Madison Medical Center

All Charges

Charge

Type

Setting

Price

SED RATE (LABCORP)

Facility

$101.00

Service Code	CPT 85652
Hospital Charge Code	22191515
Hospital Revenue Code	305
Rate for Payer: Cash Price	$90.90

SEIZURE

Facility

$5,555.43

Service Code	APR-DRG 0532
Min. Negotiated Rate	$5,555.43
Max. Negotiated Rate	$5,555.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,555.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,555.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,555.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,555.43

SEIZURE

Facility

$9,526.24

Service Code	APR-DRG 0533
Min. Negotiated Rate	$9,526.24
Max. Negotiated Rate	$9,526.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,526.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,526.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,526.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,526.24

SEIZURE

Facility

$29,410.80

Service Code	APR-DRG 0534
Min. Negotiated Rate	$29,410.80
Max. Negotiated Rate	$29,410.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,410.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,410.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,410.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,410.80

SEIZURE

Facility

$4,226.90

Service Code	APR-DRG 0531
Min. Negotiated Rate	$4,226.90
Max. Negotiated Rate	$4,226.90
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,226.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,226.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,226.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,226.90

SEIZURES WITH MCC

Facility

$34,003.78

Service Code	MSDRG 100
Min. Negotiated Rate	$17,001.89
Max. Negotiated Rate	$34,003.78
Rate for Payer: Aetna Medicare Advantage	$17,001.89
Rate for Payer: Cigna Commercial HMO & PPO	$17,001.89
Rate for Payer: Home State Health Plan Medicare Advantage	$17,001.89
Rate for Payer: Humana Commercial	$34,003.78
Rate for Payer: Humana Medicare Advantage	$17,001.89

SEIZURES WITHOUT MCC

Facility

$17,769.66

Service Code	MSDRG 101
Min. Negotiated Rate	$8,884.83
Max. Negotiated Rate	$17,769.66
Rate for Payer: Aetna Medicare Advantage	$8,884.83
Rate for Payer: Cigna Commercial HMO & PPO	$8,884.83
Rate for Payer: Home State Health Plan Medicare Advantage	$8,884.83
Rate for Payer: Humana Commercial	$17,769.66
Rate for Payer: Humana Medicare Advantage	$8,884.83

SELENIUM

Facility

$126.00

Service Code	CPT 84255
Hospital Charge Code	2284255
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$89.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$22.98
Rate for Payer: Aetna Medicare Advantage	$25.53
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	$25.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24.59
Rate for Payer: Home State Health Plan Medicare Advantage	$25.53
Rate for Payer: Humana Commercial	$51.06
Rate for Payer: Humana Medicare Advantage	$25.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

SELENIUM

Facility

$126.00

Service Code	CPT 84255
Hospital Charge Code	2284255
Hospital Revenue Code	301
Rate for Payer: Cash Price	$113.40

SELENIUM SULFIDE SHAMPOO 1% 7OZ

Facility

$51.00

Service Code	NDC 74660302
Hospital Charge Code	2698196
Hospital Revenue Code	250
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

SELENIUM SULFIDE SHAMPOO 1% 7OZ

Facility

$51.00

Service Code	NDC 74660302
Hospital Charge Code	2698196
Hospital Revenue Code	250
Rate for Payer: Cash Price	$45.90

SELLA TURSICA TOMO

Facility

$270.00

Service Code	CPT 70240
Hospital Charge Code	3219100
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$192.78
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$159.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$192.78
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.20

SELLA TURSICA TOMO

Facility

$270.00

Service Code	CPT 70240
Hospital Charge Code	3219100
Hospital Revenue Code	320
Rate for Payer: Cash Price	$243.00

SENNA/DOCUSATE (SENOKOT-S) TAB

Facility

$18.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2656167
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

SENNA/DOCUSATE (SENOKOT-S) TAB

Facility

$18.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2656167
Hospital Revenue Code	250
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

SENNA (SENOKOT) 8.6MG TAB

Facility

$18.00

Service Code	NDC 5.7896E+10
Hospital Charge Code	2656165
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

SENNA (SENOKOT) 8.6MG TAB

Facility

$18.00

Service Code	NDC 5.7896E+10
Hospital Charge Code	2656165
Hospital Revenue Code	250
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

SENSICARE GLOVE SIZE 6

Facility

$13.00

Hospital Charge Code	287276
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

SENSICARE GLOVE SIZE 6

Facility

$13.00

Hospital Charge Code	287276
Hospital Revenue Code	271
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

SENSICARE GLOVE SIZE 7

Facility

$13.00

Hospital Charge Code	287277
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

SENSICARE GLOVE SIZE 7

Facility

$13.00

Hospital Charge Code	287277
Hospital Revenue Code	271
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

SENSICARE GLOVE SIZE 8

Facility

$13.00

Hospital Charge Code	287278
Hospital Revenue Code	271
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

SENSICARE GLOVE SIZE 8

Facility

$13.00

Hospital Charge Code	287278
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

SENSICARE GLOVE SZ 7-1/2

Facility

$13.00

Hospital Charge Code	287385
Hospital Revenue Code	271
Rate for Payer: Cash Price	$11.70

SENSICARE GLOVE SZ 7-1/2

Facility

$13.00

Hospital Charge Code	287385
Hospital Revenue Code	271
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

Know your out-of-pocket cost for care.

All Charges