Madison Medical Center

All Charges

Charge

Type

Setting

Price

MYOGLOBIN SERUM

Facility

$169.00

Service Code	CPT 83874
Hospital Charge Code	2283874
Hospital Revenue Code	301
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$120.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.63
Rate for Payer: Aetna Medicare Advantage	$12.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$120.67
Rate for Payer: Cash Price	$152.10
Rate for Payer: Cash Price	$152.10
Rate for Payer: Cash Price	$152.10
Rate for Payer: Cigna Commercial HMO & PPO	$12.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.44
Rate for Payer: Home State Health Plan Medicare Advantage	$12.92
Rate for Payer: Humana Commercial	$25.84
Rate for Payer: Humana Medicare Advantage	$12.92
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.84

MYOGLOBIN SERUM

Facility

$169.00

Service Code	CPT 83874
Hospital Charge Code	2283874
Hospital Revenue Code	301
Rate for Payer: Cash Price	$152.10

MYOGLOBIN URINE

Facility

$165.00

Service Code	CPT 83874
Hospital Charge Code	2213902
Hospital Revenue Code	307
Rate for Payer: Cash Price	$148.50

MYOGLOBIN URINE

Facility

$165.00

Service Code	CPT 83874
Hospital Charge Code	2213902
Hospital Revenue Code	307
Min. Negotiated Rate	$11.63
Max. Negotiated Rate	$117.81
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.63
Rate for Payer: Aetna Medicare Advantage	$12.92
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: Cash Price	$148.50
Rate for Payer: Cigna Commercial HMO & PPO	$12.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.44
Rate for Payer: Home State Health Plan Medicare Advantage	$12.92
Rate for Payer: Humana Commercial	$25.84
Rate for Payer: Humana Medicare Advantage	$12.92
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

.MYOMARKER PANEL COMPONENT

Facility

$161.00

Service Code	CPT 83516
Hospital Charge Code	2284000
Hospital Revenue Code	302
Rate for Payer: Cash Price	$144.90

.MYOMARKER PANEL COMPONENT

Facility

$158.00

Service Code	CPT 83520
Hospital Charge Code	2284001
Hospital Revenue Code	302
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$112.81
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.54
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$93.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$112.81
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cigna Commercial HMO & PPO	$17.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.63
Rate for Payer: Home State Health Plan Medicare Advantage	$17.27
Rate for Payer: Humana Commercial	$34.54
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.88

.MYOMARKER PANEL COMPONENT

Facility

$161.00

Service Code	CPT 83516
Hospital Charge Code	2284000
Hospital Revenue Code	302
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$114.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$95.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.95
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$57.96

.MYOMARKER PANEL COMPONENT

Facility

$161.00

Service Code	CPT 86235
Hospital Charge Code	2284002
Hospital Revenue Code	302
Rate for Payer: Cash Price	$144.90

.MYOMARKER PANEL COMPONENT

Facility

$161.00

Service Code	CPT 86235
Hospital Charge Code	2284002
Hospital Revenue Code	302
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$114.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.14
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$95.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.95
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cigna Commercial HMO & PPO	$17.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.27
Rate for Payer: Home State Health Plan Medicare Advantage	$17.93
Rate for Payer: Humana Commercial	$35.86
Rate for Payer: Humana Medicare Advantage	$17.93
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$57.96

.MYOMARKER PANEL COMPONENT

Facility

$158.00

Service Code	CPT 83520
Hospital Charge Code	2284001
Hospital Revenue Code	302
Rate for Payer: Cash Price	$142.20

MYRBETRIQ 25MG TAB EMP

Facility

$51.00

Service Code	NDC 469260130
Hospital Charge Code	2624901
Hospital Revenue Code	250
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$36.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$36.41
Rate for Payer: Cash Price	$45.90
Rate for Payer: UnitedHealthcare Commercial	$34.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.36

MYRBETRIQ 25MG TAB EMP

Facility

$51.00

Service Code	NDC 469260130
Hospital Charge Code	2624901
Hospital Revenue Code	250
Rate for Payer: Cash Price	$45.90

MYRINGOPLASTY

Professional

Both

$2,700.00

Service Code	CPT 69620
Hospital Charge Code	9369620
Hospital Revenue Code	975
Min. Negotiated Rate	$419.91
Max. Negotiated Rate	$945.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$419.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$568.46
Rate for Payer: Cash Price	$2,430.00
Rate for Payer: Cash Price	$2,430.00
Rate for Payer: Cigna Commercial HMO & PPO	$419.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$568.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$625.31
Rate for Payer: Home State Health Plan Medicare Advantage	$419.91
Rate for Payer: Optum Medicare Advantage	$945.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$568.46

MYRINGOTOMY TUBE

Facility

$486.00

Hospital Charge Code	127495
Hospital Revenue Code	271
Min. Negotiated Rate	$174.96
Max. Negotiated Rate	$347.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$287.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$347.00
Rate for Payer: Cash Price	$437.40
Rate for Payer: UnitedHealthcare Commercial	$324.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$174.96

MYRINGOTOMY TUBE

Facility

$486.00

Hospital Charge Code	127495
Hospital Revenue Code	271
Rate for Payer: Cash Price	$437.40

MYRING TUBES

Facility

$288.00

Hospital Charge Code	1220722
Hospital Revenue Code	272
Min. Negotiated Rate	$103.68
Max. Negotiated Rate	$205.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$170.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$205.63
Rate for Payer: Cash Price	$259.20
Rate for Payer: UnitedHealthcare Commercial	$192.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.68

MYRING TUBES

Facility

$288.00

Hospital Charge Code	1220722
Hospital Revenue Code	272
Rate for Payer: Cash Price	$259.20

N2-202

Facility

$129.00

Hospital Charge Code	2014004
Hospital Revenue Code	370
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
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: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

N2-202

Facility

$129.00

Hospital Charge Code	2014004
Hospital Revenue Code	370
Rate for Payer: Cash Price	$116.10

NABUMETONE 500MG TAB EMP

Facility

$17.00

Service Code	NDC 115165701
Hospital Charge Code	2622246
Hospital Revenue Code	250
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$12.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.14
Rate for Payer: Cash Price	$15.30
Rate for Payer: UnitedHealthcare Commercial	$11.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.12

NABUMETONE 500MG TAB EMP

Facility

$17.00

Service Code	NDC 115165701
Hospital Charge Code	2622246
Hospital Revenue Code	250
Rate for Payer: Cash Price	$15.30

NADOLOL (CORGARD) 20MG TAB EMP

Facility

$55.00

Service Code	NDC 2.7505E+10
Hospital Charge Code	2697063
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

NADOLOL (CORGARD) 20MG TAB EMP

Facility

$55.00

Service Code	NDC 2.7505E+10
Hospital Charge Code	2697063
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
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: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

NADOLOL (CORGARD) 40MG TAB EMP

Facility

$55.00

Service Code	NDC 2.7505E+10
Hospital Charge Code	2627095
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
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: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

NADOLOL (CORGARD) 40MG TAB EMP

Facility

$55.00

Service Code	NDC 2.7505E+10
Hospital Charge Code	2627095
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

Know your out-of-pocket cost for care.

All Charges