Madison Medical Center

All Charges

Charge

Type

Setting

Price

BACLOFEN 20MG TAB EMP

Facility

$20.00

Service Code	NDC 603240621
Hospital Charge Code	2625133
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

BACLOFEN 20MG TAB EMP

Facility

$20.00

Service Code	NDC 603240621
Hospital Charge Code	2625133
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

BACLOFEN (LIORRESAL) 10MG TAB UD

Facility

$20.00

Service Code	NDC 904647561
Hospital Charge Code	2626382
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

BACLOFEN (LIORRESAL) 10MG TAB UD

Facility

$20.00

Service Code	NDC 904647561
Hospital Charge Code	2626382
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$46,613.58

Service Code	APR-DRG 0494
Min. Negotiated Rate	$46,613.58
Max. Negotiated Rate	$46,613.58
Rate for Payer: Aetna Better Health Medicaid/QHP	$46,613.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46,613.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$46,613.58
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46,613.58

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$18,085.65

Service Code	APR-DRG 0492
Min. Negotiated Rate	$18,085.65
Max. Negotiated Rate	$18,085.65
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,085.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,085.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,085.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,085.65

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$14,495.89

Service Code	APR-DRG 0491
Min. Negotiated Rate	$14,495.89
Max. Negotiated Rate	$14,495.89
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,495.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,495.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,495.89
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,495.89

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM

Facility

$27,015.24

Service Code	APR-DRG 0493
Min. Negotiated Rate	$27,015.24
Max. Negotiated Rate	$27,015.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,015.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,015.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,015.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,015.24

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC

Facility

$44,130.18

Service Code	MSDRG 095
Min. Negotiated Rate	$22,065.09
Max. Negotiated Rate	$44,130.18
Rate for Payer: Aetna Medicare Advantage	$22,065.09
Rate for Payer: Cigna Commercial HMO & PPO	$22,065.09
Rate for Payer: Home State Health Plan Medicare Advantage	$22,065.09
Rate for Payer: Humana Commercial	$44,130.18
Rate for Payer: Humana Medicare Advantage	$22,065.09

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC

Facility

$59,012.92

Service Code	MSDRG 094
Min. Negotiated Rate	$29,506.46
Max. Negotiated Rate	$59,012.92
Rate for Payer: Aetna Medicare Advantage	$29,506.46
Rate for Payer: Cigna Commercial HMO & PPO	$29,506.46
Rate for Payer: Home State Health Plan Medicare Advantage	$29,506.46
Rate for Payer: Humana Commercial	$59,012.92
Rate for Payer: Humana Medicare Advantage	$29,506.46

BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC

Facility

$44,130.18

Service Code	MSDRG 096
Min. Negotiated Rate	$22,065.09
Max. Negotiated Rate	$44,130.18
Rate for Payer: Aetna Medicare Advantage	$22,065.09
Rate for Payer: Cigna Commercial HMO & PPO	$22,065.09
Rate for Payer: Home State Health Plan Medicare Advantage	$22,065.09
Rate for Payer: Humana Commercial	$44,130.18
Rate for Payer: Humana Medicare Advantage	$22,065.09

BACTERIAL VAGINOSIS, NAA (ORANGE APTIMA)

Facility

$477.00

Hospital Charge Code	2287000
Hospital Revenue Code	306
Rate for Payer: Cash Price	$429.30

BACTERIAL VAGINOSIS, NAA (ORANGE APTIMA)

Facility

$477.00

Hospital Charge Code	2287000
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$340.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$282.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$340.58
Rate for Payer: Cash Price	$429.30
Rate for Payer: Cash Price	$429.30
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$171.72

BACTERIOSTATIC SOD CHL FLUSH 10ML VIAL

Facility

$55.00

Service Code	HCPCS A4216
Hospital Charge Code	2609362
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

BACTERIOSTATIC SOD CHL FLUSH 10ML VIAL

Facility

$55.00

Service Code	HCPCS A4216
Hospital Charge Code	2609362
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

BACT VIR RESP FILTER

Facility

$2.00

Hospital Charge Code	4500999
Hospital Revenue Code	271
Min. Negotiated Rate	$0.72
Max. Negotiated Rate	$1.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1.43
Rate for Payer: Cash Price	$1.80
Rate for Payer: UnitedHealthcare Commercial	$1.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$0.72

BACT VIR RESP FILTER

Facility

$2.00

Hospital Charge Code	4500999
Hospital Revenue Code	271
Rate for Payer: Cash Price	$1.80

BAG, FECAL COLLECTION

Facility

$65.00

Hospital Charge Code	282021
Hospital Revenue Code	271
Rate for Payer: Cash Price	$58.50

BAG, FECAL COLLECTION

Facility

$65.00

Hospital Charge Code	282021
Hospital Revenue Code	271
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

BAG,PRESSURE INFUSER 1000ML

Facility

$51.00

Hospital Charge Code	285838
Hospital Revenue Code	270
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

BAG,PRESSURE INFUSER 1000ML

Facility

$51.00

Hospital Charge Code	285838
Hospital Revenue Code	270
Rate for Payer: Cash Price	$45.90

BAIR HUGGER BLANKETS UPPER BODY

Facility

$47.00

Hospital Charge Code	80000031
Hospital Revenue Code	271
Min. Negotiated Rate	$16.92
Max. Negotiated Rate	$33.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$27.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$33.56
Rate for Payer: Cash Price	$42.30
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.92

BAIR HUGGER BLANKETS UPPER BODY

Facility

$47.00

Hospital Charge Code	80000031
Hospital Revenue Code	271
Rate for Payer: Cash Price	$42.30

BAIR HUGGER(WARMING UNIT)

Facility

$244.00

Hospital Charge Code	122246
Hospital Revenue Code	271
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

BAIR HUGGER(WARMING UNIT)

Facility

$244.00

Hospital Charge Code	122246
Hospital Revenue Code	271
Rate for Payer: Cash Price	$219.60

Know your out-of-pocket cost for care.

All Charges