Madison Medical Center

All Charges

Charge

Type

Setting

Price

LAB CHG FUNGAL SENS AMB/KETO

Facility

$842.00

Service Code	CPT 87186
Hospital Charge Code	30180968
Hospital Revenue Code	306
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$601.19
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.79
Rate for Payer: Aetna Medicare Advantage	$8.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$498.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$601.19
Rate for Payer: Cash Price	$757.80
Rate for Payer: Cash Price	$757.80
Rate for Payer: Cash Price	$757.80
Rate for Payer: Cigna Commercial HMO & PPO	$8.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.34
Rate for Payer: Home State Health Plan Medicare Advantage	$8.65
Rate for Payer: Humana Commercial	$17.30
Rate for Payer: Humana Medicare Advantage	$8.65
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$303.12

LAB CHG FUNGAL SENS AMB/KETO

Facility

$842.00

Service Code	CPT 87186
Hospital Charge Code	30180968
Hospital Revenue Code	306
Rate for Payer: Cash Price	$757.80

LAB CHG FUNGAL SENS FLUCONAZOLE

Facility

$526.00

Service Code	CPT 87186
Hospital Charge Code	30182220
Hospital Revenue Code	306
Rate for Payer: Cash Price	$473.40

LAB CHG FUNGAL SENS FLUCONAZOLE

Facility

$526.00

Service Code	CPT 87186
Hospital Charge Code	30182220
Hospital Revenue Code	306
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$375.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.79
Rate for Payer: Aetna Medicare Advantage	$8.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$311.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$375.56
Rate for Payer: Cash Price	$473.40
Rate for Payer: Cash Price	$473.40
Rate for Payer: Cash Price	$473.40
Rate for Payer: Cigna Commercial HMO & PPO	$8.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.34
Rate for Payer: Home State Health Plan Medicare Advantage	$8.65
Rate for Payer: Humana Commercial	$17.30
Rate for Payer: Humana Medicare Advantage	$8.65
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$189.36

LAB CHG FUNGAL SENS MICAFUNGIN

Facility

$663.00

Service Code	CPT 87186
Hospital Charge Code	30183509
Hospital Revenue Code	306
Rate for Payer: Cash Price	$596.70

LAB CHG FUNGAL SENS MICAFUNGIN

Facility

$663.00

Service Code	CPT 87186
Hospital Charge Code	30183509
Hospital Revenue Code	306
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$473.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.79
Rate for Payer: Aetna Medicare Advantage	$8.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$392.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$473.38
Rate for Payer: Cash Price	$596.70
Rate for Payer: Cash Price	$596.70
Rate for Payer: Cash Price	$596.70
Rate for Payer: Cigna Commercial HMO & PPO	$8.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.34
Rate for Payer: Home State Health Plan Medicare Advantage	$8.65
Rate for Payer: Humana Commercial	$17.30
Rate for Payer: Humana Medicare Advantage	$8.65
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.68

LAB CHG FUNGAL SENST POSA

Facility

$663.00

Service Code	CPT 87186
Hospital Charge Code	30183517
Hospital Revenue Code	306
Rate for Payer: Cash Price	$596.70

LAB CHG FUNGAL SENST POSA

Facility

$663.00

Service Code	CPT 87186
Hospital Charge Code	30183517
Hospital Revenue Code	306
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$473.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.79
Rate for Payer: Aetna Medicare Advantage	$8.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$392.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$473.38
Rate for Payer: Cash Price	$596.70
Rate for Payer: Cash Price	$596.70
Rate for Payer: Cash Price	$596.70
Rate for Payer: Cigna Commercial HMO & PPO	$8.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.34
Rate for Payer: Home State Health Plan Medicare Advantage	$8.65
Rate for Payer: Humana Commercial	$17.30
Rate for Payer: Humana Medicare Advantage	$8.65
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$238.68

LAB CHG ORGANISM ID AEROBIC

Facility

$105.00

Service Code	CPT 87077
Hospital Charge Code	3087076
Hospital Revenue Code	306
Rate for Payer: Cash Price	$94.50

LAB CHG ORGANISM ID AEROBIC

Facility

$105.00

Service Code	CPT 87077
Hospital Charge Code	3087076
Hospital Revenue Code	306
Min. Negotiated Rate	$7.27
Max. Negotiated Rate	$74.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.27
Rate for Payer: Aetna Medicare Advantage	$8.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cigna Commercial HMO & PPO	$8.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.78
Rate for Payer: Home State Health Plan Medicare Advantage	$8.08
Rate for Payer: Humana Commercial	$16.16
Rate for Payer: Humana Medicare Advantage	$8.08
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.80

LAB CHG ORGANISM ID ANAEROBIC

Facility

$105.00

Service Code	CPT 87076
Hospital Charge Code	3087077
Hospital Revenue Code	306
Min. Negotiated Rate	$7.27
Max. Negotiated Rate	$74.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.27
Rate for Payer: Aetna Medicare Advantage	$8.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cigna Commercial HMO & PPO	$8.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.78
Rate for Payer: Home State Health Plan Medicare Advantage	$8.08
Rate for Payer: Humana Commercial	$16.16
Rate for Payer: Humana Medicare Advantage	$8.08
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.80

LAB CHG ORGANISM ID ANAEROBIC

Facility

$105.00

Service Code	CPT 87076
Hospital Charge Code	3087077
Hospital Revenue Code	306
Rate for Payer: Cash Price	$94.50

LAB CHG SENSITIVITY BLOOD

Facility

$199.00

Service Code	CPT 87186
Hospital Charge Code	3007186
Hospital Revenue Code	306
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$142.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.79
Rate for Payer: Aetna Medicare Advantage	$8.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.09
Rate for Payer: Cash Price	$179.10
Rate for Payer: Cash Price	$179.10
Rate for Payer: Cash Price	$179.10
Rate for Payer: Cigna Commercial HMO & PPO	$8.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.34
Rate for Payer: Home State Health Plan Medicare Advantage	$8.65
Rate for Payer: Humana Commercial	$17.30
Rate for Payer: Humana Medicare Advantage	$8.65
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.64

LAB CHG SENSITIVITY BLOOD

Facility

$199.00

Service Code	CPT 87186
Hospital Charge Code	3007186
Hospital Revenue Code	306
Rate for Payer: Cash Price	$179.10

LAB CHG SENSITIVITY CULT

Facility

$199.00

Service Code	CPT 87186
Hospital Charge Code	3087186
Hospital Revenue Code	306
Rate for Payer: Cash Price	$179.10

LAB CHG SENSITIVITY CULT

Facility

$199.00

Service Code	CPT 87186
Hospital Charge Code	3087186
Hospital Revenue Code	306
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$142.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.79
Rate for Payer: Aetna Medicare Advantage	$8.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.09
Rate for Payer: Cash Price	$179.10
Rate for Payer: Cash Price	$179.10
Rate for Payer: Cash Price	$179.10
Rate for Payer: Cigna Commercial HMO & PPO	$8.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.34
Rate for Payer: Home State Health Plan Medicare Advantage	$8.65
Rate for Payer: Humana Commercial	$17.30
Rate for Payer: Humana Medicare Advantage	$8.65
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.64

LABETALOL 100MG TAB EMP

Facility

$21.00

Service Code	NDC 904592861
Hospital Charge Code	2622365
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

LABETALOL 100MG TAB EMP

Facility

$21.00

Service Code	NDC 904592861
Hospital Charge Code	2622365
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

LABETALOL (NORMODYNE) 100MG TAB

Facility

$21.00

Service Code	NDC 904592861
Hospital Charge Code	2657120
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

LABETALOL (NORMODYNE) 100MG TAB

Facility

$21.00

Service Code	NDC 904592861
Hospital Charge Code	2657120
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

LABETOCOL 1 ML

Facility

$75.00

Hospital Charge Code	2059108
Hospital Revenue Code	370
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
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: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

LABETOCOL 1 ML

Facility

$75.00

Hospital Charge Code	2059108
Hospital Revenue Code	370
Rate for Payer: Cash Price	$67.50

LABETOLOL (TRANDATE) 5MG/ML INJ 20ML MDV

Facility

$62.00

Service Code	HCPCS J3490
Hospital Charge Code	2655378
Hospital Revenue Code	250
Rate for Payer: Cash Price	$55.80

LABETOLOL (TRANDATE) 5MG/ML INJ 20ML MDV

Facility

$62.00

Service Code	HCPCS J3490
Hospital Charge Code	2655378
Hospital Revenue Code	250
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$44.27
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: UnitedHealthcare Commercial	$41.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

LACOSAMIDE

Facility

$409.00

Service Code	CPT 80339
Hospital Charge Code	2220299
Hospital Revenue Code	301
Rate for Payer: Cash Price	$368.10

Know your out-of-pocket cost for care.

All Charges