Madison Medical Center

All Charges

Charge

Type

Setting

Price

CORTISONE

Facility

$504.00

Service Code	CPT 83789
Hospital Charge Code	2283788
Hospital Revenue Code	301
Rate for Payer: Cash Price	$453.60

CORTISONE

Facility

$504.00

Service Code	CPT 83789
Hospital Charge Code	2283788
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$359.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.70
Rate for Payer: Aetna Medicare Advantage	$24.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$298.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$359.86
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cigna Commercial HMO & PPO	$24.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.22
Rate for Payer: Home State Health Plan Medicare Advantage	$24.11
Rate for Payer: Humana Commercial	$48.22
Rate for Payer: Humana Medicare Advantage	$24.11
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$181.44

CORTISPORIN TC OTIC SUSP 10ML EMP

Facility

$294.00

Service Code	NDC 2.4208E+10
Hospital Charge Code	2623415
Hospital Revenue Code	250
Min. Negotiated Rate	$105.84
Max. Negotiated Rate	$209.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$174.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$209.92
Rate for Payer: Cash Price	$264.60
Rate for Payer: UnitedHealthcare Commercial	$196.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$105.84

CORTISPORIN TC OTIC SUSP 10ML EMP

Facility

$294.00

Service Code	NDC 2.4208E+10
Hospital Charge Code	2623415
Hospital Revenue Code	250
Rate for Payer: Cash Price	$264.60

COTTON BALLS

Facility

$16.00

Hospital Charge Code	283340
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

COTTON BALLS

Facility

$16.00

Hospital Charge Code	283340
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

COUMADIN

Facility

$261.00

Service Code	CPT 80299
Hospital Charge Code	2216127
Hospital Revenue Code	305
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$186.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.78
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$154.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$186.35
Rate for Payer: Cash Price	$234.90
Rate for Payer: Cash Price	$234.90
Rate for Payer: Cash Price	$234.90
Rate for Payer: Cigna Commercial HMO & PPO	$18.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.95
Rate for Payer: Home State Health Plan Medicare Advantage	$18.64
Rate for Payer: Humana Commercial	$37.28
Rate for Payer: Humana Medicare Advantage	$18.64
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$93.96

COUMADIN

Facility

$261.00

Service Code	CPT 80299
Hospital Charge Code	2216127
Hospital Revenue Code	305
Rate for Payer: Cash Price	$234.90

COUMADIN MANAGEMENT INITIAL 90 DAYS

Facility

$240.00

Service Code	CPT 93793
Hospital Charge Code	9899363
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

COUMADIN MANAGEMENT INITIAL 90 DAYS

Facility

$240.00

Service Code	CPT 93793
Hospital Charge Code	9899363
Hospital Revenue Code	521
Min. Negotiated Rate	$142.08
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$142.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$171.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: UnitedHealthcare Commercial	$160.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

COUMADIN MANAGMENT SUBSEQ 90 DAYS

Facility

$90.00

Service Code	CPT 93793
Hospital Charge Code	9899364
Hospital Revenue Code	521
Min. Negotiated Rate	$53.28
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

COUMADIN MANAGMENT SUBSEQ 90 DAYS

Facility

$90.00

Service Code	CPT 93793
Hospital Charge Code	9899364
Hospital Revenue Code	521
Rate for Payer: Cash Price	$81.00

COUNTERSINK USAGE

Facility

$1,058.00

Hospital Charge Code	127775
Hospital Revenue Code	271
Rate for Payer: Cash Price	$952.20

COUNTERSINK USAGE

Facility

$1,058.00

Hospital Charge Code	127775
Hospital Revenue Code	271
Min. Negotiated Rate	$380.88
Max. Negotiated Rate	$755.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$626.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$755.41
Rate for Payer: Cash Price	$952.20
Rate for Payer: UnitedHealthcare Commercial	$705.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$380.88

COVID 19 ANTIGEN

Facility

$37.00

Service Code	CPT 87426
Hospital Charge Code	9787504
Hospital Revenue Code	521
Rate for Payer: Cash Price	$33.30

COVID 19 ANTIGEN

Facility

$37.00

Service Code	CPT 87426
Hospital Charge Code	9787504
Hospital Revenue Code	521
Min. Negotiated Rate	$21.90
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.80
Rate for Payer: Aetna Medicare Advantage	$35.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$26.42
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cigna Commercial HMO & PPO	$35.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$34.03
Rate for Payer: Home State Health Plan Medicare Advantage	$35.33
Rate for Payer: Humana Commercial	$70.66
Rate for Payer: Humana Medicare Advantage	$35.33
Rate for Payer: UnitedHealthcare Commercial	$24.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

.COVID-19 ANTIGEN (INHOUSE)

Facility

$45.00

Service Code	CPT 87426
Hospital Charge Code	2287504
Hospital Revenue Code	306
Rate for Payer: Cash Price	$40.50

.COVID-19 ANTIGEN (INHOUSE)

Facility

$45.00

Service Code	CPT 87426
Hospital Charge Code	2287504
Hospital Revenue Code	306
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$70.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.80
Rate for Payer: Aetna Medicare Advantage	$35.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna Commercial HMO & PPO	$35.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$34.03
Rate for Payer: Home State Health Plan Medicare Advantage	$35.33
Rate for Payer: Humana Commercial	$70.66
Rate for Payer: Humana Medicare Advantage	$35.33
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

COVID-19 PCR

Facility

$124.00

Service Code	CPT 87635
Hospital Charge Code	2287503
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$102.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$46.18
Rate for Payer: Aetna Medicare Advantage	$51.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial HMO & PPO	$51.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$49.41
Rate for Payer: Home State Health Plan Medicare Advantage	$51.31
Rate for Payer: Humana Commercial	$102.62
Rate for Payer: Humana Medicare Advantage	$51.31
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

COVID-19 PCR

Facility

$124.00

Service Code	CPT 87635
Hospital Charge Code	2287503
Hospital Revenue Code	306
Rate for Payer: Cash Price	$111.60

.COVID-19 PCR ACCULA (INHOUSE)

Facility

$258.00

Service Code	CPT 87635
Hospital Charge Code	2287505
Hospital Revenue Code	306
Rate for Payer: Cash Price	$232.20

.COVID-19 PCR ACCULA (INHOUSE)

Facility

$258.00

Service Code	CPT 87635
Hospital Charge Code	2287505
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$184.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$46.18
Rate for Payer: Aetna Medicare Advantage	$51.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$152.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$184.21
Rate for Payer: Cash Price	$232.20
Rate for Payer: Cash Price	$232.20
Rate for Payer: Cash Price	$232.20
Rate for Payer: Cigna Commercial HMO & PPO	$51.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$49.41
Rate for Payer: Home State Health Plan Medicare Advantage	$51.31
Rate for Payer: Humana Commercial	$102.62
Rate for Payer: Humana Medicare Advantage	$51.31
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$92.88

.COVID 19 PCR (AEL)

Facility

$226.00

Service Code	CPT U0003
Hospital Charge Code	2287637
Hospital Revenue Code	306
Rate for Payer: Cash Price	$203.40

.COVID 19 PCR (AEL)

Facility

$226.00

Service Code	CPT U0003
Hospital Charge Code	2287637
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$161.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$133.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$161.36
Rate for Payer: Cash Price	$203.40
Rate for Payer: Cash Price	$203.40
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$81.36

.COVID 19 PCR (INTERFACE AEL)

Facility

$226.00

Service Code	CPT 87635
Hospital Charge Code	2287638
Hospital Revenue Code	306
Rate for Payer: Cash Price	$203.40

Know your out-of-pocket cost for care.

All Charges