Madison Medical Center

All Charges

Charge

Type

Setting

Price

E.O.A. REPLACEMENT TUBE

Facility

$142.00

Hospital Charge Code	2819910
Hospital Revenue Code	271
Rate for Payer: Cash Price	$127.80

E.O.A. REPLACEMENT TUBE

Facility

$142.00

Hospital Charge Code	2819910
Hospital Revenue Code	271
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$101.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$84.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$101.39
Rate for Payer: Cash Price	$127.80
Rate for Payer: UnitedHealthcare Commercial	$94.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.12

E.O.A. TUBE

Facility

$302.00

Hospital Charge Code	2819909
Hospital Revenue Code	271
Min. Negotiated Rate	$108.72
Max. Negotiated Rate	$215.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$178.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$215.63
Rate for Payer: Cash Price	$271.80
Rate for Payer: UnitedHealthcare Commercial	$201.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.72

E.O.A. TUBE

Facility

$302.00

Hospital Charge Code	2819909
Hospital Revenue Code	271
Rate for Payer: Cash Price	$271.80

.EOSINOPHIL COUNT ABSOLUTE

Facility

$41.00

Service Code	CPT 85004
Hospital Charge Code	2285004
Hospital Revenue Code	305
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$29.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.82
Rate for Payer: Aetna Medicare Advantage	$6.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.27
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cigna Commercial HMO & PPO	$6.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.23
Rate for Payer: Home State Health Plan Medicare Advantage	$6.47
Rate for Payer: Humana Commercial	$12.94
Rate for Payer: Humana Medicare Advantage	$6.47
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.76

.EOSINOPHIL COUNT ABSOLUTE

Facility

$41.00

Service Code	CPT 85004
Hospital Charge Code	2285004
Hospital Revenue Code	305
Rate for Payer: Cash Price	$36.90

EOSINOPHIL COUNT (ABSOLUTE)

Facility

$128.00

Service Code	CPT 85048
Hospital Charge Code	2285048
Hospital Revenue Code	305
Rate for Payer: Cash Price	$115.20

EOSINOPHIL COUNT (ABSOLUTE)

Facility

$128.00

Service Code	CPT 85048
Hospital Charge Code	2285048
Hospital Revenue Code	305
Min. Negotiated Rate	$2.29
Max. Negotiated Rate	$91.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.29
Rate for Payer: Aetna Medicare Advantage	$2.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$91.39
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cigna Commercial HMO & PPO	$2.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2.45
Rate for Payer: Home State Health Plan Medicare Advantage	$2.54
Rate for Payer: Humana Commercial	$5.08
Rate for Payer: Humana Medicare Advantage	$2.54
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.08

EOSINOPHIL COUNT NASAL

Facility

$62.00

Service Code	CPT 89190
Hospital Charge Code	2285025
Hospital Revenue Code	301
Rate for Payer: Cash Price	$55.80

EOSINOPHIL COUNT NASAL

Facility

$62.00

Service Code	CPT 89190
Hospital Charge Code	2285025
Hospital Revenue Code	301
Min. Negotiated Rate	$5.21
Max. Negotiated Rate	$44.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.21
Rate for Payer: Aetna Medicare Advantage	$5.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.57
Rate for Payer: Home State Health Plan Medicare Advantage	$5.79
Rate for Payer: Humana Commercial	$11.58
Rate for Payer: Humana Medicare Advantage	$5.79
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

EOSINOPHIL COUNT URINE

Facility

$89.00

Service Code	CPT 87205
Hospital Charge Code	2222110
Hospital Revenue Code	307
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$63.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.84
Rate for Payer: Aetna Medicare Advantage	$4.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cigna Commercial HMO & PPO	$4.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.11
Rate for Payer: Home State Health Plan Medicare Advantage	$4.27
Rate for Payer: Humana Commercial	$8.54
Rate for Payer: Humana Medicare Advantage	$4.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

EOSINOPHIL COUNT URINE

Facility

$89.00

Service Code	CPT 87205
Hospital Charge Code	2222110
Hospital Revenue Code	307
Rate for Payer: Cash Price	$80.10

EPHEDRINE 50MG INJ 1ML

Facility

$167.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2654938
Hospital Revenue Code	250
Rate for Payer: Cash Price	$150.30

EPHEDRINE 50MG INJ 1ML

Facility

$167.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2654938
Hospital Revenue Code	250
Min. Negotiated Rate	$60.12
Max. Negotiated Rate	$119.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$119.24
Rate for Payer: Cash Price	$150.30
Rate for Payer: UnitedHealthcare Commercial	$111.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.12

EPHEDRINE INJ

Facility

$75.00

Service Code	HCPCS J0170
Hospital Charge Code	2058022
Hospital Revenue Code	370
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

EPHEDRINE INJ

Facility

$75.00

Service Code	HCPCS J0170
Hospital Charge Code	2058022
Hospital Revenue Code	370
Rate for Payer: Cash Price	$67.50

EPIDUO FORTE 0.3-2.5% TOP GEL PUMP EMP

Facility

$960.00

Service Code	NDC 299590645
Hospital Charge Code	2623060
Hospital Revenue Code	250
Min. Negotiated Rate	$345.60
Max. Negotiated Rate	$685.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$568.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$685.44
Rate for Payer: Cash Price	$864.00
Rate for Payer: UnitedHealthcare Commercial	$640.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$345.60

EPIDUO FORTE 0.3-2.5% TOP GEL PUMP EMP

Facility

$960.00

Service Code	NDC 299590645
Hospital Charge Code	2623060
Hospital Revenue Code	250
Rate for Payer: Cash Price	$864.00

EPIDURAL

Facility

$1,520.00

Hospital Charge Code	2059107
Hospital Revenue Code	370
Rate for Payer: Cash Price	$1,368.00

EPIDURAL

Facility

$1,520.00

Hospital Charge Code	2059107
Hospital Revenue Code	370
Min. Negotiated Rate	$547.20
Max. Negotiated Rate	$1,085.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$899.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,085.28
Rate for Payer: Cash Price	$1,368.00
Rate for Payer: UnitedHealthcare Commercial	$1,013.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$547.20

EPIDURAL TRAY

Facility

$129.00

Hospital Charge Code	2819442
Hospital Revenue Code	272
Rate for Payer: Cash Price	$116.10

EPIDURAL TRAY

Facility

$129.00

Hospital Charge Code	2819442
Hospital Revenue Code	272
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
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: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

EPIFIX, 2CM X 3CM

Facility

$594.00

Service Code	CPT Q4131
Hospital Charge Code	285230
Hospital Revenue Code	271
Min. Negotiated Rate	$213.84
Max. Negotiated Rate	$424.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$351.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$424.12
Rate for Payer: Cash Price	$534.60
Rate for Payer: UnitedHealthcare Commercial	$396.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$213.84

EPIFIX, 2CM X 3CM

Facility

$594.00

Service Code	CPT Q4131
Hospital Charge Code	285230
Hospital Revenue Code	271
Rate for Payer: Cash Price	$534.60

EPIFIX, 4CM X 4CM

Facility

$594.00

Service Code	CPT Q4131
Hospital Charge Code	285440
Hospital Revenue Code	271
Min. Negotiated Rate	$213.84
Max. Negotiated Rate	$424.12
Rate for Payer: Cash Price	$534.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$351.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$424.12
Rate for Payer: UnitedHealthcare Commercial	$396.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$213.84

Know your out-of-pocket cost for care.

All Charges