Madison Medical Center

All Charges

Charge

Type

Setting

Price

IGG

Facility

$62.00

Service Code	CPT 82784
Hospital Charge Code	229270
Hospital Revenue Code	301
Rate for Payer: Cash Price	$55.80

IGG

Facility

$62.00

Service Code	CPT 82784
Hospital Charge Code	229270
Hospital Revenue Code	301
Min. Negotiated Rate	$8.37
Max. Negotiated Rate	$44.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.37
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cigna Commercial HMO & PPO	$9.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.96
Rate for Payer: Home State Health Plan Medicare Advantage	$9.30
Rate for Payer: Humana Commercial	$18.60
Rate for Payer: Humana Medicare Advantage	$9.30
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

.IGG SUBCLASS 1

Facility

$75.00

Service Code	CPT 82787
Hospital Charge Code	2282790
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

.IGG SUBCLASS 1

Facility

$75.00

Service Code	CPT 82787
Hospital Charge Code	2282790
Hospital Revenue Code	301
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.22
Rate for Payer: Aetna Medicare Advantage	$8.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$8.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.73
Rate for Payer: Home State Health Plan Medicare Advantage	$8.02
Rate for Payer: Humana Commercial	$16.04
Rate for Payer: Humana Medicare Advantage	$8.02
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

.IGG SUBCLASS 2

Facility

$75.00

Service Code	CPT 82787
Hospital Charge Code	2282789
Hospital Revenue Code	301
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.22
Rate for Payer: Aetna Medicare Advantage	$8.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$8.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.73
Rate for Payer: Home State Health Plan Medicare Advantage	$8.02
Rate for Payer: Humana Commercial	$16.04
Rate for Payer: Humana Medicare Advantage	$8.02
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

.IGG SUBCLASS 2

Facility

$75.00

Service Code	CPT 82787
Hospital Charge Code	2282789
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

.IGG SUBCLASS 3

Facility

$75.00

Service Code	CPT 82787
Hospital Charge Code	2282788
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

.IGG SUBCLASS 3

Facility

$75.00

Service Code	CPT 82787
Hospital Charge Code	2282788
Hospital Revenue Code	301
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.22
Rate for Payer: Aetna Medicare Advantage	$8.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$8.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.73
Rate for Payer: Home State Health Plan Medicare Advantage	$8.02
Rate for Payer: Humana Commercial	$16.04
Rate for Payer: Humana Medicare Advantage	$8.02
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

.IGG SUBCLASS 4

Facility

$75.00

Service Code	CPT 82787
Hospital Charge Code	2282787
Hospital Revenue Code	301
Min. Negotiated Rate	$7.22
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.22
Rate for Payer: Aetna Medicare Advantage	$8.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$8.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.73
Rate for Payer: Home State Health Plan Medicare Advantage	$8.02
Rate for Payer: Humana Commercial	$16.04
Rate for Payer: Humana Medicare Advantage	$8.02
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

.IGG SUBCLASS 4

Facility

$75.00

Service Code	CPT 82787
Hospital Charge Code	2282787
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

IGM

Facility

$70.00

Service Code	CPT 82784
Hospital Charge Code	229274
Hospital Revenue Code	301
Min. Negotiated Rate	$8.37
Max. Negotiated Rate	$49.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.37
Rate for Payer: Aetna Medicare Advantage	$9.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$9.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.96
Rate for Payer: Home State Health Plan Medicare Advantage	$9.30
Rate for Payer: Humana Commercial	$18.60
Rate for Payer: Humana Medicare Advantage	$9.30
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

IGM

Facility

$70.00

Service Code	CPT 82784
Hospital Charge Code	229274
Hospital Revenue Code	301
Rate for Payer: Cash Price	$63.00

IL28B

Facility

$448.00

Service Code	CPT 81479
Hospital Charge Code	2281479
Hospital Revenue Code	305
Rate for Payer: Cash Price	$403.20

IL28B

Facility

$448.00

Service Code	CPT 81479
Hospital Charge Code	2281479
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$963.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$900.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$265.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$319.87
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cash Price	$403.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$900.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$963.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$900.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$161.28

IMIPEN-CILAST(PRIMAXIN) 500MG 10ML VL

Facility

$263.00

Service Code	HCPCS J0743
Hospital Charge Code	2656019
Hospital Revenue Code	250
Rate for Payer: Cash Price	$236.70

IMIPEN-CILAST(PRIMAXIN) 500MG 10ML VL

Facility

$263.00

Service Code	HCPCS J0743
Hospital Charge Code	2656019
Hospital Revenue Code	250
Min. Negotiated Rate	$94.68
Max. Negotiated Rate	$187.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$155.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$187.78
Rate for Payer: Cash Price	$236.70
Rate for Payer: UnitedHealthcare Commercial	$175.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$94.68

IMIPRAMINE

Facility

$165.00

Service Code	CPT 80335
Hospital Charge Code	229500
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

IMIPRAMINE

Facility

$165.00

Service Code	CPT 80335
Hospital Charge Code	229500
Hospital Revenue Code	301
Rate for Payer: Cash Price	$148.50

IMMUNOFIXATION 24 HR URINE

Facility

$91.00

Service Code	CPT 86335
Hospital Charge Code	2286336
Hospital Revenue Code	302
Rate for Payer: Cash Price	$81.90

IMMUNOFIXATION 24 HR URINE

Facility

$91.00

Service Code	CPT 86335
Hospital Charge Code	2286336
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$64.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$26.42
Rate for Payer: Aetna Medicare Advantage	$29.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cigna Commercial HMO & PPO	$29.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28.27
Rate for Payer: Home State Health Plan Medicare Advantage	$29.35
Rate for Payer: Humana Commercial	$58.70
Rate for Payer: Humana Medicare Advantage	$29.35
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

IMMUNOFIXATION RANDOM URINE

Facility

$196.00

Service Code	CPT 86335
Hospital Charge Code	2286335
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$139.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$26.42
Rate for Payer: Aetna Medicare Advantage	$29.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$116.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.94
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cash Price	$176.40
Rate for Payer: Cigna Commercial HMO & PPO	$29.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28.27
Rate for Payer: Home State Health Plan Medicare Advantage	$29.35
Rate for Payer: Humana Commercial	$58.70
Rate for Payer: Humana Medicare Advantage	$29.35
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.56

IMMUNOFIXATION RANDOM URINE

Facility

$196.00

Service Code	CPT 86335
Hospital Charge Code	2286335
Hospital Revenue Code	302
Rate for Payer: Cash Price	$176.40

IMMUNOFIXATION SERUM

Facility

$121.00

Service Code	CPT 86334
Hospital Charge Code	2286344
Hospital Revenue Code	302
Rate for Payer: Cash Price	$108.90

IMMUNOFIXATION SERUM

Facility

$121.00

Service Code	CPT 86334
Hospital Charge Code	2286344
Hospital Revenue Code	302
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$86.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$20.11
Rate for Payer: Aetna Medicare Advantage	$22.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$71.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$86.39
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cigna Commercial HMO & PPO	$22.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21.52
Rate for Payer: Home State Health Plan Medicare Advantage	$22.34
Rate for Payer: Humana Commercial	$44.68
Rate for Payer: Humana Medicare Advantage	$22.34
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$43.56

IMOVAX RABIES VAC 1ML IM INJ (EGG FREE)

Facility

$2,330.00

Service Code	HCPCS 90675
Hospital Charge Code	2625477
Hospital Revenue Code	250
Min. Negotiated Rate	$331.98
Max. Negotiated Rate	$1,663.62
Rate for Payer: Aetna Medicare Advantage	$331.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,379.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,663.62
Rate for Payer: Cash Price	$2,097.00
Rate for Payer: Cash Price	$2,097.00
Rate for Payer: Cigna Commercial HMO & PPO	$331.98
Rate for Payer: Home State Health Plan Medicare Advantage	$331.98
Rate for Payer: Humana Commercial	$663.96
Rate for Payer: Humana Medicare Advantage	$331.98
Rate for Payer: UnitedHealthcare Commercial	$1,554.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.80

Know your out-of-pocket cost for care.

All Charges