Madison Medical Center

All Charges

Charge

Type

Setting

Price

NUT 4 OZ.

Facility

$16.00

Hospital Charge Code	2819907
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

NUT. 8 OZ. CAN

Facility

$18.00

Hospital Charge Code	2819908
Hospital Revenue Code	271
Rate for Payer: Cash Price	$16.20

NUT. 8 OZ. CAN

Facility

$18.00

Hospital Charge Code	2819908
Hospital Revenue Code	271
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

NUT. PUMP SET

Facility

$106.00

Hospital Charge Code	285836
Hospital Revenue Code	271
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$75.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: UnitedHealthcare Commercial	$70.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

NUT. PUMP SET

Facility

$106.00

Hospital Charge Code	285836
Hospital Revenue Code	271
Rate for Payer: Cash Price	$95.40

NUTR.PUMP CHG. (DAILY)

Facility

$199.00

Hospital Charge Code	280005
Hospital Revenue Code	271
Rate for Payer: Cash Price	$179.10

NUTR.PUMP CHG. (DAILY)

Facility

$199.00

Hospital Charge Code	280005
Hospital Revenue Code	271
Min. Negotiated Rate	$71.64
Max. Negotiated Rate	$142.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.09
Rate for Payer: Cash Price	$179.10
Rate for Payer: UnitedHealthcare Commercial	$132.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.64

NUT. SPIKE SET

Facility

$101.00

Hospital Charge Code	2819902
Hospital Revenue Code	271
Rate for Payer: Cash Price	$90.90

NUT. SPIKE SET

Facility

$101.00

Hospital Charge Code	2819902
Hospital Revenue Code	271
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

NUT. Y EXT

Facility

$44.00

Hospital Charge Code	280020
Hospital Revenue Code	271
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

NUT. Y EXT

Facility

$44.00

Hospital Charge Code	280020
Hospital Revenue Code	271
Rate for Payer: Cash Price	$39.60

NUVARING 0.015MG/0.12MG VAG (3) EMP

Facility

$479.00

Service Code	NDC 7.8206E+10
Hospital Charge Code	2625499
Hospital Revenue Code	250
Min. Negotiated Rate	$172.44
Max. Negotiated Rate	$342.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$283.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$342.01
Rate for Payer: Cash Price	$431.10
Rate for Payer: UnitedHealthcare Commercial	$319.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$172.44

NUVARING 0.015MG/0.12MG VAG (3) EMP

Facility

$479.00

Service Code	NDC 7.8206E+10
Hospital Charge Code	2625499
Hospital Revenue Code	250
Rate for Payer: Cash Price	$431.10

NW NH INTERMEDIATE - WARD W

Facility

$190.00

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	$171.00
Rate for Payer: UnitedHealthcare Commercial	$1,519.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,754.00

NW NH INTERMEDIATE - WARD W

Facility

$190.00

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	$171.00
Rate for Payer: UnitedHealthcare Commercial	$1,519.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,754.00

NYS/MINTO/VLIDO/DIPH ORAL SUSP 240ML

Facility

$244.00

Service Code	NDC 6.6689E+10
Hospital Charge Code	2623594
Hospital Revenue Code	250
Rate for Payer: Cash Price	$219.60

NYS/MINTO/VLIDO/DIPH ORAL SUSP 240ML

Facility

$244.00

Service Code	NDC 6.6689E+10
Hospital Charge Code	2623594
Hospital Revenue Code	250
Min. Negotiated Rate	$87.84
Max. Negotiated Rate	$174.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$144.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.22
Rate for Payer: Cash Price	$219.60
Rate for Payer: UnitedHealthcare Commercial	$162.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$87.84

NYSTATIN 100 M-U/GM CRM 15GM

Facility

$71.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2655750
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

NYSTATIN 100 M-U/GM CRM 15GM

Facility

$71.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2655750
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.90

NYSTATIN 100 M-U/GM CRM 15GM EMP

Facility

$71.00

Service Code	NDC 472016315
Hospital Charge Code	2622996
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

NYSTATIN 100 M-U/GM CRM 15GM EMP

Facility

$71.00

Service Code	NDC 472016315
Hospital Charge Code	2622996
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.90

NYSTATIN 100 M-U/GM CRM 30GM EMP

Facility

$71.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2622825
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

NYSTATIN 100 M-U/GM CRM 30GM EMP

Facility

$71.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2622825
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.90

NYSTATIN 100 M-U/GM CRM 60GM EMP

Facility

$71.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2627009
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.90

NYSTATIN 100 M-U/GM CRM 60GM EMP

Facility

$71.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2627009
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

Know your out-of-pocket cost for care.

All Charges