Madison Medical Center

All Charges

Charge

Type

Setting

Price

CD4 COUNT

Facility

$211.00

Service Code	CPT 86361
Hospital Charge Code	2286362
Hospital Revenue Code	301
Rate for Payer: Cash Price	$189.90

CD4 COUNT (SEND TO AEL)

Facility

$231.00

Service Code	CPT 86361
Hospital Charge Code	2286363
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$164.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$24.10
Rate for Payer: Aetna Medicare Advantage	$26.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$136.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$164.93
Rate for Payer: Cash Price	$207.90
Rate for Payer: Cash Price	$207.90
Rate for Payer: Cash Price	$207.90
Rate for Payer: Cigna Commercial HMO & PPO	$26.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25.79
Rate for Payer: Home State Health Plan Medicare Advantage	$26.78
Rate for Payer: Humana Commercial	$53.56
Rate for Payer: Humana Medicare Advantage	$26.78
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$83.16

CD4 COUNT (SEND TO AEL)

Facility

$231.00

Service Code	CPT 86361
Hospital Charge Code	2286363
Hospital Revenue Code	301
Rate for Payer: Cash Price	$207.90

CD57

Facility

$102.00

Service Code	CPT 88184
Hospital Charge Code	2223106
Hospital Revenue Code	305
Rate for Payer: Cash Price	$91.80

CD57

Facility

$102.00

Service Code	CPT 88184
Hospital Charge Code	2223106
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$732.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$323.12
Rate for Payer: Aetna Medicare Advantage	$366.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$60.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.83
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna Commercial HMO & PPO	$366.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$323.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$345.74
Rate for Payer: Home State Health Plan Medicare Advantage	$366.21
Rate for Payer: Humana Commercial	$732.42
Rate for Payer: Humana Medicare Advantage	$366.21
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$323.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.72

C D CATH SET

Facility

$244.00

Hospital Charge Code	1219016
Hospital Revenue Code	761
Rate for Payer: Cash Price	$219.60

C D CATH SET

Facility

$244.00

Hospital Charge Code	1219016
Hospital Revenue Code	761
Min. Negotiated Rate	$87.84
Max. Negotiated Rate	$174.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$144.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.22
Rate for Payer: Cash Price	$219.60
Rate for Payer: UnitedHealthcare Commercial	$162.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$87.84

C D DRNG CATH

Facility

$234.00

Hospital Charge Code	1219018
Hospital Revenue Code	761
Rate for Payer: Cash Price	$210.60

C D DRNG CATH

Facility

$234.00

Hospital Charge Code	1219018
Hospital Revenue Code	761
Min. Negotiated Rate	$84.24
Max. Negotiated Rate	$167.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$138.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.08
Rate for Payer: Cash Price	$210.60
Rate for Payer: UnitedHealthcare Commercial	$156.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.24

CDIFF

Facility

$217.00

Service Code	CPT 87324
Hospital Charge Code	2212008
Hospital Revenue Code	306
Rate for Payer: Cash Price	$195.30

CDIFF

Facility

$217.00

Service Code	CPT 87324
Hospital Charge Code	3012007
Hospital Revenue Code	306
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$154.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.78
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$128.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$154.94
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cigna Commercial HMO & PPO	$11.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.53
Rate for Payer: Home State Health Plan Medicare Advantage	$11.98
Rate for Payer: Humana Commercial	$23.96
Rate for Payer: Humana Medicare Advantage	$11.98
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$78.12

CDIFF

Facility

$217.00

Service Code	CPT 87324
Hospital Charge Code	3012007
Hospital Revenue Code	306
Rate for Payer: Cash Price	$195.30

CDIFF

Facility

$217.00

Service Code	CPT 87324
Hospital Charge Code	2212008
Hospital Revenue Code	306
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$154.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.78
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$128.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$154.94
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cigna Commercial HMO & PPO	$11.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.53
Rate for Payer: Home State Health Plan Medicare Advantage	$11.98
Rate for Payer: Humana Commercial	$23.96
Rate for Payer: Humana Medicare Advantage	$11.98
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$78.12

CDIFF LABCORP

Facility

$67.00

Service Code	CPT 87324
Hospital Charge Code	308016
Hospital Revenue Code	306
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$47.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.78
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cigna Commercial HMO & PPO	$11.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.53
Rate for Payer: Home State Health Plan Medicare Advantage	$11.98
Rate for Payer: Humana Commercial	$23.96
Rate for Payer: Humana Medicare Advantage	$11.98
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

CDIFF LABCORP

Facility

$67.00

Service Code	CPT 87324
Hospital Charge Code	308016
Hospital Revenue Code	306
Rate for Payer: Cash Price	$60.30

CEA

Facility

$168.00

Service Code	CPT 82378
Hospital Charge Code	223502
Hospital Revenue Code	301
Rate for Payer: Cash Price	$151.20

CEA

Facility

$168.00

Service Code	CPT 82378
Hospital Charge Code	223502
Hospital Revenue Code	301
Min. Negotiated Rate	$17.06
Max. Negotiated Rate	$119.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$17.06
Rate for Payer: Aetna Medicare Advantage	$18.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$99.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$119.95
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cigna Commercial HMO & PPO	$18.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18.25
Rate for Payer: Home State Health Plan Medicare Advantage	$18.96
Rate for Payer: Humana Commercial	$37.92
Rate for Payer: Humana Medicare Advantage	$18.96
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.48

CEFADROXIL (DURICEF) 500MG CAP

Facility

$32.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2697172
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

CEFADROXIL (DURICEF) 500MG CAP

Facility

$32.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2697172
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

CEFAZOLIN (ANCEF) 1GM INJ

Facility

$75.00

Service Code	HCPCS J0690
Hospital Charge Code	2654470
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

CEFAZOLIN (ANCEF) 1GM INJ

Facility

$75.00

Service Code	HCPCS J0690
Hospital Charge Code	2654470
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

CEFAZOLIN (ANCEF) 2GM KIT IVPB

Facility

$703.00

Service Code	HCPCS J0690
Hospital Charge Code	2626937
Hospital Revenue Code	250
Rate for Payer: Cash Price	$632.70

CEFAZOLIN (ANCEF) 2GM KIT IVPB

Facility

$703.00

Service Code	HCPCS J0690
Hospital Charge Code	2626937
Hospital Revenue Code	250
Min. Negotiated Rate	$253.08
Max. Negotiated Rate	$501.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$416.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$501.94
Rate for Payer: Cash Price	$632.70
Rate for Payer: UnitedHealthcare Commercial	$468.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$253.08

CEFAZOLIN (ANCEF) 350MG IVPB

Facility

$75.00

Service Code	HCPCS J0690
Hospital Charge Code	2622337
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

CEFAZOLIN (ANCEF) 350MG IVPB

Facility

$75.00

Service Code	HCPCS J0690
Hospital Charge Code	2622337
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

Know your out-of-pocket cost for care.

All Charges