Madison Medical Center

All Charges

Charge

Type

Setting

Price

OLIVERO URINE DIP

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	5481002
Hospital Revenue Code	307
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$21.00
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: Cigna Commercial HMO & PPO	$3.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.13
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	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72

OLIVERO URINE DIP

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	5481002
Hospital Revenue Code	307
Rate for Payer: Cash Price	$24.30

OLIVERO URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	5481025
Hospital Revenue Code	307
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$28.56
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: Cigna Commercial HMO & PPO	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.75
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	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

OLIVERO URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	5481025
Hospital Revenue Code	307
Rate for Payer: Cash Price	$36.00

OLMESARTAN (BENICAR) 20MG TAB

Facility

$21.00

Service Code	NDC 6.5597E+10
Hospital Charge Code	2626347
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

OLMESARTAN (BENICAR) 20MG TAB

Facility

$21.00

Service Code	NDC 6.5597E+10
Hospital Charge Code	2626347
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

OLMESARTAN (BENICAR) 20MG TAB EMP

Facility

$21.00

Service Code	NDC 6.5597E+10
Hospital Charge Code	2622617
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

OLMESARTAN (BENICAR) 20MG TAB EMP

Facility

$21.00

Service Code	NDC 6.5597E+10
Hospital Charge Code	2622617
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

OLOPATADINE 0.1% OP SOLN 5ML EMP

Facility

$624.00

Service Code	NDC 65027105
Hospital Charge Code	2684672
Hospital Revenue Code	250
Rate for Payer: Cash Price	$561.60

OLOPATADINE 0.1% OP SOLN 5ML EMP

Facility

$624.00

Service Code	NDC 65027105
Hospital Charge Code	2684672
Hospital Revenue Code	250
Min. Negotiated Rate	$224.64
Max. Negotiated Rate	$445.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$369.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$445.54
Rate for Payer: Cash Price	$561.60
Rate for Payer: UnitedHealthcare Commercial	$416.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$224.64

OLOPATADINE 0.2% OP SOLN 2.5ML EMP

Facility

$624.00

Service Code	NDC 65027105
Hospital Charge Code	2623509
Hospital Revenue Code	250
Min. Negotiated Rate	$224.64
Max. Negotiated Rate	$445.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$369.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$445.54
Rate for Payer: Cash Price	$561.60
Rate for Payer: UnitedHealthcare Commercial	$416.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$224.64

OLOPATADINE 0.2% OP SOLN 2.5ML EMP

Facility

$624.00

Service Code	NDC 65027105
Hospital Charge Code	2623509
Hospital Revenue Code	250
Rate for Payer: Cash Price	$561.60

OMEGA 3 ACID (LOVAZA) 1GM CAP

Facility

$20.00

Service Code	NDC 173078302
Hospital Charge Code	2626490
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

OMEGA 3 ACID (LOVAZA) 1GM CAP

Facility

$20.00

Service Code	NDC 173078302
Hospital Charge Code	2626490
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

OMEGA 3 ACID (LOVAZA) 1GM CAP EMP

Facility

$20.00

Service Code	NDC 6.9784E+10
Hospital Charge Code	2622506
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

OMEGA 3 ACID (LOVAZA) 1GM CAP EMP

Facility

$20.00

Service Code	NDC 6.9784E+10
Hospital Charge Code	2622506
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

OMEGA 3 (FISH OIL) 1000MG CAP

Facility

$16.00

Service Code	NDC 7.7333E+10
Hospital Charge Code	2626520
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

OMEGA 3 (FISH OIL) 1000MG CAP

Facility

$16.00

Service Code	NDC 7.7333E+10
Hospital Charge Code	2626520
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

OMENTECTOMY

Professional

Both

$1,709.00

Service Code	CPT 49255
Hospital Charge Code	4149255
Hospital Revenue Code	975
Min. Negotiated Rate	$597.83
Max. Negotiated Rate	$715.26
Rate for Payer: Aetna Commercial/Medicare Advantage	$715.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$597.83
Rate for Payer: Cash Price	$1,538.10
Rate for Payer: Cash Price	$1,538.10
Rate for Payer: Cigna Commercial HMO & PPO	$715.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$597.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$657.61
Rate for Payer: Home State Health Plan Medicare Advantage	$715.26
Rate for Payer: Optum Medicare Advantage	$598.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$597.83

OMENTECTOMY, EPIPLEOCTOMY, RESEC OF OMEN

Professional

Both

$2,100.00

Service Code	CPT 49255
Hospital Charge Code	5449255
Hospital Revenue Code	975
Min. Negotiated Rate	$597.83
Max. Negotiated Rate	$735.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$715.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$597.83
Rate for Payer: Cash Price	$1,890.00
Rate for Payer: Cash Price	$1,890.00
Rate for Payer: Cigna Commercial HMO & PPO	$715.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$597.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$657.61
Rate for Payer: Home State Health Plan Medicare Advantage	$715.26
Rate for Payer: Optum Medicare Advantage	$735.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$597.83

OMEPRAZOLE 40MG CAP EMP

Facility

$55.00

Service Code	NDC 6.2175E+10
Hospital Charge Code	2697325
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

OMEPRAZOLE 40MG CAP EMP

Facility

$55.00

Service Code	NDC 6.2175E+10
Hospital Charge Code	2697325
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

OMEPRAZOLE ORAL SUSP 2MG/ML 150ML

Facility

$259.00

Service Code	NDC 6.5628E+10
Hospital Charge Code	2622636
Hospital Revenue Code	250
Min. Negotiated Rate	$93.24
Max. Negotiated Rate	$184.93
Rate for Payer: Cash Price	$233.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$184.93
Rate for Payer: UnitedHealthcare Commercial	$172.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$93.24

OMEPRAZOLE ORAL SUSP 2MG/ML 150ML

Facility

$259.00

Service Code	NDC 6.5628E+10
Hospital Charge Code	2622636
Hospital Revenue Code	250
Rate for Payer: Cash Price	$233.10

OMEPRAZOLE (PRILOSEC) 20MG CAP

Facility

$62.00

Service Code	NDC 904691761
Hospital Charge Code	2655442
Hospital Revenue Code	250
Rate for Payer: Cash Price	$55.80

Know your out-of-pocket cost for care.

All Charges