Madison Medical Center

All Charges

Charge

Type

Setting

Price

APPLICATION OF SHORT LEG CAST BELOW KNEE

Facility

$300.00

Service Code	CPT 29405
Hospital Charge Code	9829405
Hospital Revenue Code	521
Rate for Payer: Cash Price	$270.00

APPLICATION OF SHORT LEG CAST BELOW KNEE

Facility

$300.00

Service Code	CPT 29405
Hospital Charge Code	9829405
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$571.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$252.13
Rate for Payer: Aetna Medicare Advantage	$285.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.20
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cigna Commercial HMO & PPO	$285.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$226.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$269.78
Rate for Payer: Home State Health Plan Medicare Advantage	$285.75
Rate for Payer: Humana Commercial	$571.50
Rate for Payer: Humana Medicare Advantage	$285.75
Rate for Payer: UnitedHealthcare Commercial	$200.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$252.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

APPLIER, MULTIPLE CLIP LARGE ER420

Facility

$382.00

Hospital Charge Code	125357
Hospital Revenue Code	271
Rate for Payer: Cash Price	$343.80

APPLIER, MULTIPLE CLIP LARGE ER420

Facility

$382.00

Hospital Charge Code	125357
Hospital Revenue Code	271
Min. Negotiated Rate	$137.52
Max. Negotiated Rate	$272.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$226.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$272.75
Rate for Payer: Cash Price	$343.80
Rate for Payer: UnitedHealthcare Commercial	$254.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$137.52

APREPITANT (EMEND) 40MG CAP EMP

Facility

$125.00

Service Code	NDC 781232106
Hospital Charge Code	2624441
Hospital Revenue Code	250
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$89.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: UnitedHealthcare Commercial	$83.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

APREPITANT (EMEND) 40MG CAP EMP

Facility

$125.00

Service Code	NDC 781232106
Hospital Charge Code	2624441
Hospital Revenue Code	250
Rate for Payer: Cash Price	$112.50

APTT

Facility

$126.00

Service Code	CPT 85730
Hospital Charge Code	2216193
Hospital Revenue Code	305
Rate for Payer: Cash Price	$113.40

APTT

Facility

$126.00

Service Code	CPT 85730
Hospital Charge Code	2216193
Hospital Revenue Code	305
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$89.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.41
Rate for Payer: Aetna Medicare Advantage	$6.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cigna Commercial HMO & PPO	$6.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.79
Rate for Payer: Home State Health Plan Medicare Advantage	$6.01
Rate for Payer: Humana Commercial	$12.02
Rate for Payer: Humana Medicare Advantage	$6.01
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

AQUACEL AG EXTRA 4 X 5 #420677

Facility

$51.00

Hospital Charge Code	28403764
Hospital Revenue Code	272
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$36.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$36.41
Rate for Payer: Cash Price	$45.90
Rate for Payer: UnitedHealthcare Commercial	$34.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.36

AQUACEL AG EXTRA 4 X 5 #420677

Facility

$51.00

Hospital Charge Code	28403764
Hospital Revenue Code	272
Rate for Payer: Cash Price	$45.90

AQUACEL AG SURGICAL 3 1/2 X 4

Facility

$138.00

Hospital Charge Code	28412009
Hospital Revenue Code	271
Min. Negotiated Rate	$49.68
Max. Negotiated Rate	$98.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$81.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$98.53
Rate for Payer: Cash Price	$124.20
Rate for Payer: UnitedHealthcare Commercial	$92.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$49.68

AQUACEL AG SURGICAL 3 1/2 X 4

Facility

$138.00

Hospital Charge Code	28412009
Hospital Revenue Code	271
Rate for Payer: Cash Price	$124.20

AQUACEL AG SURGICAL 3.5X10

Facility

$182.00

Hospital Charge Code	28412011
Hospital Revenue Code	272
Rate for Payer: Cash Price	$163.80

AQUACEL AG SURGICAL 3.5X10

Facility

$182.00

Hospital Charge Code	28412011
Hospital Revenue Code	272
Min. Negotiated Rate	$65.52
Max. Negotiated Rate	$129.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$107.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$129.95
Rate for Payer: Cash Price	$163.80
Rate for Payer: UnitedHealthcare Commercial	$121.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.52

AQUACEL EXTRA #420674

Facility

$80.00

Hospital Charge Code	28403765
Hospital Revenue Code	271
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$57.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: UnitedHealthcare Commercial	$53.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.80

AQUACEL EXTRA #420674

Facility

$80.00

Hospital Charge Code	28403765
Hospital Revenue Code	271
Rate for Payer: Cash Price	$72.00

ARIPIPRAZOLE

Facility

$389.00

Service Code	CPT 80299
Hospital Charge Code	2215922
Hospital Revenue Code	301
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$277.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.78
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$230.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$277.75
Rate for Payer: Cash Price	$350.10
Rate for Payer: Cash Price	$350.10
Rate for Payer: Cash Price	$350.10
Rate for Payer: Cigna Commercial HMO & PPO	$18.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.95
Rate for Payer: Home State Health Plan Medicare Advantage	$18.64
Rate for Payer: Humana Commercial	$37.28
Rate for Payer: Humana Medicare Advantage	$18.64
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$140.04

ARIPIPRAZOLE

Facility

$389.00

Service Code	CPT 80299
Hospital Charge Code	2215922
Hospital Revenue Code	301
Rate for Payer: Cash Price	$350.10

ARIPIPRAZOLE 10MG TAB EMP

Facility

$101.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2625622
Hospital Revenue Code	250
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

ARIPIPRAZOLE 10MG TAB EMP

Facility

$101.00

Service Code	NDC 3.1722E+10
Hospital Charge Code	2621815
Hospital Revenue Code	250
Rate for Payer: Cash Price	$90.90

ARIPIPRAZOLE 10MG TAB EMP

Facility

$101.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2625623
Hospital Revenue Code	250
Rate for Payer: Cash Price	$90.90

ARIPIPRAZOLE 10MG TAB EMP

Facility

$101.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2625622
Hospital Revenue Code	250
Rate for Payer: Cash Price	$90.90

ARIPIPRAZOLE 10MG TAB EMP

Facility

$101.00

Service Code	NDC 3.1722E+10
Hospital Charge Code	2621815
Hospital Revenue Code	250
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

ARIPIPRAZOLE 10MG TAB EMP

Facility

$101.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2625623
Hospital Revenue Code	250
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

ARIPIPRAZOLE 15MG TAB EMP

Facility

$101.00

Service Code	NDC 1.3668E+10
Hospital Charge Code	2626198
Hospital Revenue Code	250
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

Know your out-of-pocket cost for care.

All Charges