Madison Medical Center

All Charges

Charge

Type

Setting

Price

ALP BONE SPECIFIC

Facility

$129.00

Service Code	CPT 84080
Hospital Charge Code	2284081
Hospital Revenue Code	301
Rate for Payer: Cash Price	$116.10

ALP BONE SPECIFIC

Facility

$129.00

Service Code	CPT 84080
Hospital Charge Code	2284081
Hospital Revenue Code	301
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$92.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.30
Rate for Payer: Aetna Medicare Advantage	$14.78
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	$14.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.23
Rate for Payer: Home State Health Plan Medicare Advantage	$14.78
Rate for Payer: Humana Commercial	$29.56
Rate for Payer: Humana Medicare Advantage	$14.78
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

ALPHA 1 ANTIPRYP PHENOTYPE

Facility

$25.00

Service Code	CPT 82104
Hospital Charge Code	2282104
Hospital Revenue Code	301
Rate for Payer: Cash Price	$22.50

ALPHA 1 ANTIPRYP PHENOTYPE

Facility

$25.00

Service Code	CPT 82104
Hospital Charge Code	2282104
Hospital Revenue Code	301
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$28.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.01
Rate for Payer: Aetna Medicare Advantage	$14.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna Commercial HMO & PPO	$14.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.92
Rate for Payer: Home State Health Plan Medicare Advantage	$14.46
Rate for Payer: Humana Commercial	$28.92
Rate for Payer: Humana Medicare Advantage	$14.46
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.00

ALPHA 1 ANTITRYPSIN

Facility

$129.00

Service Code	CPT 82103
Hospital Charge Code	2282103
Hospital Revenue Code	301
Min. Negotiated Rate	$12.10
Max. Negotiated Rate	$92.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.10
Rate for Payer: Aetna Medicare Advantage	$13.44
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	$13.44
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.95
Rate for Payer: Home State Health Plan Medicare Advantage	$13.44
Rate for Payer: Humana Commercial	$26.88
Rate for Payer: Humana Medicare Advantage	$13.44
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

ALPHA 1 ANTITRYPSIN

Facility

$129.00

Service Code	CPT 82103
Hospital Charge Code	2282103
Hospital Revenue Code	301
Rate for Payer: Cash Price	$116.10

ALPHA 2 MACROGLOBOLIN

Facility

$240.00

Service Code	CPT 83883
Hospital Charge Code	2203883
Hospital Revenue Code	305
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$171.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.24
Rate for Payer: Aetna Medicare Advantage	$13.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$142.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$171.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cigna Commercial HMO & PPO	$13.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.10
Rate for Payer: Home State Health Plan Medicare Advantage	$13.60
Rate for Payer: Humana Commercial	$27.20
Rate for Payer: Humana Medicare Advantage	$13.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$86.40

ALPHA 2 MACROGLOBOLIN

Facility

$240.00

Service Code	CPT 83883
Hospital Charge Code	2203883
Hospital Revenue Code	305
Rate for Payer: Cash Price	$216.00

.ALPHA 2-MACROGLOBULINS, QN CPT 83883

Facility

$55.00

Service Code	CPT 83883
Hospital Charge Code	22283883
Hospital Revenue Code	307
Rate for Payer: Cash Price	$49.50

.ALPHA 2-MACROGLOBULINS, QN CPT 83883

Facility

$55.00

Service Code	CPT 83883
Hospital Charge Code	22283883
Hospital Revenue Code	307
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.24
Rate for Payer: Aetna Medicare Advantage	$13.60
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: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$13.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.10
Rate for Payer: Home State Health Plan Medicare Advantage	$13.60
Rate for Payer: Humana Commercial	$27.20
Rate for Payer: Humana Medicare Advantage	$13.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

ALPHA-Galactosidase A Deficiency

Facility

$588.00

Service Code	CPT 82657
Hospital Charge Code	2282657
Hospital Revenue Code	301
Rate for Payer: Cash Price	$529.20

ALPHA-Galactosidase A Deficiency

Facility

$588.00

Service Code	CPT 82657
Hospital Charge Code	2282657
Hospital Revenue Code	301
Min. Negotiated Rate	$19.95
Max. Negotiated Rate	$419.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.95
Rate for Payer: Aetna Medicare Advantage	$22.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$348.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$419.83
Rate for Payer: Cash Price	$529.20
Rate for Payer: Cash Price	$529.20
Rate for Payer: Cash Price	$529.20
Rate for Payer: Cigna Commercial HMO & PPO	$22.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21.35
Rate for Payer: Home State Health Plan Medicare Advantage	$22.17
Rate for Payer: Humana Commercial	$44.34
Rate for Payer: Humana Medicare Advantage	$22.17
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$211.68

ALPHA GAL IGE (LABCORP 650003)

Facility

$296.00

Service Code	CPT 86003
Hospital Charge Code	2282956
Hospital Revenue Code	302
Rate for Payer: Cash Price	$266.40

ALPHA GAL IGE (LABCORP 650003)

Facility

$296.00

Service Code	CPT 86003
Hospital Charge Code	2282956
Hospital Revenue Code	302
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$211.34
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	$175.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$211.34
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cash Price	$266.40
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	$106.56

ALPHA SUBUNIT

Facility

$391.00

Service Code	CPT 83519
Hospital Charge Code	223519
Hospital Revenue Code	301
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$279.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.56
Rate for Payer: Aetna Medicare Advantage	$18.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$231.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$279.17
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cigna Commercial HMO & PPO	$18.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.72
Rate for Payer: Home State Health Plan Medicare Advantage	$18.40
Rate for Payer: Humana Commercial	$36.80
Rate for Payer: Humana Medicare Advantage	$18.40
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$140.76

ALPHA SUBUNIT

Facility

$391.00

Service Code	CPT 83519
Hospital Charge Code	223519
Hospital Revenue Code	301
Rate for Payer: Cash Price	$351.90

ALPHA THALASSEMIA DNA ANAL

Facility

$516.00

Service Code	CPT 81257
Hospital Charge Code	2281257
Hospital Revenue Code	305
Rate for Payer: Cash Price	$464.40

ALPHA THALASSEMIA DNA ANAL

Facility

$516.00

Service Code	CPT 81257
Hospital Charge Code	2281257
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$368.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$92.03
Rate for Payer: Aetna Medicare Advantage	$102.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$305.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$368.42
Rate for Payer: Cash Price	$464.40
Rate for Payer: Cash Price	$464.40
Rate for Payer: Cash Price	$464.40
Rate for Payer: Cigna Commercial HMO & PPO	$102.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$92.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$98.47
Rate for Payer: Home State Health Plan Medicare Advantage	$102.26
Rate for Payer: Humana Commercial	$204.52
Rate for Payer: Humana Medicare Advantage	$102.26
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$92.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$185.76

ALP ISOENZYMES

Facility

$129.00

Service Code	CPT 84080
Hospital Charge Code	2284080
Hospital Revenue Code	301
Min. Negotiated Rate	$13.30
Max. Negotiated Rate	$92.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.30
Rate for Payer: Aetna Medicare Advantage	$14.78
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	$14.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.23
Rate for Payer: Home State Health Plan Medicare Advantage	$14.78
Rate for Payer: Humana Commercial	$29.56
Rate for Payer: Humana Medicare Advantage	$14.78
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

ALP ISOENZYMES

Facility

$129.00

Service Code	CPT 84080
Hospital Charge Code	2284080
Hospital Revenue Code	301
Rate for Payer: Cash Price	$116.10

ALPRAZOLAM

Facility

$127.00

Service Code	CPT 80299
Hospital Charge Code	2200299
Hospital Revenue Code	301
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$90.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.78
Rate for Payer: Aetna Medicare Advantage	$18.64
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	$18.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.95
Rate for Payer: Home State Health Plan Medicare Advantage	$18.64
Rate for Payer: Humana Commercial	$37.28
Rate for Payer: Humana Medicare Advantage	$18.64
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

ALPRAZOLAM

Facility

$127.00

Service Code	CPT 80299
Hospital Charge Code	2200299
Hospital Revenue Code	301
Rate for Payer: Cash Price	$114.30

ALPRAZOLAM 0.25MG TAB EMP C4

Facility

$21.00

Service Code	NDC 904585861
Hospital Charge Code	2620518
Hospital Revenue Code	250
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

ALPRAZOLAM 0.25MG TAB EMP C4

Facility

$21.00

Service Code	NDC 904585861
Hospital Charge Code	2620518
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

ALPRAZOLAM 0.5MG TAB EMP C4

Facility

$21.00

Service Code	NDC 6.7253E+10
Hospital Charge Code	2619231
Hospital Revenue Code	250
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

Know your out-of-pocket cost for care.

All Charges