Madison Medical Center

All Charges

Charge

Type

Setting

Price

NS AVIVA BAG 6E1323 500ML IV SOL

Facility

$129.00

Service Code	HCPCS J7040
Hospital Charge Code	2626565
Hospital Revenue Code	250
Rate for Payer: Cash Price	$116.10

NS FLUSH 10 ML

Facility

$41.00

Service Code	HCPCS A4216
Hospital Charge Code	260452
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.90

NS FLUSH 10 ML

Facility

$41.00

Service Code	HCPCS A4216
Hospital Charge Code	260452
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$29.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.27
Rate for Payer: Cash Price	$36.90
Rate for Payer: UnitedHealthcare Commercial	$27.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.76

NS IV FLUSH PF 10ML PFS

Facility

$55.00

Service Code	HCPCS A4216
Hospital Charge Code	2626476
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

NS IV FLUSH PF 10ML PFS

Facility

$55.00

Service Code	HCPCS A4216
Hospital Charge Code	2626476
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

NS IV FLUSH PF 3ML PFS

Facility

$19.00

Service Code	HCPCS A4216
Hospital Charge Code	2625740
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

NS IV FLUSH PF 3ML PFS

Facility

$19.00

Service Code	HCPCS A4216
Hospital Charge Code	2625740
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

NS IV FLUSH PF 5ML PFS

Facility

$55.00

Service Code	HCPCS A4216
Hospital Charge Code	2624758
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

NS IV FLUSH PF 5ML PFS

Facility

$55.00

Service Code	HCPCS A4216
Hospital Charge Code	2624758
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

NS (MINIBAG PLUS) 100ML IV

Facility

$129.00

Service Code	HCPCS J7050
Hospital Charge Code	2626421
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 (MINIBAG PLUS) 100ML IV

Facility

$129.00

Service Code	HCPCS J7050
Hospital Charge Code	2626421
Hospital Revenue Code	250
Rate for Payer: Cash Price	$116.10

NS NH INTERMEDIATE - S/PRIV S

Facility

$200.00

Hospital Charge Code	30500080
Hospital Revenue Code	120
Min. Negotiated Rate	$742.00
Max. Negotiated Rate	$1,754.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$742.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$742.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: UnitedHealthcare Commercial	$1,519.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,754.00

NS NH INTERMEDIATE - S/PRIV S

Facility

$200.00

Hospital Charge Code	30500080
Hospital Revenue Code	110
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$1,754.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$185.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: UnitedHealthcare Commercial	$1,519.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,754.00

N-TELOPEPTIDE SERUM

Facility

$403.00

Service Code	CPT 82523
Hospital Charge Code	2282521
Hospital Revenue Code	301
Rate for Payer: Cash Price	$362.70

N-TELOPEPTIDE SERUM

Facility

$403.00

Service Code	CPT 82523
Hospital Charge Code	2282521
Hospital Revenue Code	301
Min. Negotiated Rate	$16.81
Max. Negotiated Rate	$287.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.81
Rate for Payer: Aetna Medicare Advantage	$18.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$238.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$287.74
Rate for Payer: Cash Price	$362.70
Rate for Payer: Cash Price	$362.70
Rate for Payer: Cash Price	$362.70
Rate for Payer: Cigna Commercial HMO & PPO	$18.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.99
Rate for Payer: Home State Health Plan Medicare Advantage	$18.68
Rate for Payer: Humana Commercial	$37.36
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$145.08

N-TELOPEPTIDE URINE

Facility

$67.00

Service Code	CPT 82523
Hospital Charge Code	2284682
Hospital Revenue Code	301
Min. Negotiated Rate	$16.81
Max. Negotiated Rate	$47.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.81
Rate for Payer: Aetna Medicare Advantage	$18.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cigna Commercial HMO & PPO	$18.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.99
Rate for Payer: Home State Health Plan Medicare Advantage	$18.68
Rate for Payer: Humana Commercial	$37.36
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

N-TELOPEPTIDE URINE

Facility

$67.00

Service Code	CPT 82523
Hospital Charge Code	2284682
Hospital Revenue Code	301
Rate for Payer: Cash Price	$60.30

.NT PROBNP

Facility

$365.00

Service Code	CPT 83880
Hospital Charge Code	2283531
Hospital Revenue Code	301
Rate for Payer: Cash Price	$328.50

.NT PROBNP

Facility

$365.00

Service Code	CPT 83880
Hospital Charge Code	2283531
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$260.61
Rate for Payer: Aetna Better Health Medicaid/QHP	$35.33
Rate for Payer: Aetna Medicare Advantage	$39.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$216.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$260.61
Rate for Payer: Cash Price	$328.50
Rate for Payer: Cash Price	$328.50
Rate for Payer: Cash Price	$328.50
Rate for Payer: Cigna Commercial HMO & PPO	$39.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$35.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37.80
Rate for Payer: Home State Health Plan Medicare Advantage	$39.26
Rate for Payer: Humana Commercial	$78.52
Rate for Payer: Humana Medicare Advantage	$39.26
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$35.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$131.40

NT PROBNP 2

Facility

$365.00

Service Code	CPT 83880
Hospital Charge Code	2283532
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$260.61
Rate for Payer: Aetna Better Health Medicaid/QHP	$35.33
Rate for Payer: Aetna Medicare Advantage	$39.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$216.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$260.61
Rate for Payer: Cash Price	$328.50
Rate for Payer: Cash Price	$328.50
Rate for Payer: Cash Price	$328.50
Rate for Payer: Cigna Commercial HMO & PPO	$39.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$35.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37.80
Rate for Payer: Home State Health Plan Medicare Advantage	$39.26
Rate for Payer: Humana Commercial	$78.52
Rate for Payer: Humana Medicare Advantage	$39.26
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$35.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$131.40

NT PROBNP 2

Facility

$365.00

Service Code	CPT 83880
Hospital Charge Code	2283532
Hospital Revenue Code	301
Rate for Payer: Cash Price	$328.50

NT PROBNP (PATHFAST)

Facility

$365.00

Service Code	CPT 83880
Hospital Charge Code	2283533
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$260.61
Rate for Payer: Aetna Better Health Medicaid/QHP	$35.33
Rate for Payer: Aetna Medicare Advantage	$39.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$216.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$260.61
Rate for Payer: Cash Price	$328.50
Rate for Payer: Cash Price	$328.50
Rate for Payer: Cash Price	$328.50
Rate for Payer: Cigna Commercial HMO & PPO	$39.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$35.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37.80
Rate for Payer: Home State Health Plan Medicare Advantage	$39.26
Rate for Payer: Humana Commercial	$78.52
Rate for Payer: Humana Medicare Advantage	$39.26
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$35.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$131.40

NT PROBNP (PATHFAST)

Facility

$365.00

Service Code	CPT 83880
Hospital Charge Code	2283533
Hospital Revenue Code	301
Rate for Payer: Cash Price	$328.50

NURSING FAC. DISH. < 30 MIN.

Facility

$170.00

Service Code	CPT 99315
Hospital Charge Code	4499315
Hospital Revenue Code	525
Min. Negotiated Rate	$100.64
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$121.38
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: UnitedHealthcare Commercial	$113.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NURSING FAC. DISH. < 30 MIN.

Facility

$170.00

Service Code	CPT 99315
Hospital Charge Code	4499315
Hospital Revenue Code	525
Rate for Payer: Cash Price	$153.00

Know your out-of-pocket cost for care.

All Charges