Madison Medical Center

All Charges

Charge

Type

Setting

Price

CANNULA NASAL ADULT

Facility

$273.00

Hospital Charge Code	1299113
Hospital Revenue Code	271
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$194.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$161.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$194.92
Rate for Payer: Cash Price	$245.70
Rate for Payer: UnitedHealthcare Commercial	$182.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$98.28

CANNULA, NASAL CO2 SAMPLING

Facility

$34.00

Hospital Charge Code	2824487
Hospital Revenue Code	271
Rate for Payer: Cash Price	$30.60

CANNULA, NASAL CO2 SAMPLING

Facility

$34.00

Hospital Charge Code	2824487
Hospital Revenue Code	271
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$24.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.28
Rate for Payer: Cash Price	$30.60
Rate for Payer: UnitedHealthcare Commercial	$22.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.24

CANNULA RFK,10CM 20GA

Facility

$80.00

Hospital Charge Code	2824481
Hospital Revenue Code	270
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

CANNULA RFK,10CM 20GA

Facility

$80.00

Hospital Charge Code	2824481
Hospital Revenue Code	270
Rate for Payer: Cash Price	$72.00

CANNULA SHILEY

Facility

$62.00

Hospital Charge Code	283002
Hospital Revenue Code	271
Rate for Payer: Cash Price	$55.80

CANNULA SHILEY

Facility

$62.00

Hospital Charge Code	283002
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

CANNULATED DRILL

Facility

$1,098.00

Hospital Charge Code	123310
Hospital Revenue Code	271
Min. Negotiated Rate	$395.28
Max. Negotiated Rate	$783.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$650.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$783.97
Rate for Payer: Cash Price	$988.20
Rate for Payer: UnitedHealthcare Commercial	$732.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$395.28

CANNULATED DRILL

Facility

$1,098.00

Hospital Charge Code	123310
Hospital Revenue Code	271
Rate for Payer: Cash Price	$988.20

CANNULATED DRILL BIT 2.7MM AO FITTING

Facility

$829.00

Hospital Charge Code	123418
Hospital Revenue Code	271
Min. Negotiated Rate	$298.44
Max. Negotiated Rate	$591.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$490.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$591.91
Rate for Payer: Cash Price	$746.10
Rate for Payer: UnitedHealthcare Commercial	$552.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$298.44

CANNULATED DRILL BIT 2.7MM AO FITTING

Facility

$829.00

Hospital Charge Code	123418
Hospital Revenue Code	271
Rate for Payer: Cash Price	$746.10

CAPTOPRIL 25MG TAB EMP

Facility

$10.00

Service Code	NDC 904504661
Hospital Charge Code	2622848
Hospital Revenue Code	250
Rate for Payer: Cash Price	$9.00

CAPTOPRIL 25MG TAB EMP

Facility

$10.00

Service Code	NDC 904504661
Hospital Charge Code	2622848
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$7.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.14
Rate for Payer: Cash Price	$9.00
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

CAPTOPRIL (CAPOTEN) 12.5MG TAB

Facility

$22.00

Service Code	NDC 781805201
Hospital Charge Code	2654378
Hospital Revenue Code	250
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

CAPTOPRIL (CAPOTEN) 12.5MG TAB

Facility

$22.00

Service Code	NDC 781805201
Hospital Charge Code	2654378
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

CAPTOPRIL (CAPOTEN) 50MG TAB

Facility

$24.00

Service Code	NDC 3048251
Hospital Charge Code	2654385
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

CAPTOPRIL (CAPOTEN) 50MG TAB

Facility

$24.00

Service Code	NDC 3048251
Hospital Charge Code	2654385
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

CARBAMAZEPINE 100MG TAB

Facility

$13.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2619820
Hospital Revenue Code	250
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

CARBAMAZEPINE 100MG TAB

Facility

$13.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2619820
Hospital Revenue Code	250
Rate for Payer: Cash Price	$11.70

CARBAMAZEPINE (TEGRETOL) 200MG TAB

Facility

$21.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2657129
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

CARBAMAZEPINE (TEGRETOL) 200MG TAB

Facility

$21.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2657129
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

CARBAMAZ (TEGRETOL) 100MG/5ML SUSP

Facility

$20.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2626272
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

CARBAMAZ (TEGRETOL) 100MG/5ML SUSP

Facility

$20.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2626272
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

CARBAMIDE PEROX (DEBROX) 15ML EAR DRP

Facility

$89.00

Service Code	NDC 904662735
Hospital Charge Code	2655114
Hospital Revenue Code	250
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$63.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: UnitedHealthcare Commercial	$59.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

CARBAMIDE PEROX (DEBROX) 15ML EAR DRP

Facility

$89.00

Service Code	NDC 904662735
Hospital Charge Code	2655114
Hospital Revenue Code	250
Rate for Payer: Cash Price	$80.10

Know your out-of-pocket cost for care.

All Charges