Madison Medical Center

All Charges

Charge

Type

Setting

Price

EPSTEIN BARR IGM

Facility

$80.00

Service Code	CPT 86665
Hospital Charge Code	2286664
Hospital Revenue Code	301
Rate for Payer: Cash Price	$72.00

EPSTEIN BARR NUCL AG

Facility

$43.00

Service Code	CPT 86664
Hospital Charge Code	228664
Hospital Revenue Code	302
Min. Negotiated Rate	$13.76
Max. Negotiated Rate	$30.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.76
Rate for Payer: Aetna Medicare Advantage	$15.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cigna Commercial HMO & PPO	$15.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.72
Rate for Payer: Home State Health Plan Medicare Advantage	$15.29
Rate for Payer: Humana Commercial	$30.58
Rate for Payer: Humana Medicare Advantage	$15.29
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

EPSTEIN BARR NUCL AG

Facility

$43.00

Service Code	CPT 86664
Hospital Charge Code	228664
Hospital Revenue Code	302
Rate for Payer: Cash Price	$38.70

EPSTEIN BARR PCR QUANT

Facility

$342.00

Service Code	CPT 87799
Hospital Charge Code	228666
Hospital Revenue Code	302
Rate for Payer: Cash Price	$307.80

EPSTEIN BARR PCR QUANT

Facility

$342.00

Service Code	CPT 87799
Hospital Charge Code	228666
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$244.19
Rate for Payer: Aetna Better Health Medicaid/QHP	$38.56
Rate for Payer: Aetna Medicare Advantage	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$202.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$244.19
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cigna Commercial HMO & PPO	$42.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$38.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41.26
Rate for Payer: Home State Health Plan Medicare Advantage	$42.84
Rate for Payer: Humana Commercial	$85.68
Rate for Payer: Humana Medicare Advantage	$42.84
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$38.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$123.12

EPSTEIN BARR VCA

Facility

$129.00

Service Code	CPT 86665
Hospital Charge Code	228665
Hospital Revenue Code	302
Min. Negotiated Rate	$16.33
Max. Negotiated Rate	$92.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.33
Rate for Payer: Aetna Medicare Advantage	$18.14
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	$18.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.47
Rate for Payer: Home State Health Plan Medicare Advantage	$18.14
Rate for Payer: Humana Commercial	$36.28
Rate for Payer: Humana Medicare Advantage	$18.14
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

EPSTEIN BARR VCA

Facility

$129.00

Service Code	CPT 86665
Hospital Charge Code	228665
Hospital Revenue Code	302
Rate for Payer: Cash Price	$116.10

EPTIFIBATIDE(INTEGRILIN)20MG/10ML J

Facility

$841.00

Service Code	HCPCS J3246
Hospital Charge Code	2626546
Hospital Revenue Code	250
Rate for Payer: Cash Price	$756.90

EPTIFIBATIDE(INTEGRILIN)20MG/10ML J

Facility

$841.00

Service Code	HCPCS J3246
Hospital Charge Code	2626546
Hospital Revenue Code	250
Min. Negotiated Rate	$302.76
Max. Negotiated Rate	$600.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$497.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$600.47
Rate for Payer: Cash Price	$756.90
Rate for Payer: UnitedHealthcare Commercial	$560.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$302.76

EPTIFIBAT (INTEGRILIN)75MG/100ML J

Facility

$2,312.00

Service Code	HCPCS J3246
Hospital Charge Code	2626545
Hospital Revenue Code	250
Min. Negotiated Rate	$832.32
Max. Negotiated Rate	$1,650.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,368.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,650.77
Rate for Payer: Cash Price	$2,080.80
Rate for Payer: UnitedHealthcare Commercial	$1,542.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$832.32

EPTIFIBAT (INTEGRILIN)75MG/100ML J

Facility

$2,312.00

Service Code	HCPCS J3246
Hospital Charge Code	2626545
Hospital Revenue Code	250
Rate for Payer: Cash Price	$2,080.80

ER CODE BLUE

Facility

$937.00

Service Code	CPT 99205
Hospital Charge Code	1819006
Hospital Revenue Code	450
Rate for Payer: Cash Price	$843.30

ER CODE BLUE

Facility

$937.00

Service Code	CPT 99205
Hospital Charge Code	1819006
Hospital Revenue Code	450
Min. Negotiated Rate	$337.32
Max. Negotiated Rate	$337.32
Rate for Payer: Cash Price	$843.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$337.32

ERCP CYTOLOGY BRUSH

Facility

$308.00

Hospital Charge Code	1299123
Hospital Revenue Code	271
Min. Negotiated Rate	$110.88
Max. Negotiated Rate	$219.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$182.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.91
Rate for Payer: Cash Price	$277.20
Rate for Payer: UnitedHealthcare Commercial	$205.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$110.88

ERCP CYTOLOGY BRUSH

Facility

$308.00

Hospital Charge Code	1299123
Hospital Revenue Code	271
Rate for Payer: Cash Price	$277.20

ER EXTENDED OVER 2 HRS

Facility

$320.00

Hospital Charge Code	1819003
Hospital Revenue Code	450
Min. Negotiated Rate	$115.20
Max. Negotiated Rate	$115.20
Rate for Payer: Cash Price	$288.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$115.20

ER EXTENDED OVER 2 HRS

Facility

$320.00

Hospital Charge Code	1819003
Hospital Revenue Code	450
Rate for Payer: Cash Price	$288.00

ER EXTENDED OVER 3 HRS

Facility

$368.00

Hospital Charge Code	1899203
Hospital Revenue Code	450
Min. Negotiated Rate	$132.48
Max. Negotiated Rate	$132.48
Rate for Payer: Cash Price	$331.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$132.48

ER EXTENDED OVER 3 HRS

Facility

$368.00

Hospital Charge Code	1899203
Hospital Revenue Code	450
Rate for Payer: Cash Price	$331.20

ER EXTENDED OVER 4 HRS

Facility

$417.00

Hospital Charge Code	1819004
Hospital Revenue Code	450
Min. Negotiated Rate	$150.12
Max. Negotiated Rate	$150.12
Rate for Payer: Cash Price	$375.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$150.12

ER EXTENDED OVER 4 HRS

Facility

$417.00

Hospital Charge Code	1819004
Hospital Revenue Code	450
Rate for Payer: Cash Price	$375.30

ER EXTENDED OVER 5 HRS

Facility

$504.00

Hospital Charge Code	1819005
Hospital Revenue Code	450
Min. Negotiated Rate	$181.44
Max. Negotiated Rate	$181.44
Rate for Payer: Cash Price	$453.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$181.44

ER EXTENDED OVER 5 HRS

Facility

$504.00

Hospital Charge Code	1819005
Hospital Revenue Code	450
Rate for Payer: Cash Price	$453.60

ER EXTENSIVE

Facility

$532.00

Hospital Charge Code	1819002
Hospital Revenue Code	450
Min. Negotiated Rate	$191.52
Max. Negotiated Rate	$191.52
Rate for Payer: Cash Price	$478.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$191.52

ER EXTENSIVE

Facility

$532.00

Hospital Charge Code	1819002
Hospital Revenue Code	450
Rate for Payer: Cash Price	$478.80

Know your out-of-pocket cost for care.

All Charges