Madison Medical Center

All Charges

Charge

Type

Setting

Price

ALLERGEN WATERMELON

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	222718
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

ALLERGEN WATERMELON

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	222718
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN W/IGE AREA 8(LC607020)

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218601
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

ALLERGEN W/IGE AREA 8(LC607020)

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218601
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGIC REACTIONS

Facility

$29,862.58

Service Code	APR-DRG 8114
Min. Negotiated Rate	$29,862.58
Max. Negotiated Rate	$29,862.58
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,862.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,862.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,862.58
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,862.58

ALLERGIC REACTIONS

Facility

$16,126.06

Service Code	APR-DRG 8113
Min. Negotiated Rate	$16,126.06
Max. Negotiated Rate	$16,126.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$16,126.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16,126.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16,126.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16,126.06

ALLERGIC REACTIONS

Facility

$8,087.86

Service Code	APR-DRG 8112
Min. Negotiated Rate	$8,087.86
Max. Negotiated Rate	$8,087.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,087.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,087.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,087.86
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,087.86

ALLERGIC REACTIONS

Facility

$4,765.76

Service Code	APR-DRG 8111
Min. Negotiated Rate	$4,765.76
Max. Negotiated Rate	$4,765.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,765.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,765.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,765.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,765.76

ALLERGIC REACTIONS WITH MCC

Facility

$29,983.40

Service Code	MSDRG 915
Min. Negotiated Rate	$14,991.70
Max. Negotiated Rate	$29,983.40
Rate for Payer: Aetna Medicare Advantage	$14,991.70
Rate for Payer: Cigna Commercial HMO & PPO	$14,991.70
Rate for Payer: Home State Health Plan Medicare Advantage	$14,991.70
Rate for Payer: Humana Commercial	$29,983.40
Rate for Payer: Humana Medicare Advantage	$14,991.70

ALLERGIC REACTIONS WITHOUT MCC

Facility

$14,076.70

Service Code	MSDRG 916
Min. Negotiated Rate	$7,038.35
Max. Negotiated Rate	$14,076.70
Rate for Payer: Aetna Medicare Advantage	$7,038.35
Rate for Payer: Cigna Commercial HMO & PPO	$7,038.35
Rate for Payer: Home State Health Plan Medicare Advantage	$7,038.35
Rate for Payer: Humana Commercial	$14,076.70
Rate for Payer: Humana Medicare Advantage	$7,038.35

ALLEVYN, DRESSING 3 X 3 ADHESIVE

Facility

$15.00

Hospital Charge Code	90000142
Hospital Revenue Code	272
Rate for Payer: Cash Price	$13.50

ALLEVYN, DRESSING 3 X 3 ADHESIVE

Facility

$15.00

Hospital Charge Code	90000142
Hospital Revenue Code	272
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

ALLOGENEIC BONE MARROW TRANSPLANT

Facility

$193,914.58

Service Code	MSDRG 014
Min. Negotiated Rate	$96,957.29
Max. Negotiated Rate	$193,914.58
Rate for Payer: Aetna Medicare Advantage	$96,957.29
Rate for Payer: Cigna Commercial HMO & PPO	$96,957.29
Rate for Payer: Home State Health Plan Medicare Advantage	$96,957.29
Rate for Payer: Humana Commercial	$193,914.58
Rate for Payer: Humana Medicare Advantage	$96,957.29

ALLOPURINOL 100MG TAB EMP

Facility

$18.00

Service Code	NDC 378013701
Hospital Charge Code	2697253
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

ALLOPURINOL 100MG TAB EMP

Facility

$18.00

Service Code	NDC 378013701
Hospital Charge Code	2697253
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

ALLOPURINOL 100MG TAB HE

Facility

$18.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2625810
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

ALLOPURINOL 100MG TAB HE

Facility

$18.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2625810
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

ALLOPURINOL 300MG TAB EMP

Facility

$15.00

Service Code	NDC 591554401
Hospital Charge Code	2697206
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

ALLOPURINOL 300MG TAB EMP

Facility

$15.00

Service Code	NDC 591554401
Hospital Charge Code	2697206
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

ALLOPURINOL (ZYLOPRIM) 100MG TAB

Facility

$20.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2654060
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

ALLOPURINOL (ZYLOPRIM) 100MG TAB

Facility

$20.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2654060
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

ALMOTRIPTAN 6.25MG 6-TAB PACK EMP

Facility

$147.00

Service Code	NDC 378524585
Hospital Charge Code	2626136
Hospital Revenue Code	250
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$104.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$87.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$104.96
Rate for Payer: Cash Price	$132.30
Rate for Payer: UnitedHealthcare Commercial	$98.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$52.92

ALMOTRIPTAN 6.25MG 6-TAB PACK EMP

Facility

$147.00

Service Code	NDC 378524585
Hospital Charge Code	2626136
Hospital Revenue Code	250
Rate for Payer: Cash Price	$132.30

ALOE VESTA PROTECTIVE OINTMENT 8OZ

Facility

$35.00

Hospital Charge Code	28324908
Hospital Revenue Code	271
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

ALOE VESTA PROTECTIVE OINTMENT 8OZ

Facility

$35.00

Hospital Charge Code	28324908
Hospital Revenue Code	271
Rate for Payer: Cash Price	$31.50

Know your out-of-pocket cost for care.

All Charges