Madison Medical Center

All Charges

Charge

Type

Setting

Price

MENZ KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9787210
Hospital Revenue Code	521
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.24
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$5.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.61
Rate for Payer: Home State Health Plan Medicare Advantage	$5.82
Rate for Payer: Humana Commercial	$11.64
Rate for Payer: Humana Medicare Advantage	$5.82
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MENZ KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9787210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$36.00

MENZ RAPID STREP

Facility

$75.00

Service Code	CPT 87880
Hospital Charge Code	9787880
Hospital Revenue Code	521
Rate for Payer: Cash Price	$67.50

MENZ RAPID STREP

Facility

$75.00

Service Code	CPT 87880
Hospital Charge Code	9787880
Hospital Revenue Code	521
Min. Negotiated Rate	$13.39
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.88
Rate for Payer: Aetna Medicare Advantage	$16.53
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: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$16.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.92
Rate for Payer: Home State Health Plan Medicare Advantage	$16.53
Rate for Payer: Humana Commercial	$33.06
Rate for Payer: Humana Medicare Advantage	$16.53
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MENZ RSV

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	9787634
Hospital Revenue Code	521
Min. Negotiated Rate	$56.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$63.18
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$72.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$87.82
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$70.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$56.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$67.60
Rate for Payer: Home State Health Plan Medicare Advantage	$70.20
Rate for Payer: Humana Commercial	$140.40
Rate for Payer: Humana Medicare Advantage	$70.20
Rate for Payer: UnitedHealthcare Commercial	$82.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$63.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MENZ RSV

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	9787634
Hospital Revenue Code	521
Rate for Payer: Cash Price	$110.70

MENZ STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	9787651
Hospital Revenue Code	521
Min. Negotiated Rate	$28.42
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.58
Rate for Payer: Aetna Medicare Advantage	$35.09
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: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$35.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.79
Rate for Payer: Home State Health Plan Medicare Advantage	$35.09
Rate for Payer: Humana Commercial	$70.18
Rate for Payer: Humana Medicare Advantage	$35.09
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MENZ STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	9787651
Hospital Revenue Code	521
Rate for Payer: Cash Price	$67.50

MENZ URINE DIP

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	9781002
Hospital Revenue Code	521
Min. Negotiated Rate	$2.82
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$15.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.28
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cigna Commercial HMO & PPO	$3.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.35
Rate for Payer: Home State Health Plan Medicare Advantage	$3.48
Rate for Payer: Humana Commercial	$6.96
Rate for Payer: Humana Medicare Advantage	$3.48
Rate for Payer: UnitedHealthcare Commercial	$18.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MENZ URINE DIP

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	9781002
Hospital Revenue Code	521
Rate for Payer: Cash Price	$24.30

MENZ URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9781025
Hospital Revenue Code	521
Rate for Payer: Cash Price	$36.00

MENZ URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9781025
Hospital Revenue Code	521
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.75
Rate for Payer: Aetna Medicare Advantage	$8.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.29
Rate for Payer: Home State Health Plan Medicare Advantage	$8.61
Rate for Payer: Humana Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$8.61
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MEPERDINE INJ

Facility

$65.00

Service Code	HCPCS J2180
Hospital Charge Code	2058016
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

MEPERDINE INJ

Facility

$65.00

Service Code	HCPCS J2180
Hospital Charge Code	2058016
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

MEPERIDINE (DEMEROL) 25MG/ML INJ C2

Facility

$89.00

Service Code	HCPCS J2175
Hospital Charge Code	2655470
Hospital Revenue Code	250
Rate for Payer: Cash Price	$80.10

MEPERIDINE (DEMEROL) 25MG/ML INJ C2

Facility

$89.00

Service Code	HCPCS J2175
Hospital Charge Code	2655470
Hospital Revenue Code	250
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$63.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: UnitedHealthcare Commercial	$59.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

MEPERIDINE (DEMEROL) 50MG/ML INJ C2

Facility

$93.00

Service Code	HCPCS J2180
Hospital Charge Code	2655471
Hospital Revenue Code	250
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$66.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: UnitedHealthcare Commercial	$62.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

MEPERIDINE (DEMEROL) 50MG/ML INJ C2

Facility

$93.00

Service Code	HCPCS J2180
Hospital Charge Code	2655471
Hospital Revenue Code	250
Rate for Payer: Cash Price	$83.70

MEPERIDINE (DEMEROL) 75MG INJ 1ML C2

Facility

$89.00

Service Code	NDC 74117901
Hospital Charge Code	2655473
Hospital Revenue Code	250
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$63.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: UnitedHealthcare Commercial	$59.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

MEPERIDINE (DEMEROL) 75MG INJ 1ML C2

Facility

$89.00

Service Code	NDC 74117901
Hospital Charge Code	2655473
Hospital Revenue Code	250
Rate for Payer: Cash Price	$80.10

MEPILEX BORDER 4X4

Facility

$48.00

Hospital Charge Code	289905
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

MEPILEX BORDER 4X4

Facility

$48.00

Hospital Charge Code	289905
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

MEPILEX BORDER DRESSING--HEEL

Facility

$30.00

Hospital Charge Code	28285580
Hospital Revenue Code	271
Rate for Payer: Cash Price	$27.00

MEPILEX BORDER DRESSING--HEEL

Facility

$30.00

Hospital Charge Code	28285580
Hospital Revenue Code	271
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$21.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: UnitedHealthcare Commercial	$20.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

MEPILEX BORDER SACRUM

Facility

$44.00

Hospital Charge Code	80000349
Hospital Revenue Code	272
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

Know your out-of-pocket cost for care.

All Charges