Madison Medical Center

All Charges

Charge

Type

Setting

Price

NOVOLOG MIX 70/30 FLEXPEN EMP 5X3ML

Facility

$256.00

Service Code	NDC 169369619
Hospital Charge Code	2622912
Hospital Revenue Code	250
Min. Negotiated Rate	$92.16
Max. Negotiated Rate	$182.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$151.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.78
Rate for Payer: Cash Price	$230.40
Rate for Payer: UnitedHealthcare Commercial	$170.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$92.16

NOVOLOG MIX 70/30 FLEXPEN EMP 5X3ML

Facility

$256.00

Service Code	NDC 169369619
Hospital Charge Code	2622912
Hospital Revenue Code	250
Rate for Payer: Cash Price	$230.40

NP HCY AGE 12 - 17

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	9899384
Hospital Revenue Code	521
Rate for Payer: Cash Price	$261.00

NP HCY AGE 12 - 17

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	9899384
Hospital Revenue Code	521
Min. Negotiated Rate	$171.68
Max. Negotiated Rate	$207.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$171.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$207.06
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: UnitedHealthcare Commercial	$193.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP HCY AGE 12-17

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	4199384
Hospital Revenue Code	521
Min. Negotiated Rate	$171.68
Max. Negotiated Rate	$207.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$171.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$207.06
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: UnitedHealthcare Commercial	$193.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP HCY AGE 12-17

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	4199384
Hospital Revenue Code	521
Rate for Payer: Cash Price	$261.00

NP HCY AGE 1 - 4

Facility

$250.00

Service Code	CPT 99382
Hospital Charge Code	9899382
Hospital Revenue Code	521
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

NP HCY AGE 1 - 4

Facility

$250.00

Service Code	CPT 99382
Hospital Charge Code	9899382
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

NP HCY AGE 1-4

Facility

$250.00

Service Code	CPT 99382
Hospital Charge Code	4199382
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

NP HCY AGE 1-4

Facility

$250.00

Service Code	CPT 99382
Hospital Charge Code	4199382
Hospital Revenue Code	521
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

NP HCY AGE 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	9899383
Hospital Revenue Code	521
Min. Negotiated Rate	$153.92
Max. Negotiated Rate	$185.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: UnitedHealthcare Commercial	$173.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP HCY AGE 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	9899383
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

NP HCY AGE 5-11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	4199383
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

NP HCY AGE 5-11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	4199383
Hospital Revenue Code	521
Min. Negotiated Rate	$153.92
Max. Negotiated Rate	$185.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: UnitedHealthcare Commercial	$173.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP HCY AGES 12 - 17

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	9299384
Hospital Revenue Code	521
Rate for Payer: Cash Price	$261.00

NP HCY AGES 12 - 17

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	9499384
Hospital Revenue Code	521
Rate for Payer: Cash Price	$261.00

NP HCY AGES 12 - 17

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	9499384
Hospital Revenue Code	521
Min. Negotiated Rate	$171.68
Max. Negotiated Rate	$207.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$171.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$207.06
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: UnitedHealthcare Commercial	$193.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP HCY AGES 12 - 17

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	9299384
Hospital Revenue Code	521
Min. Negotiated Rate	$171.68
Max. Negotiated Rate	$207.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$171.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$207.06
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: UnitedHealthcare Commercial	$193.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP HCY AGES 1 - 4

Facility

$250.00

Service Code	CPT 99382
Hospital Charge Code	9499382
Hospital Revenue Code	521
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

NP HCY AGES 1 - 4

Facility

$250.00

Service Code	CPT 99382
Hospital Charge Code	9299382
Hospital Revenue Code	521
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

NP HCY AGES 1 - 4

Facility

$250.00

Service Code	CPT 99382
Hospital Charge Code	9499382
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

NP HCY AGES 1 - 4

Facility

$250.00

Service Code	CPT 99382
Hospital Charge Code	9299382
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

NP HCY AGES 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	9299383
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

NP HCY AGES 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	9299383
Hospital Revenue Code	521
Min. Negotiated Rate	$153.92
Max. Negotiated Rate	$185.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: UnitedHealthcare Commercial	$173.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP HCY AGES 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	9499383
Hospital Revenue Code	521
Min. Negotiated Rate	$153.92
Max. Negotiated Rate	$185.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: UnitedHealthcare Commercial	$173.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges