Madison Medical Center

All Charges

Charge

Type

Setting

Price

CITALOPRAM

Facility

$523.00

Service Code	CPT 80332
Hospital Charge Code	2280300
Hospital Revenue Code	301
Rate for Payer: Cash Price	$470.70

CITALOPRAM

Facility

$523.00

Service Code	CPT 80332
Hospital Charge Code	2280300
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$373.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$309.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$373.42
Rate for Payer: Cash Price	$470.70
Rate for Payer: Cash Price	$470.70
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$188.28

CITALOPRAM 40MG TAB EMP

Facility

$15.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2619421
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

CITALOPRAM 40MG TAB EMP

Facility

$15.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2619421
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

CITALOPRAM (CELEXA) 10MG TAB EMP

Facility

$15.00

Service Code	NDC 4.2806E+10
Hospital Charge Code	2623325
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

CITALOPRAM (CELEXA) 10MG TAB EMP

Facility

$15.00

Service Code	NDC 4.2806E+10
Hospital Charge Code	2623325
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

CITALOPRAM (CELEXA) 20MG TAB

Facility

$28.00

Service Code	NDC 904608561
Hospital Charge Code	2626299
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

CITALOPRAM (CELEXA) 20MG TAB

Facility

$28.00

Service Code	NDC 904608561
Hospital Charge Code	2626299
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

CITALOPRAM (CELEXA) 20MG TAB EMP

Facility

$15.00

Service Code	NDC 1.3668E+10
Hospital Charge Code	2697256
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

CITALOPRAM (CELEXA) 20MG TAB EMP

Facility

$15.00

Service Code	NDC 1.3668E+10
Hospital Charge Code	2697256
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

CITRIC ACID, URINE

Facility

$129.00

Service Code	CPT 82507
Hospital Charge Code	223952
Hospital Revenue Code	301
Rate for Payer: Cash Price	$116.10

CITRIC ACID, URINE

Facility

$129.00

Service Code	CPT 82507
Hospital Charge Code	223952
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$92.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$25.02
Rate for Payer: Aetna Medicare Advantage	$27.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cigna Commercial HMO & PPO	$27.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.77
Rate for Payer: Home State Health Plan Medicare Advantage	$27.80
Rate for Payer: Humana Commercial	$55.60
Rate for Payer: Humana Medicare Advantage	$27.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

CK ISOENZYMES

Facility

$107.00

Service Code	CPT 82552
Hospital Charge Code	2282552
Hospital Revenue Code	301
Rate for Payer: Cash Price	$96.30

CK ISOENZYMES

Facility

$107.00

Service Code	CPT 82552
Hospital Charge Code	2282552
Hospital Revenue Code	301
Min. Negotiated Rate	$12.05
Max. Negotiated Rate	$76.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.05
Rate for Payer: Aetna Medicare Advantage	$13.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cigna Commercial HMO & PPO	$13.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.89
Rate for Payer: Home State Health Plan Medicare Advantage	$13.39
Rate for Payer: Humana Commercial	$26.78
Rate for Payer: Humana Medicare Advantage	$13.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

.CKMB

Facility

$250.00

Service Code	CPT 82553
Hospital Charge Code	223300
Hospital Revenue Code	301
Rate for Payer: Cash Price	$225.00

.CKMB

Facility

$250.00

Service Code	CPT 82553
Hospital Charge Code	223300
Hospital Revenue Code	301
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.40
Rate for Payer: Aetna Medicare Advantage	$11.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial HMO & PPO	$11.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.13
Rate for Payer: Home State Health Plan Medicare Advantage	$11.55
Rate for Payer: Humana Commercial	$23.10
Rate for Payer: Humana Medicare Advantage	$11.55
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.00

CKMB2

Facility

$250.00

Service Code	CPT 82553
Hospital Charge Code	223301
Hospital Revenue Code	301
Rate for Payer: Cash Price	$225.00

CKMB2

Facility

$250.00

Service Code	CPT 82553
Hospital Charge Code	223301
Hospital Revenue Code	301
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.40
Rate for Payer: Aetna Medicare Advantage	$11.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial HMO & PPO	$11.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.13
Rate for Payer: Home State Health Plan Medicare Advantage	$11.55
Rate for Payer: Humana Commercial	$23.10
Rate for Payer: Humana Medicare Advantage	$11.55
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.00

CKMB2(PATHFAST)

Facility

$250.00

Service Code	CPT 82553
Hospital Charge Code	223305
Hospital Revenue Code	301
Rate for Payer: Cash Price	$225.00

CKMB2(PATHFAST)

Facility

$250.00

Service Code	CPT 82553
Hospital Charge Code	223305
Hospital Revenue Code	301
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.40
Rate for Payer: Aetna Medicare Advantage	$11.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial HMO & PPO	$11.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.13
Rate for Payer: Home State Health Plan Medicare Advantage	$11.55
Rate for Payer: Humana Commercial	$23.10
Rate for Payer: Humana Medicare Advantage	$11.55
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.00

CL- ALLEN DEPO ESTRADIOL 5 MG

Facility

$150.00

Service Code	HCPCS J1000
Hospital Charge Code	4401000
Hospital Revenue Code	636
Min. Negotiated Rate	$100.05
Max. Negotiated Rate	$100.05
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05

CL- ALLEN DEPO ESTRADIOL 5 MG

Facility

$150.00

Service Code	HCPCS J1000
Hospital Charge Code	4401000
Hospital Revenue Code	636
Min. Negotiated Rate	$54.00
Max. Negotiated Rate	$107.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.00

CL- ALLEN DEPO MEDROL 1 MG

Facility

$60.00

Service Code	HCPCS J1010
Hospital Charge Code	4401030
Hospital Revenue Code	636
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

CL- ALLEN DEPO MEDROL 1 MG

Facility

$115.00

Service Code	HCPCS J1010
Hospital Charge Code	4401040
Hospital Revenue Code	636
Min. Negotiated Rate	$41.40
Max. Negotiated Rate	$82.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$68.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$82.11
Rate for Payer: Cash Price	$103.50
Rate for Payer: UnitedHealthcare Commercial	$76.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$41.40

CL- ALLEN DEPO MEDROL 1 MG

Facility

$115.00

Service Code	HCPCS J1010
Hospital Charge Code	4401040
Hospital Revenue Code	636
Min. Negotiated Rate	$76.70
Max. Negotiated Rate	$76.70
Rate for Payer: Cash Price	$103.50
Rate for Payer: UnitedHealthcare Commercial	$76.70

Know your out-of-pocket cost for care.

All Charges