Madison Medical Center

All Charges

Charge

Type

Setting

Price

CARBID/LEVOD (SINEMET) 25-100MG TAB

Facility

$21.00

Service Code	NDC 904623761
Hospital Charge Code	2654405
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

CARBID/LEVOD (SINEMET) 25-100MG TAB

Facility

$21.00

Service Code	NDC 904623761
Hospital Charge Code	2654405
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

CARBON DIOXIDE

Facility

$127.00

Service Code	CPT 82374
Hospital Charge Code	223173
Hospital Revenue Code	301
Rate for Payer: Cash Price	$114.30

CARBON DIOXIDE

Facility

$127.00

Service Code	CPT 82374
Hospital Charge Code	223173
Hospital Revenue Code	301
Min. Negotiated Rate	$4.39
Max. Negotiated Rate	$90.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.39
Rate for Payer: Aetna Medicare Advantage	$4.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$90.68
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cigna Commercial HMO & PPO	$4.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicare Advantage	$4.88
Rate for Payer: Humana Commercial	$9.76
Rate for Payer: Humana Medicare Advantage	$4.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

.CARBONIC ANHYDRASE V1 IGA

Facility

$55.00

Service Code	CPT 83520
Hospital Charge Code	22816858
Hospital Revenue Code	302
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.54
Rate for Payer: Aetna Medicare Advantage	$17.27
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: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$17.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.63
Rate for Payer: Home State Health Plan Medicare Advantage	$17.27
Rate for Payer: Humana Commercial	$34.54
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

.CARBONIC ANHYDRASE V1 IGA

Facility

$55.00

Service Code	CPT 83520
Hospital Charge Code	22816858
Hospital Revenue Code	302
Rate for Payer: Cash Price	$49.50

.CARBONIC ANHYDRASE V1 IGG

Facility

$55.00

Service Code	CPT 83520
Hospital Charge Code	22816857
Hospital Revenue Code	302
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.54
Rate for Payer: Aetna Medicare Advantage	$17.27
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: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$17.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.63
Rate for Payer: Home State Health Plan Medicare Advantage	$17.27
Rate for Payer: Humana Commercial	$34.54
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

.CARBONIC ANHYDRASE V1 IGG

Facility

$55.00

Service Code	CPT 83520
Hospital Charge Code	22816857
Hospital Revenue Code	302
Rate for Payer: Cash Price	$49.50

.CARBONIC ANHYDRASE V1 IGM

Facility

$55.00

Service Code	CPT 83520
Hospital Charge Code	22816859
Hospital Revenue Code	302
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.54
Rate for Payer: Aetna Medicare Advantage	$17.27
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: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$17.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.63
Rate for Payer: Home State Health Plan Medicare Advantage	$17.27
Rate for Payer: Humana Commercial	$34.54
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

.CARBONIC ANHYDRASE V1 IGM

Facility

$55.00

Service Code	CPT 83520
Hospital Charge Code	22816859
Hospital Revenue Code	302
Rate for Payer: Cash Price	$49.50

CARBON MONOXIDE

Facility

$112.00

Service Code	CPT 82375
Hospital Charge Code	2227035
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

CARBON MONOXIDE

Facility

$112.00

Service Code	CPT 82375
Hospital Charge Code	2227035
Hospital Revenue Code	301
Min. Negotiated Rate	$11.09
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.09
Rate for Payer: Aetna Medicare Advantage	$12.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$12.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.87
Rate for Payer: Home State Health Plan Medicare Advantage	$12.32
Rate for Payer: Humana Commercial	$24.64
Rate for Payer: Humana Medicare Advantage	$12.32
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

CARBOPLAT (PARAPLAT) 150MG/15ML IVP

Facility

$248.00

Service Code	HCPCS J9045
Hospital Charge Code	2626585
Hospital Revenue Code	335
Rate for Payer: Cash Price	$223.20

CARBOPLAT (PARAPLAT) 150MG/15ML IVP

Facility

$248.00

Service Code	HCPCS J9045
Hospital Charge Code	2626585
Hospital Revenue Code	335
Min. Negotiated Rate	$89.28
Max. Negotiated Rate	$177.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$146.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$177.07
Rate for Payer: Cash Price	$223.20
Rate for Payer: UnitedHealthcare Commercial	$165.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$89.28

CARBOPLAT (PARAPLAT) 450MG/45ML IVP

Facility

$814.00

Service Code	HCPCS J9045
Hospital Charge Code	2626584
Hospital Revenue Code	335
Min. Negotiated Rate	$293.04
Max. Negotiated Rate	$581.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$481.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$581.20
Rate for Payer: Cash Price	$732.60
Rate for Payer: UnitedHealthcare Commercial	$542.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.04

CARBOPLAT (PARAPLAT) 450MG/45ML IVP

Facility

$814.00

Service Code	HCPCS J9045
Hospital Charge Code	2626584
Hospital Revenue Code	335
Rate for Payer: Cash Price	$732.60

CARBOPLAT(PARAPLAT) 600MG/60ML IVPB

Facility

$670.00

Service Code	HCPCS J9045
Hospital Charge Code	2626582
Hospital Revenue Code	335
Rate for Payer: Cash Price	$603.00

CARBOPLAT(PARAPLAT) 600MG/60ML IVPB

Facility

$670.00

Service Code	HCPCS J9045
Hospital Charge Code	2626582
Hospital Revenue Code	335
Min. Negotiated Rate	$241.20
Max. Negotiated Rate	$478.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$396.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$478.38
Rate for Payer: Cash Price	$603.00
Rate for Payer: UnitedHealthcare Commercial	$446.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$241.20

CARDIAC ARREST AND SHOCK

Facility

$4,996.10

Service Code	APR-DRG 1961
Min. Negotiated Rate	$4,996.10
Max. Negotiated Rate	$4,996.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,996.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,996.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,996.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,996.10

CARDIAC ARREST AND SHOCK

Facility

$20,404.13

Service Code	APR-DRG 1964
Min. Negotiated Rate	$20,404.13
Max. Negotiated Rate	$20,404.13
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,404.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,404.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,404.13
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,404.13

CARDIAC ARREST AND SHOCK

Facility

$6,386.58

Service Code	APR-DRG 1962
Min. Negotiated Rate	$6,386.58
Max. Negotiated Rate	$6,386.58
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,386.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,386.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,386.58
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,386.58

CARDIAC ARREST AND SHOCK

Facility

$10,607.93

Service Code	APR-DRG 1963
Min. Negotiated Rate	$10,607.93
Max. Negotiated Rate	$10,607.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,607.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,607.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,607.93
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,607.93

CARDIAC ARREST, UNEXPLAINED WITH CC

Facility

$13,573.50

Service Code	MSDRG 297
Min. Negotiated Rate	$6,786.75
Max. Negotiated Rate	$13,573.50
Rate for Payer: Aetna Medicare Advantage	$6,786.75
Rate for Payer: Cigna Commercial HMO & PPO	$6,786.75
Rate for Payer: Home State Health Plan Medicare Advantage	$6,786.75
Rate for Payer: Humana Commercial	$13,573.50
Rate for Payer: Humana Medicare Advantage	$6,786.75

CARDIAC ARREST, UNEXPLAINED WITH MCC

Facility

$28,097.68

Service Code	MSDRG 296
Min. Negotiated Rate	$14,048.84
Max. Negotiated Rate	$28,097.68
Rate for Payer: Aetna Medicare Advantage	$14,048.84
Rate for Payer: Cigna Commercial HMO & PPO	$14,048.84
Rate for Payer: Home State Health Plan Medicare Advantage	$14,048.84
Rate for Payer: Humana Commercial	$28,097.68
Rate for Payer: Humana Medicare Advantage	$14,048.84

CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC

Facility

$10,820.54

Service Code	MSDRG 298
Min. Negotiated Rate	$5,410.27
Max. Negotiated Rate	$10,820.54
Rate for Payer: Aetna Medicare Advantage	$5,410.27
Rate for Payer: Cigna Commercial HMO & PPO	$5,410.27
Rate for Payer: Home State Health Plan Medicare Advantage	$5,410.27
Rate for Payer: Humana Commercial	$10,820.54
Rate for Payer: Humana Medicare Advantage	$5,410.27

Know your out-of-pocket cost for care.

All Charges