Madison Medical Center

All Charges

Charge

Type

Setting

Price

C ARM FLUORO LESS THAN 1 HR

Facility

$431.00

Service Code	CPT 77002
Hospital Charge Code	3277002
Hospital Revenue Code	360
Min. Negotiated Rate	$155.16
Max. Negotiated Rate	$287.48
Rate for Payer: Cash Price	$387.90
Rate for Payer: UnitedHealthcare Commercial	$287.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$155.16

C ARM SPINE FLUORO LESS THAN 1 HR

Facility

$431.00

Service Code	CPT 77003
Hospital Charge Code	3277003
Hospital Revenue Code	360
Min. Negotiated Rate	$155.16
Max. Negotiated Rate	$287.48
Rate for Payer: Cash Price	$387.90
Rate for Payer: UnitedHealthcare Commercial	$287.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$155.16

C ARM SPINE FLUORO LESS THAN 1 HR

Facility

$431.00

Service Code	CPT 77003
Hospital Charge Code	3277003
Hospital Revenue Code	360
Rate for Payer: Cash Price	$387.90

CARNITINE FREE AND TOTAL

Facility

$135.00

Service Code	CPT 82379
Hospital Charge Code	2282379
Hospital Revenue Code	301
Rate for Payer: Cash Price	$121.50

CARNITINE FREE AND TOTAL

Facility

$135.00

Service Code	CPT 82379
Hospital Charge Code	2282379
Hospital Revenue Code	301
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$96.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.18
Rate for Payer: Aetna Medicare Advantage	$16.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$16.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.24
Rate for Payer: Home State Health Plan Medicare Advantage	$16.87
Rate for Payer: Humana Commercial	$33.74
Rate for Payer: Humana Medicare Advantage	$16.87
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$48.60

CAROTID ARTERY STENT PROCEDURES WITH CC

Facility

$41,151.28

Service Code	MSDRG 035
Min. Negotiated Rate	$20,575.64
Max. Negotiated Rate	$41,151.28
Rate for Payer: Aetna Medicare Advantage	$20,575.64
Rate for Payer: Cigna Commercial HMO & PPO	$20,575.64
Rate for Payer: Home State Health Plan Medicare Advantage	$20,575.64
Rate for Payer: Humana Commercial	$41,151.28
Rate for Payer: Humana Medicare Advantage	$20,575.64

CAROTID ARTERY STENT PROCEDURES WITH MCC

Facility

$64,584.74

Service Code	MSDRG 034
Min. Negotiated Rate	$32,292.37
Max. Negotiated Rate	$64,584.74
Rate for Payer: Aetna Medicare Advantage	$32,292.37
Rate for Payer: Cigna Commercial HMO & PPO	$32,292.37
Rate for Payer: Home State Health Plan Medicare Advantage	$32,292.37
Rate for Payer: Humana Commercial	$64,584.74
Rate for Payer: Humana Medicare Advantage	$32,292.37

CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC

Facility

$34,098.30

Service Code	MSDRG 036
Min. Negotiated Rate	$17,049.15
Max. Negotiated Rate	$34,098.30
Rate for Payer: Aetna Medicare Advantage	$17,049.15
Rate for Payer: Cigna Commercial HMO & PPO	$17,049.15
Rate for Payer: Home State Health Plan Medicare Advantage	$17,049.15
Rate for Payer: Humana Commercial	$34,098.30
Rate for Payer: Humana Medicare Advantage	$17,049.15

CARRINGTON GEL

Facility

$106.00

Hospital Charge Code	283009
Hospital Revenue Code	271
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: UnitedHealthcare Commercial	$70.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

CARRINGTON GEL

Facility

$106.00

Hospital Charge Code	283009
Hospital Revenue Code	271
Rate for Payer: Cash Price	$95.40

CARRINGTON SPRAY

Facility

$106.00

Hospital Charge Code	283007
Hospital Revenue Code	271
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$75.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: UnitedHealthcare Commercial	$70.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

CARRINGTON SPRAY

Facility

$106.00

Hospital Charge Code	283007
Hospital Revenue Code	271
Rate for Payer: Cash Price	$95.40

CARVEDILOL 12.5MG TAB EMP

Facility

$24.00

Service Code	NDC 93729501
Hospital Charge Code	2618996
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

CARVEDILOL 12.5MG TAB EMP

Facility

$24.00

Service Code	NDC 93729501
Hospital Charge Code	2618996
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

CARVEDILOL 25MG TAB EMP

Facility

$24.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2620903
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

CARVEDILOL 25MG TAB EMP

Facility

$24.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2620903
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

CARVEDILOL 3.125MG TAB EMP

Facility

$7.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2621734
Hospital Revenue Code	250
Rate for Payer: Cash Price	$6.30

CARVEDILOL 3.125MG TAB EMP

Facility

$21.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2619967
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

CARVEDILOL 3.125MG TAB EMP

Facility

$7.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2621734
Hospital Revenue Code	250
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$5.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.00
Rate for Payer: Cash Price	$6.30
Rate for Payer: UnitedHealthcare Commercial	$4.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.52

CARVEDILOL 3.125MG TAB EMP

Facility

$21.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2619967
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

CARVEDILOL (COREG) 12.5MG TAB

Facility

$24.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2626367
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

CARVEDILOL (COREG) 12.5MG TAB

Facility

$24.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2626367
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

CARVEDILOL (COREG) 3.125MG TAB

Facility

$21.00

Service Code	NDC 904630061
Hospital Charge Code	2626365
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

CARVEDILOL (COREG) 3.125MG TAB

Facility

$21.00

Service Code	NDC 904630061
Hospital Charge Code	2626365
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

CARVEDILOL (COREG) 6.25MG TAB

Facility

$22.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626366
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

Know your out-of-pocket cost for care.

All Charges