Madison Medical Center

All Charges

Charge

Type

Setting

Price

COENZYME Q10

Facility

$248.00

Service Code	CPT 82542
Hospital Charge Code	2202491
Hospital Revenue Code	301
Rate for Payer: Cash Price	$223.20

COENZYME Q10

Facility

$248.00

Service Code	CPT 82542
Hospital Charge Code	2202491
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$177.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.68
Rate for Payer: Aetna Medicare Advantage	$24.09
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: Cash Price	$223.20
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cigna Commercial HMO & PPO	$24.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.20
Rate for Payer: Home State Health Plan Medicare Advantage	$24.09
Rate for Payer: Humana Commercial	$48.18
Rate for Payer: Humana Medicare Advantage	$24.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$89.28

COFLEX-TLC, COMPRESSION DRESSING

Facility

$60.00

Hospital Charge Code	283014
Hospital Revenue Code	271
Rate for Payer: Cash Price	$54.00

COFLEX-TLC, COMPRESSION DRESSING

Facility

$60.00

Hospital Charge Code	283014
Hospital Revenue Code	271
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

COLCHICINE (COLCRYS) 0.6MG TAB

Facility

$42.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2654647
Hospital Revenue Code	250
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

COLCHICINE (COLCRYS) 0.6MG TAB

Facility

$42.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2654647
Hospital Revenue Code	250
Rate for Payer: Cash Price	$37.80

COLCHICINE (COLCRYS) 0.6MG TAB EMP

Facility

$42.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2624819
Hospital Revenue Code	250
Rate for Payer: Cash Price	$37.80

COLCHICINE (COLCRYS) 0.6MG TAB EMP

Facility

$42.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2624819
Hospital Revenue Code	250
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

COLD AGGLUTININ

Facility

$155.00

Service Code	CPT 86157
Hospital Charge Code	223178
Hospital Revenue Code	301
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$110.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.25
Rate for Payer: Aetna Medicare Advantage	$8.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$91.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$110.67
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cigna Commercial HMO & PPO	$8.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.76
Rate for Payer: Home State Health Plan Medicare Advantage	$8.06
Rate for Payer: Humana Commercial	$16.12
Rate for Payer: Humana Medicare Advantage	$8.06
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.80

COLD AGGLUTININ

Facility

$155.00

Service Code	CPT 86157
Hospital Charge Code	223178
Hospital Revenue Code	301
Rate for Payer: Cash Price	$139.50

COLECTOMY-PARTIAL

Facility

$1,331.00

Service Code	CPT 44145
Hospital Charge Code	5244145
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$950.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$787.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$950.33
Rate for Payer: Cash Price	$1,197.90
Rate for Payer: Cash Price	$1,197.90
Rate for Payer: UnitedHealthcare Commercial	$887.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

COLECTOMY-PARTIAL

Facility

$1,331.00

Service Code	CPT 44145
Hospital Charge Code	5244145
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,197.90

COLECTOMY, PART W/ANASTOMOSIS

Professional

Both

$3,245.00

Service Code	CPT 44140
Hospital Charge Code	4144140
Hospital Revenue Code	975
Min. Negotiated Rate	$1,013.65
Max. Negotiated Rate	$1,199.41
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,199.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,013.65
Rate for Payer: Cash Price	$2,920.50
Rate for Payer: Cash Price	$2,920.50
Rate for Payer: Cigna Commercial HMO & PPO	$1,199.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,013.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,115.02
Rate for Payer: Home State Health Plan Medicare Advantage	$1,199.41
Rate for Payer: Optum Medicare Advantage	$1,135.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,013.65

COLECTOMY,PART W/COLCPROCTOSTOMY

Professional

Both

$3,807.00

Service Code	CPT 44145
Hospital Charge Code	4144145
Hospital Revenue Code	975
Min. Negotiated Rate	$1,242.59
Max. Negotiated Rate	$1,457.82
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,457.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,242.59
Rate for Payer: Cash Price	$3,426.30
Rate for Payer: Cash Price	$3,426.30
Rate for Payer: Cigna Commercial HMO & PPO	$1,457.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,242.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,366.85
Rate for Payer: Home State Health Plan Medicare Advantage	$1,457.82
Rate for Payer: Optum Medicare Advantage	$1,332.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,242.59

COLECTOMY,PART W/COLCPROCTOSTOMY W/COLOS

Professional

Both

$4,474.00

Service Code	CPT 44146
Hospital Charge Code	4144146
Hospital Revenue Code	975
Min. Negotiated Rate	$1,565.90
Max. Negotiated Rate	$1,862.15
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,862.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,582.19
Rate for Payer: Cash Price	$4,026.60
Rate for Payer: Cash Price	$4,026.60
Rate for Payer: Cigna Commercial HMO & PPO	$1,862.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,582.19
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,740.41
Rate for Payer: Home State Health Plan Medicare Advantage	$1,862.15
Rate for Payer: Optum Medicare Advantage	$1,565.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,582.19

COLECTOMY,PART W/END CLOSURE OF DIST SEG

Professional

Both

$3,401.00

Service Code	CPT 44143
Hospital Charge Code	4144143
Hospital Revenue Code	975
Min. Negotiated Rate	$1,190.35
Max. Negotiated Rate	$1,469.12
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,469.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,250.31
Rate for Payer: Cash Price	$3,060.90
Rate for Payer: Cash Price	$3,060.90
Rate for Payer: Cigna Commercial HMO & PPO	$1,469.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,250.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,375.34
Rate for Payer: Home State Health Plan Medicare Advantage	$1,469.12
Rate for Payer: Optum Medicare Advantage	$1,190.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,250.31

COLECTOMY,PART W/SKIN LEVEL CECOS OR COL

Professional

Both

$3,366.00

Service Code	CPT 44141
Hospital Charge Code	4144141
Hospital Revenue Code	975
Min. Negotiated Rate	$1,178.10
Max. Negotiated Rate	$1,618.91
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,618.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,371.77
Rate for Payer: Cash Price	$3,029.40
Rate for Payer: Cash Price	$3,029.40
Rate for Payer: Cigna Commercial HMO & PPO	$1,618.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,371.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,508.95
Rate for Payer: Home State Health Plan Medicare Advantage	$1,618.91
Rate for Payer: Optum Medicare Advantage	$1,178.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,371.77

COLESEVELAM (WELCHOL) 625MG TAB

Facility

$19.00

Service Code	NDC 6.5597E+10
Hospital Charge Code	2697605
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

COLESEVELAM (WELCHOL) 625MG TAB

Facility

$9.00

Service Code	NDC 6.5597E+10
Hospital Charge Code	260651
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

COLESEVELAM (WELCHOL) 625MG TAB

Facility

$9.00

Service Code	NDC 6.5597E+10
Hospital Charge Code	260651
Hospital Revenue Code	250
Rate for Payer: Cash Price	$8.10

COLESEVELAM (WELCHOL) 625MG TAB

Facility

$19.00

Service Code	NDC 6.5597E+10
Hospital Charge Code	2697605
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

COLESTIPOL 1GM TAB EMP

Facility

$22.00

Service Code	NDC 9045003
Hospital Charge Code	2623312
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

COLESTIPOL 1GM TAB EMP

Facility

$22.00

Service Code	NDC 9045003
Hospital Charge Code	2623312
Hospital Revenue Code	250
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

COLESTIPOL (COLESTID) 1GM TAB

Facility

$22.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2626377
Hospital Revenue Code	250
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

COLESTIPOL (COLESTID) 1GM TAB

Facility

$22.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2626377
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

Know your out-of-pocket cost for care.

All Charges