Madison Medical Center

All Charges

Charge

Type

Setting

Price

AIRWAY, SUPRAGLOTTIC MEDIUM ADULT #4

Facility

$131.00

Hospital Charge Code	2810041
Hospital Revenue Code	271
Rate for Payer: Cash Price	$117.90

AIRWAY, SUPRAGLOTTIC PEDI #2

Facility

$131.00

Hospital Charge Code	2810040
Hospital Revenue Code	271
Rate for Payer: Cash Price	$117.90

AIRWAY, SUPRAGLOTTIC PEDI #2

Facility

$131.00

Hospital Charge Code	2810040
Hospital Revenue Code	271
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$93.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$77.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$93.53
Rate for Payer: Cash Price	$117.90
Rate for Payer: UnitedHealthcare Commercial	$87.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.16

ALA DELTA RANDOM URINE

Facility

$202.00

Service Code	CPT 82135
Hospital Charge Code	2282135
Hospital Revenue Code	307
Rate for Payer: Cash Price	$181.80

ALA DELTA RANDOM URINE

Facility

$202.00

Service Code	CPT 82135
Hospital Charge Code	2282135
Hospital Revenue Code	307
Min. Negotiated Rate	$14.81
Max. Negotiated Rate	$144.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.81
Rate for Payer: Aetna Medicare Advantage	$16.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$119.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$144.23
Rate for Payer: Cash Price	$181.80
Rate for Payer: Cash Price	$181.80
Rate for Payer: Cash Price	$181.80
Rate for Payer: Cigna Commercial HMO & PPO	$16.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.85
Rate for Payer: Home State Health Plan Medicare Advantage	$16.45
Rate for Payer: Humana Commercial	$32.90
Rate for Payer: Humana Medicare Advantage	$16.45
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$72.72

ALBUMIN

Facility

$113.00

Service Code	CPT 82040
Hospital Charge Code	221116
Hospital Revenue Code	301
Rate for Payer: Cash Price	$101.70

ALBUMIN

Facility

$113.00

Service Code	CPT 82040
Hospital Charge Code	221116
Hospital Revenue Code	301
Min. Negotiated Rate	$4.46
Max. Negotiated Rate	$80.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.46
Rate for Payer: Aetna Medicare Advantage	$4.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial HMO & PPO	$4.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.77
Rate for Payer: Home State Health Plan Medicare Advantage	$4.95
Rate for Payer: Humana Commercial	$9.90
Rate for Payer: Humana Medicare Advantage	$4.95
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

ALBUMIN 25% 50ML IVPB

Facility

$816.00

Service Code	NDC 6.8517E+10
Hospital Charge Code	2654040
Hospital Revenue Code	250
Rate for Payer: Cash Price	$734.40

ALBUMIN 25% 50ML IVPB

Facility

$816.00

Service Code	NDC 6.8517E+10
Hospital Charge Code	2654040
Hospital Revenue Code	250
Min. Negotiated Rate	$293.76
Max. Negotiated Rate	$582.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$483.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$582.62
Rate for Payer: Cash Price	$734.40
Rate for Payer: UnitedHealthcare Commercial	$544.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.76

ALBUMIN PERITONEAL FLUID

Facility

$81.00

Service Code	CPT 82042
Hospital Charge Code	2282042
Hospital Revenue Code	301
Rate for Payer: Cash Price	$72.90

ALBUMIN PERITONEAL FLUID

Facility

$81.00

Service Code	CPT 82042
Hospital Charge Code	2282042
Hospital Revenue Code	301
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$57.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.00
Rate for Payer: Aetna Medicare Advantage	$7.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna Commercial HMO & PPO	$7.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.49
Rate for Payer: Home State Health Plan Medicare Advantage	$7.78
Rate for Payer: Humana Commercial	$15.56
Rate for Payer: Humana Medicare Advantage	$7.78
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

ALBUTEROL 2.5MG/3ML INH/NEB 0.083% EMP

Facility

$21.00

Service Code	NDC 487950103
Hospital Charge Code	2619228
Hospital Revenue Code	412
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

ALBUTEROL 2.5MG/3ML INH/NEB 0.083% EMP

Facility

$21.00

Service Code	NDC 487950103
Hospital Charge Code	2619228
Hospital Revenue Code	412
Rate for Payer: Cash Price	$18.90

ALBUTEROL 2.5MG/3ML INH/NEB 0.083% U/D

Facility

$21.00

Service Code	NDC 487950101
Hospital Charge Code	2697099
Hospital Revenue Code	412
Rate for Payer: Cash Price	$18.90

ALBUTEROL 2.5MG/3ML INH/NEB 0.083% U/D

Facility

$21.00

Service Code	NDC 487950101
Hospital Charge Code	2697099
Hospital Revenue Code	412
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

ALBUTEROL 2.5MG/3ML NEB 0.083% 60V EMP

Facility

$21.00

Service Code	NDC 591379760
Hospital Charge Code	2622874
Hospital Revenue Code	412
Rate for Payer: Cash Price	$18.90

ALBUTEROL 2.5MG/3ML NEB 0.083% 60V EMP

Facility

$21.00

Service Code	NDC 591379760
Hospital Charge Code	2622874
Hospital Revenue Code	412
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

ALBUTEROL 90MCG 8.5GM INH 200 DOSE

Facility

$184.00

Service Code	NDC 5.931E+10
Hospital Charge Code	2623380
Hospital Revenue Code	250
Min. Negotiated Rate	$66.24
Max. Negotiated Rate	$131.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$108.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$131.38
Rate for Payer: Cash Price	$165.60
Rate for Payer: UnitedHealthcare Commercial	$122.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.24

ALBUTEROL 90MCG 8.5GM INH 200 DOSE

Facility

$184.00

Service Code	NDC 5.931E+10
Hospital Charge Code	2623380
Hospital Revenue Code	250
Rate for Payer: Cash Price	$165.60

ALBUTEROL (PROVENTIL) 6.7GM INH EMP

Facility

$184.00

Service Code	NDC 85113204
Hospital Charge Code	2623391
Hospital Revenue Code	250
Rate for Payer: Cash Price	$165.60

ALBUTEROL (PROVENTIL) 6.7GM INH EMP

Facility

$184.00

Service Code	NDC 85113204
Hospital Charge Code	2623391
Hospital Revenue Code	250
Min. Negotiated Rate	$66.24
Max. Negotiated Rate	$131.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$108.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$131.38
Rate for Payer: Cash Price	$165.60
Rate for Payer: UnitedHealthcare Commercial	$122.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.24

ALBUTEROL SULF (PROVENTIL) 6.7GM INHALER

Facility

$184.00

Service Code	NDC 93317431
Hospital Charge Code	2626497
Hospital Revenue Code	250
Min. Negotiated Rate	$66.24
Max. Negotiated Rate	$131.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$108.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$131.38
Rate for Payer: Cash Price	$165.60
Rate for Payer: UnitedHealthcare Commercial	$122.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.24

ALBUTEROL SULF (PROVENTIL) 6.7GM INHALER

Facility

$184.00

Service Code	NDC 93317431
Hospital Charge Code	2626497
Hospital Revenue Code	250
Rate for Payer: Cash Price	$165.60

ALBUTEROL (VENTOLIN)HFA 200-DOSE INH EMP

Facility

$112.00

Service Code	NDC 173068220
Hospital Charge Code	2621960
Hospital Revenue Code	250
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$79.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: UnitedHealthcare Commercial	$74.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

ALBUTEROL (VENTOLIN)HFA 200-DOSE INH EMP

Facility

$112.00

Service Code	NDC 173068220
Hospital Charge Code	2621960
Hospital Revenue Code	250
Rate for Payer: Cash Price	$100.80

Know your out-of-pocket cost for care.

All Charges