Madison Medical Center

All Charges

Charge

Type

Setting

Price

ACETAMIN/COD (TYL#3) 300/30 TAB C3

Facility

$39.00

Service Code	NDC 406048423
Hospital Charge Code	2654025
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

ACETAMIN/COD (TYL#3) 300/30 TAB C3

Facility

$39.00

Service Code	NDC 406048423
Hospital Charge Code	2654025
Hospital Revenue Code	250
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

ACETAMIN (MAPAP) 80MG CHEWABLE TAB

Facility

$7.00

Service Code	NDC 904525646
Hospital Charge Code	260515
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

ACETAMIN (MAPAP) 80MG CHEWABLE TAB

Facility

$7.00

Service Code	NDC 904525646
Hospital Charge Code	260515
Hospital Revenue Code	250
Rate for Payer: Cash Price	$6.30

ACETAMINOPHEN

Facility

$168.00

Service Code	CPT 80329
Hospital Charge Code	2226999
Hospital Revenue Code	301
Rate for Payer: Cash Price	$151.20

ACETAMINOPHEN

Facility

$168.00

Service Code	CPT 80329
Hospital Charge Code	2226999
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$119.95
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: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.48

ACETAMINOPHEN 500MG TAB

Facility

$9.00

Service Code	NDC 904198340
Hospital Charge Code	2621692
Hospital Revenue Code	250
Rate for Payer: Cash Price	$8.10

ACETAMINOPHEN 500MG TAB

Facility

$9.00

Service Code	NDC 904198340
Hospital Charge Code	2621692
Hospital Revenue Code	250
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$6.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$6.43
Rate for Payer: Cash Price	$8.10
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.24

ACETAMINOPHEN 650MG SUPPOSITORY

Facility

$20.00

Service Code	NDC 1E+11
Hospital Charge Code	2623895
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

ACETAMINOPHEN 650MG SUPPOSITORY

Facility

$20.00

Service Code	NDC 1E+11
Hospital Charge Code	2623895
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

ACETAMINOPHEN 80MG SUPP (FEVER ALL)

Facility

$24.00

Service Code	NDC 472120006
Hospital Charge Code	2697142
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

ACETAMINOPHEN 80MG SUPP (FEVER ALL)

Facility

$24.00

Service Code	NDC 472120006
Hospital Charge Code	2697142
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

ACETAMINOPHEN (TYLENOL) 120MG SUPP

Facility

$20.00

Service Code	NDC 182166211
Hospital Charge Code	2654004
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

ACETAMINOPHEN (TYLENOL) 120MG SUPP

Facility

$20.00

Service Code	NDC 182166211
Hospital Charge Code	2654004
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

ACETAMINOPHEN (TYLENOL) 325MG TAB UD

Facility

$20.00

Service Code	NDC 536322201
Hospital Charge Code	2654015
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

ACETAMINOPHEN (TYLENOL) 325MG TAB UD

Facility

$20.00

Service Code	NDC 536322201
Hospital Charge Code	2654015
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

ACETAMINOPHEN (TYLENOL) 650MG SUPP

Facility

$14.00

Service Code	NDC 713016506
Hospital Charge Code	2654006
Hospital Revenue Code	250
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$10.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.00
Rate for Payer: Cash Price	$12.60
Rate for Payer: UnitedHealthcare Commercial	$9.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04

ACETAMINOPHEN (TYLENOL) 650MG SUPP

Facility

$14.00

Service Code	NDC 713016506
Hospital Charge Code	2654006
Hospital Revenue Code	250
Rate for Payer: Cash Price	$12.60

ACETAMIN(TYLENOL)160MG/5MLSOL/SUSP

Facility

$20.00

Service Code	NDC 536012285
Hospital Charge Code	2654010
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

ACETAMIN(TYLENOL)160MG/5MLSOL/SUSP

Facility

$20.00

Service Code	NDC 536012285
Hospital Charge Code	2654010
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

ACETECHOLINE RECEPTOR BINDING AB

Facility

$563.00

Service Code	CPT 83519
Hospital Charge Code	2283600
Hospital Revenue Code	301
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$401.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.56
Rate for Payer: Aetna Medicare Advantage	$18.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$333.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$401.98
Rate for Payer: Cash Price	$506.70
Rate for Payer: Cash Price	$506.70
Rate for Payer: Cash Price	$506.70
Rate for Payer: Cigna Commercial HMO & PPO	$18.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.72
Rate for Payer: Home State Health Plan Medicare Advantage	$18.40
Rate for Payer: Humana Commercial	$36.80
Rate for Payer: Humana Medicare Advantage	$18.40
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$202.68

ACETECHOLINE RECEPTOR BINDING AB

Facility

$563.00

Service Code	CPT 83519
Hospital Charge Code	2283600
Hospital Revenue Code	301
Rate for Payer: Cash Price	$506.70

ACETONE SCREEN SERUM OR PLASMA

Facility

$58.00

Service Code	CPT 82010
Hospital Charge Code	221168
Hospital Revenue Code	301
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$41.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.35
Rate for Payer: Aetna Medicare Advantage	$8.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cigna Commercial HMO & PPO	$8.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.86
Rate for Payer: Home State Health Plan Medicare Advantage	$8.17
Rate for Payer: Humana Commercial	$16.34
Rate for Payer: Humana Medicare Advantage	$8.17
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

ACETONE SCREEN SERUM OR PLASMA

Facility

$58.00

Service Code	CPT 82010
Hospital Charge Code	221168
Hospital Revenue Code	301
Rate for Payer: Cash Price	$52.20

ACETYLCYS (10% 10ML) 100MG/1000ML IVPB

Facility

$195.00

Service Code	HCPCS J7608
Hospital Charge Code	2697739
Hospital Revenue Code	250
Min. Negotiated Rate	$70.20
Max. Negotiated Rate	$139.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$115.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.23
Rate for Payer: Cash Price	$175.50
Rate for Payer: UnitedHealthcare Commercial	$130.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.20

Know your out-of-pocket cost for care.

All Charges