer: Home State Health Plan Medicare Advantage	$17.06
Rate for Payer: Humana Commercial	$34.12
Rate for Payer: Humana Medicare Advantage	$17.06
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$126.36

NICARDIPINE HCL 20MG/200ML PREMIX

Facility

$315.00

Service Code	NDC 409452030
Hospital Charge Code	2625934
Hospital Revenue Code	250
Min. Negotiated Rate	$113.40
Max. Negotiated Rate	$224.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$186.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$224.91
Rate for Payer: Cash Price	$283.50
Rate for Payer: UnitedHealthcare Commercial	$210.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$113.40

NICARDIPINE HCL 20MG/200ML PREMIX

Facility

$315.00

Service Code	NDC 409452030
Hospital Charge Code	2625934
Hospital Revenue Code	250
Rate for Payer: Cash Price	$283.50

NICKEL LEVEL

Facility

$239.00

Service Code	CPT 83885
Hospital Charge Code	2212276
Hospital Revenue Code	301
Rate for Payer: Cash Price	$215.10

NICKEL LEVEL

Facility

$239.00

Service Code	CPT 83885
Hospital Charge Code	2212276
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$170.65
Rate for Payer: Aetna Better Health Medicaid/QHP	$22.06
Rate for Payer: Aetna Medicare Advantage	$24.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$141.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$170.65
Rate for Payer: Cash Price	$215.10
Rate for Payer: Cash Price	$215.10
Rate for Payer: Cash Price	$215.10
Rate for Payer: Cigna Commercial HMO & PPO	$24.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.60
Rate for Payer: Home State Health Plan Medicare Advantage	$24.51
Rate for Payer: Humana Commercial	$49.02
Rate for Payer: Humana Medicare Advantage	$24.51
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$86.04

NICOTINE 14MG/DAY PATCH EMP

Facility

$71.00

Service Code	NDC 67512514
Hospital Charge Code	2622481
Hospital Revenue Code	250
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$50.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: UnitedHealthcare Commercial	$47.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

NICOTINE 14MG/DAY PATCH EMP

Facility

$71.00

Service Code	NDC 67512514
Hospital Charge Code	2622481
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.90

NICOTINE 21MG/24H PATCH EMP

Facility

$73.00

Service Code	NDC 7E+10
Hospital Charge Code	2622238
Hospital Revenue Code	250
Rate for Payer: Cash Price	$65.70

NICOTINE 21MG/24H PATCH EMP

Facility

$73.00

Service Code	NDC 7E+10
Hospital Charge Code	2622238
Hospital Revenue Code	250
Min. Negotiated Rate	$26.28
Max. Negotiated Rate	$52.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$43.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$52.12
Rate for Payer: Cash Price	$65.70
Rate for Payer: UnitedHealthcare Commercial	$48.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.28

NICOTINE 7MG/DAY PATCH EMP

Facility

$71.00

Service Code	NDC 4.3598E+10
Hospital Charge Code	2627312
Hospital Revenue Code	250
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: UnitedHealthcare Commercial	$47.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

NICOTINE 7MG/DAY PATCH EMP

Facility

$71.00

Service Code	NDC 4.3598E+10
Hospital Charge Code	2627312
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.90

NICOTINE AND METABOLITE SERUM

Facility

$250.00

Service Code	CPT 80323
Hospital Charge Code	2280323
Hospital Revenue Code	301
Rate for Payer: Cash Price	$225.00

NICOTINE AND METABOLITE SERUM

Facility

$250.00

Service Code	CPT 80323
Hospital Charge Code	2280323
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
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	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.00

NICOTINE (NICODERM) 14MG/DAY PATCH

Facility

$71.00

Service Code	NDC 67512514
Hospital Charge Code	2626471
Hospital Revenue Code	250
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$50.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: UnitedHealthcare Commercial	$47.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

NICOTINE (NICODERM) 14MG/DAY PATCH

Facility

$71.00

Service Code	NDC 67512514
Hospital Charge Code	2626471
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.90

Know your out-of-pocket cost for care.

All Charges