Madison Medical Center

All Charges

Charge

Type

Setting

Price

ORTHOVISC 30MG INJ 2ML

Facility

$2,374.00

Service Code	HCPCS J7325
Hospital Charge Code	2621597
Hospital Revenue Code	250
Rate for Payer: Cash Price	$2,136.60

ORTHOVISC 30MG INJ 2ML

Facility

$561.00

Service Code	HCPCS J7325
Hospital Charge Code	9107324
Hospital Revenue Code	521
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$400.55
Rate for Payer: Aetna Medicare Advantage	$6.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$332.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$400.55
Rate for Payer: Cash Price	$504.90
Rate for Payer: Cash Price	$504.90
Rate for Payer: Cash Price	$504.90
Rate for Payer: Cigna Commercial HMO & PPO	$6.02
Rate for Payer: Home State Health Plan Medicare Advantage	$6.02
Rate for Payer: Humana Commercial	$12.04
Rate for Payer: Humana Medicare Advantage	$6.02
Rate for Payer: UnitedHealthcare Commercial	$374.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OSCALSIS LT

Facility

$443.00

Service Code	CPT 73650
Hospital Charge Code	3215167
Hospital Revenue Code	320
Rate for Payer: Cash Price	$398.70

OSCALSIS LT

Facility

$443.00

Service Code	CPT 73650
Hospital Charge Code	3215167
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$316.30
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$262.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$316.30
Rate for Payer: Cash Price	$398.70
Rate for Payer: Cash Price	$398.70
Rate for Payer: Cash Price	$398.70
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$159.48

OSCALSIS RT

Facility

$443.00

Service Code	CPT 73650
Hospital Charge Code	3215166
Hospital Revenue Code	320
Rate for Payer: Cash Price	$398.70

OSCALSIS RT

Facility

$443.00

Service Code	CPT 73650
Hospital Charge Code	3215166
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$316.30
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$262.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$316.30
Rate for Payer: Cash Price	$398.70
Rate for Payer: Cash Price	$398.70
Rate for Payer: Cash Price	$398.70
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$159.48

OSELTAMIVIR (TAMIFLU) 45MG CAP

Facility

$59.00

Service Code	NDC 4080185
Hospital Charge Code	2626552
Hospital Revenue Code	250
Rate for Payer: Cash Price	$53.10

OSELTAMIVIR (TAMIFLU) 45MG CAP

Facility

$59.00

Service Code	NDC 4080185
Hospital Charge Code	2626552
Hospital Revenue Code	250
Min. Negotiated Rate	$21.24
Max. Negotiated Rate	$42.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.13
Rate for Payer: Cash Price	$53.10
Rate for Payer: UnitedHealthcare Commercial	$39.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.24

OSELTAMIVIR(TAMIFLU) 6MG/ML60ML SUS

Facility

$715.00

Service Code	NDC 4082009
Hospital Charge Code	2626553
Hospital Revenue Code	250
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$510.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$423.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$510.51
Rate for Payer: Cash Price	$643.50
Rate for Payer: UnitedHealthcare Commercial	$476.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$257.40

OSELTAMIVIR(TAMIFLU) 6MG/ML60ML SUS

Facility

$715.00

Service Code	NDC 4082009
Hospital Charge Code	2626553
Hospital Revenue Code	250
Rate for Payer: Cash Price	$643.50

OSELTAMIVIR (TAMIFLU) 75MG CAP

Facility

$63.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2626336
Hospital Revenue Code	250
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

OSELTAMIVIR (TAMIFLU) 75MG CAP

Facility

$63.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2626336
Hospital Revenue Code	250
Rate for Payer: Cash Price	$56.70

OSELTAMIVIR (TAMIFLU) 75MG CAP EMP

Facility

$63.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2623224
Hospital Revenue Code	250
Rate for Payer: Cash Price	$56.70

OSELTAMIVIR (TAMIFLU) 75MG CAP EMP

Facility

$63.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2623224
Hospital Revenue Code	250
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

OSMOLALITY, FECAL

Facility

$62.00

Service Code	CPT 83935
Hospital Charge Code	2227084
Hospital Revenue Code	307
Min. Negotiated Rate	$6.14
Max. Negotiated Rate	$44.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.14
Rate for Payer: Aetna Medicare Advantage	$6.82
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: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cigna Commercial HMO & PPO	$6.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.57
Rate for Payer: Home State Health Plan Medicare Advantage	$6.82
Rate for Payer: Humana Commercial	$13.64
Rate for Payer: Humana Medicare Advantage	$6.82
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

OSMOLALITY, FECAL

Facility

$62.00

Service Code	CPT 83935
Hospital Charge Code	2227084
Hospital Revenue Code	307
Rate for Payer: Cash Price	$55.80

OSMOLALITY, SERUM

Facility

$67.00

Service Code	CPT 83930
Hospital Charge Code	2227083
Hospital Revenue Code	307
Rate for Payer: Cash Price	$60.30

OSMOLALITY, SERUM

Facility

$67.00

Service Code	CPT 83930
Hospital Charge Code	2227083
Hospital Revenue Code	307
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$47.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.95
Rate for Payer: Aetna Medicare Advantage	$6.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cigna Commercial HMO & PPO	$6.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.37
Rate for Payer: Home State Health Plan Medicare Advantage	$6.61
Rate for Payer: Humana Commercial	$13.22
Rate for Payer: Humana Medicare Advantage	$6.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

OSMOLALITY, UR 24HR OR RAND

Facility

$62.00

Service Code	CPT 83935
Hospital Charge Code	2283935
Hospital Revenue Code	307
Min. Negotiated Rate	$6.14
Max. Negotiated Rate	$44.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.14
Rate for Payer: Aetna Medicare Advantage	$6.82
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: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cigna Commercial HMO & PPO	$6.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.57
Rate for Payer: Home State Health Plan Medicare Advantage	$6.82
Rate for Payer: Humana Commercial	$13.64
Rate for Payer: Humana Medicare Advantage	$6.82
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

OSMOLALITY, UR 24HR OR RAND

Facility

$62.00

Service Code	CPT 83935
Hospital Charge Code	2283935
Hospital Revenue Code	307
Rate for Payer: Cash Price	$55.80

OSSEOUS SURVEY COMPLETE INFANT

Facility

$236.00

Service Code	CPT 77075
Hospital Charge Code	3276065
Hospital Revenue Code	320
Rate for Payer: Cash Price	$212.40

OSSEOUS SURVEY COMPLETE INFANT

Facility

$236.00

Service Code	CPT 77075
Hospital Charge Code	3276065
Hospital Revenue Code	320
Min. Negotiated Rate	$84.96
Max. Negotiated Rate	$213.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$168.50
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.96

OSTEOCALCIN

Facility

$192.00

Service Code	CPT 83937
Hospital Charge Code	2283937
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$137.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$26.87
Rate for Payer: Aetna Medicare Advantage	$29.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$113.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$137.09
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cigna Commercial HMO & PPO	$29.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28.75
Rate for Payer: Home State Health Plan Medicare Advantage	$29.85
Rate for Payer: Humana Commercial	$59.70
Rate for Payer: Humana Medicare Advantage	$29.85
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$69.12

OSTEOCALCIN

Facility

$192.00

Service Code	CPT 83937
Hospital Charge Code	2283937
Hospital Revenue Code	301
Rate for Payer: Cash Price	$172.80

OSTEOMYELITIS, SEPTIC ARTHRITIS AND OTHER MUSCULOSKELETAL INFECTIONS

Facility

$12,593.22

Service Code	APR-DRG 3442
Min. Negotiated Rate	$12,593.22
Max. Negotiated Rate	$12,593.22
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,593.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,593.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,593.22
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,593.22

Know your out-of-pocket cost for care.

All Charges