Madison Medical Center

All Charges

Charge

Type

Setting

Price

ALCOHOLIC LIVER DISEASE

Facility

$9,483.07

Service Code	APR-DRG 2802
Min. Negotiated Rate	$9,483.07
Max. Negotiated Rate	$9,483.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,483.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,483.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,483.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,483.07

ALCOHOL ISOPROPYL 70% 473ML

Facility

$55.00

Service Code	HCPCS A4244
Hospital Charge Code	2696419
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

ALCOHOL ISOPROPYL 70% 473ML

Facility

$55.00

Service Code	HCPCS A4244
Hospital Charge Code	2696419
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

ALCOHOL URINE

Facility

$271.00

Service Code	CPT 80320
Hospital Charge Code	221411
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$193.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$160.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$193.49
Rate for Payer: Cash Price	$243.90
Rate for Payer: Cash Price	$243.90
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.56

ALCOHOL URINE

Facility

$271.00

Service Code	CPT 80320
Hospital Charge Code	221411
Hospital Revenue Code	301
Rate for Payer: Cash Price	$243.90

ALDOLASE

Facility

$112.00

Service Code	CPT 82085
Hospital Charge Code	221412
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

ALDOLASE

Facility

$112.00

Service Code	CPT 82085
Hospital Charge Code	221412
Hospital Revenue Code	301
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.74
Rate for Payer: Aetna Medicare Advantage	$9.71
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: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$9.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.35
Rate for Payer: Home State Health Plan Medicare Advantage	$9.71
Rate for Payer: Humana Commercial	$19.42
Rate for Payer: Humana Medicare Advantage	$9.71
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

ALDOSTERONE

Facility

$125.00

Service Code	CPT 82088
Hospital Charge Code	2282088
Hospital Revenue Code	301
Rate for Payer: Cash Price	$112.50

ALDOSTERONE

Facility

$125.00

Service Code	CPT 82088
Hospital Charge Code	2282088
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$89.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$36.68
Rate for Payer: Aetna Medicare Advantage	$40.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna Commercial HMO & PPO	$40.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$36.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$39.25
Rate for Payer: Home State Health Plan Medicare Advantage	$40.75
Rate for Payer: Humana Commercial	$81.50
Rate for Payer: Humana Medicare Advantage	$40.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$36.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

ALDOSTERONE 24 HR URINE

Facility

$110.00

Service Code	CPT 82088
Hospital Charge Code	222088
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

ALDOSTERONE 24 HR URINE

Facility

$110.00

Service Code	CPT 82088
Hospital Charge Code	222088
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$81.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$36.68
Rate for Payer: Aetna Medicare Advantage	$40.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$40.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$36.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$39.25
Rate for Payer: Home State Health Plan Medicare Advantage	$40.75
Rate for Payer: Humana Commercial	$81.50
Rate for Payer: Humana Medicare Advantage	$40.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$36.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

ALDOSTERONE/RENIN RATIO

Facility

$83.00

Service Code	CPT 82088
Hospital Charge Code	2282080
Hospital Revenue Code	301
Rate for Payer: Cash Price	$74.70

ALDOSTERONE/RENIN RATIO

Facility

$83.00

Service Code	CPT 82088
Hospital Charge Code	2282080
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$81.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$36.68
Rate for Payer: Aetna Medicare Advantage	$40.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$49.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$59.26
Rate for Payer: Cash Price	$74.70
Rate for Payer: Cash Price	$74.70
Rate for Payer: Cash Price	$74.70
Rate for Payer: Cigna Commercial HMO & PPO	$40.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$36.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$39.25
Rate for Payer: Home State Health Plan Medicare Advantage	$40.75
Rate for Payer: Humana Commercial	$81.50
Rate for Payer: Humana Medicare Advantage	$40.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$36.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.88

ALENDRONATE SOD (FOSAMAX) 70MG TAB

Facility

$110.00

Service Code	NDC 6.9097E+10
Hospital Charge Code	2697158
Hospital Revenue Code	250
Rate for Payer: Cash Price	$99.00

ALENDRONATE SOD (FOSAMAX) 70MG TAB

Facility

$110.00

Service Code	NDC 6.9097E+10
Hospital Charge Code	2697158
Hospital Revenue Code	250
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$78.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: UnitedHealthcare Commercial	$73.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

ALFENTA INJ

Facility

$166.00

Hospital Charge Code	2058078
Hospital Revenue Code	370
Rate for Payer: Cash Price	$149.40

ALFENTA INJ

Facility

$166.00

Hospital Charge Code	2058078
Hospital Revenue Code	370
Min. Negotiated Rate	$59.76
Max. Negotiated Rate	$118.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$118.52
Rate for Payer: Cash Price	$149.40
Rate for Payer: UnitedHealthcare Commercial	$110.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

ALFUZOSIN (UROXATRAL) 10MG TAB

Facility

$39.00

Service Code	NDC 1.3668E+10
Hospital Charge Code	2626426
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

ALFUZOSIN (UROXATRAL) 10MG TAB

Facility

$39.00

Service Code	NDC 1.3668E+10
Hospital Charge Code	2626426
Hospital Revenue Code	250
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

ALKALINE PHOSPHATASE

Facility

$127.00

Service Code	CPT 84075
Hospital Charge Code	2216118
Hospital Revenue Code	301
Rate for Payer: Cash Price	$114.30

ALKALINE PHOSPHATASE

Facility

$127.00

Service Code	CPT 84075
Hospital Charge Code	2216118
Hospital Revenue Code	301
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$90.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.66
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$90.68
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cigna Commercial HMO & PPO	$5.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.99
Rate for Payer: Home State Health Plan Medicare Advantage	$5.18
Rate for Payer: Humana Commercial	$10.36
Rate for Payer: Humana Medicare Advantage	$5.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

ALLEN GLUCAGON

Facility

$33.50

Hospital Charge Code	4400610
Hospital Revenue Code	250
Rate for Payer: Cash Price	$30.15

ALLEN GLUCAGON

Facility

$33.50

Hospital Charge Code	4400610
Hospital Revenue Code	250
Min. Negotiated Rate	$12.06
Max. Negotiated Rate	$23.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$19.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$23.92
Rate for Payer: Cash Price	$30.15
Rate for Payer: UnitedHealthcare Commercial	$22.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.06

ALLEN GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	4482962
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

ALLEN GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	4482962
Hospital Revenue Code	301
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$21.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.95
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$3.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.16
Rate for Payer: Home State Health Plan Medicare Advantage	$3.28
Rate for Payer: Humana Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.28
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

Know your out-of-pocket cost for care.

All Charges