Madison Medical Center

All Charges

Charge

Type

Setting

Price

NP THYROID 60MG TAB EMP

Facility

$12.00

Service Code	NDC 4.2192E+10
Hospital Charge Code	2624707
Hospital Revenue Code	250
Rate for Payer: Cash Price	$10.80

NP THYROID 60MG TAB EMP

Facility

$12.00

Service Code	NDC 4.2192E+10
Hospital Charge Code	2624707
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$8.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8.57
Rate for Payer: Cash Price	$10.80
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

NS 0.45% 1000ML IV

Facility

$129.00

Service Code	NDC 409798509
Hospital Charge Code	2659111
Hospital Revenue Code	258
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

NS 0.45% 1000ML IV

Facility

$129.00

Service Code	NDC 409798509
Hospital Charge Code	2659111
Hospital Revenue Code	258
Min. Negotiated Rate	$86.04
Max. Negotiated Rate	$86.04
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04

NS 1000ML IV FLUID

Facility

$129.00

Service Code	NDC 264780009
Hospital Charge Code	2659110
Hospital Revenue Code	258
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

NS 1000ML IV FLUID

Facility

$129.00

Service Code	NDC 264780009
Hospital Charge Code	2659110
Hospital Revenue Code	258
Min. Negotiated Rate	$86.04
Max. Negotiated Rate	$86.04
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04

NS 100ML IV FLUID

Facility

$129.00

Service Code	NDC 338004938
Hospital Charge Code	2659104
Hospital Revenue Code	250
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

NS 100ML IV FLUID

Facility

$129.00

Service Code	NDC 338004938
Hospital Charge Code	2659104
Hospital Revenue Code	250
Rate for Payer: Cash Price	$116.10

NS 150ML IV FLUID

Facility

$129.00

Service Code	NDC 990798361
Hospital Charge Code	2625076
Hospital Revenue Code	250
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

NS 150ML IV FLUID

Facility

$129.00

Service Code	NDC 990798361
Hospital Charge Code	2625076
Hospital Revenue Code	250
Rate for Payer: Cash Price	$116.10

NS 250ML IV

Facility

$129.00

Service Code	NDC 409798302
Hospital Charge Code	2659112
Hospital Revenue Code	258
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

NS 250ML IV

Facility

$129.00

Service Code	NDC 409798302
Hospital Charge Code	2659112
Hospital Revenue Code	258
Min. Negotiated Rate	$86.04
Max. Negotiated Rate	$86.04
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04

NS 500ML IV

Facility

$129.00

Service Code	NDC 338004903
Hospital Charge Code	2659113
Hospital Revenue Code	258
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

NS 500ML IV

Facility

$129.00

Service Code	NDC 338004903
Hospital Charge Code	2659113
Hospital Revenue Code	258
Min. Negotiated Rate	$86.04
Max. Negotiated Rate	$86.04
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04

NS 50ML IV FLUID

Facility

$129.00

Service Code	NDC 338004911
Hospital Charge Code	2621092
Hospital Revenue Code	250
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

NS 50ML IV FLUID

Facility

$129.00

Service Code	NDC 338004911
Hospital Charge Code	2621092
Hospital Revenue Code	250
Rate for Payer: Cash Price	$116.10

NS 50ML IV (MINIBAG PLUS)

Facility

$129.00

Service Code	HCPCS J7050
Hospital Charge Code	2624557
Hospital Revenue Code	250
Rate for Payer: Cash Price	$116.10

NS 50ML IV (MINIBAG PLUS)

Facility

$129.00

Service Code	HCPCS J7050
Hospital Charge Code	2624557
Hospital Revenue Code	250
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

NS ADVANTAGE 100ML

Facility

$129.00

Service Code	NDC 409710169
Hospital Charge Code	2698320
Hospital Revenue Code	250
Rate for Payer: Cash Price	$116.10

NS ADVANTAGE 100ML

Facility

$129.00

Service Code	NDC 409710169
Hospital Charge Code	2698320
Hospital Revenue Code	250
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

NSASOPHARYNGOSCOPY W/ENDOSCOPE

Facility

$330.00

Service Code	CPT 92511
Hospital Charge Code	9392511
Hospital Revenue Code	521
Min. Negotiated Rate	$161.94
Max. Negotiated Rate	$407.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$179.93
Rate for Payer: Aetna Medicare Advantage	$203.93
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: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cigna Commercial HMO & PPO	$203.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$161.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$192.53
Rate for Payer: Home State Health Plan Medicare Advantage	$203.93
Rate for Payer: Humana Commercial	$407.86
Rate for Payer: Humana Medicare Advantage	$203.93
Rate for Payer: UnitedHealthcare Commercial	$220.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$179.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NSASOPHARYNGOSCOPY W/ENDOSCOPE

Facility

$330.00

Service Code	CPT 92511
Hospital Charge Code	9392511
Hospital Revenue Code	521
Rate for Payer: Cash Price	$297.00

NS AVIVA BAG 6E1322 250ML IV SOL

Facility

$129.00

Service Code	HCPCS J7050
Hospital Charge Code	2626566
Hospital Revenue Code	250
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

NS AVIVA BAG 6E1322 250ML IV SOL

Facility

$129.00

Service Code	HCPCS J7050
Hospital Charge Code	2626566
Hospital Revenue Code	250
Rate for Payer: Cash Price	$116.10

NS AVIVA BAG 6E1323 500ML IV SOL

Facility

$129.00

Service Code	HCPCS J7040
Hospital Charge Code	2626565
Hospital Revenue Code	250
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

Know your out-of-pocket cost for care.

All Charges