Madison Medical Center

All Charges

Charge

Type

Setting

Price

BEDPAN

Facility

$62.00

Hospital Charge Code	282019
Hospital Revenue Code	271
Rate for Payer: Cash Price	$55.80

BEDPAN

Facility

$62.00

Hospital Charge Code	282019
Hospital Revenue Code	271
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$44.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: UnitedHealthcare Commercial	$41.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

BEDPAN FRACTURE #H10210

Facility

$42.00

Hospital Charge Code	282020
Hospital Revenue Code	271
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

BEDPAN FRACTURE #H10210

Facility

$42.00

Hospital Charge Code	282020
Hospital Revenue Code	271
Rate for Payer: Cash Price	$37.80

BEHAVIORAL AND DEVELOPMENTAL DISORDERS

Facility

$36,185.68

Service Code	MSDRG 886
Min. Negotiated Rate	$18,092.84
Max. Negotiated Rate	$36,185.68
Rate for Payer: Aetna Medicare Advantage	$18,092.84
Rate for Payer: Cigna Commercial HMO & PPO	$18,092.84
Rate for Payer: Home State Health Plan Medicare Advantage	$18,092.84
Rate for Payer: Humana Commercial	$36,185.68
Rate for Payer: Humana Medicare Advantage	$18,092.84

BELIMUMAB (BENLYSTA) 400MG VIAL

Facility

$9,270.00

Service Code	NDC 1E+11
Hospital Charge Code	2627267
Hospital Revenue Code	250
Min. Negotiated Rate	$3,337.20
Max. Negotiated Rate	$6,618.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5,487.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$6,618.78
Rate for Payer: Cash Price	$8,343.00
Rate for Payer: UnitedHealthcare Commercial	$6,183.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$3,337.20

BELIMUMAB (BENLYSTA) 400MG VIAL

Facility

$9,270.00

Service Code	NDC 1E+11
Hospital Charge Code	2627267
Hospital Revenue Code	250
Rate for Payer: Cash Price	$8,343.00

BELT OSTOMY

Facility

$45.00

Hospital Charge Code	282156
Hospital Revenue Code	271
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

BELT OSTOMY

Facility

$45.00

Hospital Charge Code	282156
Hospital Revenue Code	271
Rate for Payer: Cash Price	$40.50

BELT, PELV-TRACT

Facility

$223.00

Hospital Charge Code	282247
Hospital Revenue Code	271
Rate for Payer: Cash Price	$200.70

BELT, PELV-TRACT

Facility

$223.00

Hospital Charge Code	282247
Hospital Revenue Code	271
Min. Negotiated Rate	$80.28
Max. Negotiated Rate	$159.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$132.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$159.22
Rate for Payer: Cash Price	$200.70
Rate for Payer: UnitedHealthcare Commercial	$148.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$80.28

BENAZEPRIL (LOTENSIN) 20MG TAB

Facility

$18.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2626281
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

BENAZEPRIL (LOTENSIN) 20MG TAB

Facility

$18.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2626281
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

BENAZEPRIL (LOTENSIN) 5MG TAB

Facility

$15.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2697906
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

BENAZEPRIL (LOTENSIN) 5MG TAB

Facility

$15.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2697906
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

BENIGN PROSTATIC HYPERTROPHY WITH MCC

Facility

$21,957.38

Service Code	MSDRG 725
Min. Negotiated Rate	$10,978.69
Max. Negotiated Rate	$21,957.38
Rate for Payer: Aetna Medicare Advantage	$10,978.69
Rate for Payer: Cigna Commercial HMO & PPO	$10,978.69
Rate for Payer: Home State Health Plan Medicare Advantage	$10,978.69
Rate for Payer: Humana Commercial	$21,957.38
Rate for Payer: Humana Medicare Advantage	$10,978.69

BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC

Facility

$14,944.38

Service Code	MSDRG 726
Min. Negotiated Rate	$7,472.19
Max. Negotiated Rate	$14,944.38
Rate for Payer: Aetna Medicare Advantage	$7,472.19
Rate for Payer: Cigna Commercial HMO & PPO	$7,472.19
Rate for Payer: Home State Health Plan Medicare Advantage	$7,472.19
Rate for Payer: Humana Commercial	$14,944.38
Rate for Payer: Humana Medicare Advantage	$7,472.19

BENTYL 20MG/2ML INJ

Facility

$128.00

Service Code	NDC 5.8914E+10
Hospital Charge Code	2697044
Hospital Revenue Code	250
Rate for Payer: Cash Price	$115.20

BENTYL 20MG/2ML INJ

Facility

$128.00

Service Code	NDC 5.8914E+10
Hospital Charge Code	2697044
Hospital Revenue Code	250
Min. Negotiated Rate	$46.08
Max. Negotiated Rate	$91.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$91.39
Rate for Payer: Cash Price	$115.20
Rate for Payer: UnitedHealthcare Commercial	$85.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.08

BENZ GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9582962
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

BENZ GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9582962
Hospital Revenue Code	301
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$21.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.95
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$3.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.16
Rate for Payer: Home State Health Plan Medicare Advantage	$3.28
Rate for Payer: Humana Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.28
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

BENZ KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9587210
Hospital Revenue Code	301
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.24
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$5.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.61
Rate for Payer: Home State Health Plan Medicare Advantage	$5.82
Rate for Payer: Humana Commercial	$11.64
Rate for Payer: Humana Medicare Advantage	$5.82
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

BENZ KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9587210
Hospital Revenue Code	301
Rate for Payer: Cash Price	$36.00

BENZOCAINE/MENTHOL LOZ (1 BOX) 16 LOZ

Facility

$21.00

Service Code	NDC 6.3824E+10
Hospital Charge Code	2619723
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

BENZOCAINE/MENTHOL LOZ (1 BOX) 16 LOZ

Facility

$21.00

Service Code	NDC 6.3824E+10
Hospital Charge Code	2619723
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

Know your out-of-pocket cost for care.

All Charges