Madison Medical Center

All Charges

Charge

Type

Setting

Price

AMIKACIN SULF 500MG/2ML INJ

Facility

$74.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2697747
Hospital Revenue Code	250
Rate for Payer: Cash Price	$66.60

AMIKACIN SULF 500MG/2ML INJ

Facility

$74.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2697747
Hospital Revenue Code	250
Min. Negotiated Rate	$26.64
Max. Negotiated Rate	$52.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$43.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$52.84
Rate for Payer: Cash Price	$66.60
Rate for Payer: UnitedHealthcare Commercial	$49.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.64

AMIKACIN, TROUGH

Facility

$102.00

Service Code	CPT 80150
Hospital Charge Code	2280151
Hospital Revenue Code	301
Rate for Payer: Cash Price	$91.80

AMIKACIN, TROUGH

Facility

$102.00

Service Code	CPT 80150
Hospital Charge Code	2280151
Hospital Revenue Code	301
Min. Negotiated Rate	$13.57
Max. Negotiated Rate	$72.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.57
Rate for Payer: Aetna Medicare Advantage	$15.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$60.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.83
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cash Price	$91.80
Rate for Payer: Cigna Commercial HMO & PPO	$15.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.52
Rate for Payer: Home State Health Plan Medicare Advantage	$15.08
Rate for Payer: Humana Commercial	$30.16
Rate for Payer: Humana Medicare Advantage	$15.08
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.72

AMINO ACID PROFILE, PLASMA

Facility

$429.00

Service Code	CPT 82139
Hospital Charge Code	2222108
Hospital Revenue Code	301
Rate for Payer: Cash Price	$386.10

AMINO ACID PROFILE, PLASMA

Facility

$429.00

Service Code	CPT 82139
Hospital Charge Code	2222108
Hospital Revenue Code	301
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$306.31
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.18
Rate for Payer: Aetna Medicare Advantage	$16.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$253.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$306.31
Rate for Payer: Cash Price	$386.10
Rate for Payer: Cash Price	$386.10
Rate for Payer: Cash Price	$386.10
Rate for Payer: Cigna Commercial HMO & PPO	$16.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.24
Rate for Payer: Home State Health Plan Medicare Advantage	$16.87
Rate for Payer: Humana Commercial	$33.74
Rate for Payer: Humana Medicare Advantage	$16.87
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$154.44

AMINO ACID PROFILE, URINE

Facility

$429.00

Service Code	CPT 82139
Hospital Charge Code	2222109
Hospital Revenue Code	301
Min. Negotiated Rate	$15.18
Max. Negotiated Rate	$306.31
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.18
Rate for Payer: Aetna Medicare Advantage	$16.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$253.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$306.31
Rate for Payer: Cash Price	$386.10
Rate for Payer: Cash Price	$386.10
Rate for Payer: Cash Price	$386.10
Rate for Payer: Cigna Commercial HMO & PPO	$16.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.24
Rate for Payer: Home State Health Plan Medicare Advantage	$16.87
Rate for Payer: Humana Commercial	$33.74
Rate for Payer: Humana Medicare Advantage	$16.87
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$154.44

AMINO ACID PROFILE, URINE

Facility

$429.00

Service Code	CPT 82139
Hospital Charge Code	2222109
Hospital Revenue Code	301
Rate for Payer: Cash Price	$386.10

AMINOPHYLLIN 250MG INJ 10ML

Facility

$106.00

Service Code	HCPCS J0280
Hospital Charge Code	2654105
Hospital Revenue Code	250
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$75.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: UnitedHealthcare Commercial	$70.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

AMINOPHYLLIN 250MG INJ 10ML

Facility

$106.00

Service Code	HCPCS J0280
Hospital Charge Code	2654105
Hospital Revenue Code	250
Rate for Payer: Cash Price	$95.40

AMINOPHYLLINE 250MG

Facility

$65.00

Service Code	HCPCS J0280
Hospital Charge Code	2058000
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

AMINOPHYLLINE 250MG

Facility

$65.00

Service Code	HCPCS J0280
Hospital Charge Code	2058000
Hospital Revenue Code	370
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

AMINOPHYLLINE 500MG INJ 20ML SDV

Facility

$60.00

Service Code	NDC 409592201
Hospital Charge Code	2697050
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

AMINOPHYLLINE 500MG INJ 20ML SDV

Facility

$60.00

Service Code	NDC 409592201
Hospital Charge Code	2697050
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

AMIODARONE

Facility

$110.00

Service Code	CPT 80299
Hospital Charge Code	222149
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

AMIODARONE

Facility

$110.00

Service Code	CPT 80299
Hospital Charge Code	222149
Hospital Revenue Code	301
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$78.54
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	$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	$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	$39.60

AMIODARONE 150MG/100ML DEX PREMIX 100ML

Facility

$152.00

Service Code	HCPCS J0282
Hospital Charge Code	2625827
Hospital Revenue Code	250
Rate for Payer: Cash Price	$136.80

AMIODARONE 150MG/100ML DEX PREMIX 100ML

Facility

$152.00

Service Code	HCPCS J0282
Hospital Charge Code	2625827
Hospital Revenue Code	250
Min. Negotiated Rate	$54.72
Max. Negotiated Rate	$108.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$108.53
Rate for Payer: Cash Price	$136.80
Rate for Payer: UnitedHealthcare Commercial	$101.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.72

AMIODARONE 150MG INJ 3ML VIAL

Facility

$111.00

Service Code	HCPCS J0282
Hospital Charge Code	2626360
Hospital Revenue Code	250
Rate for Payer: Cash Price	$99.90

AMIODARONE 150MG INJ 3ML VIAL

Facility

$111.00

Service Code	HCPCS J0282
Hospital Charge Code	2626360
Hospital Revenue Code	250
Min. Negotiated Rate	$39.96
Max. Negotiated Rate	$79.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.25
Rate for Payer: Cash Price	$99.90
Rate for Payer: UnitedHealthcare Commercial	$74.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.96

AMIODARONE 360MG/200ML DEX PREMIX 200ML

Facility

$184.00

Service Code	HCPCS J0282
Hospital Charge Code	2625828
Hospital Revenue Code	250
Rate for Payer: Cash Price	$165.60

AMIODARONE 360MG/200ML DEX PREMIX 200ML

Facility

$184.00

Service Code	HCPCS J0282
Hospital Charge Code	2625828
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

AMIODARONE (PACERONE) 200MG TAB EMP

Facility

$24.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2624229
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

AMIODARONE (PACERONE) 200MG TAB EMP

Facility

$24.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2624229
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

AMIODARONE (PACERONE) 200MG TAB UD

Facility

$24.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2626598
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

Know your out-of-pocket cost for care.

All Charges