Madison Medical Center

All Charges

Charge

Type

Setting

Price

ARIPIPRAZOLE 15MG TAB EMP

Facility

$101.00

Service Code	NDC 1.3668E+10
Hospital Charge Code	2626198
Hospital Revenue Code	250
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

ARIPIPRAZOLE (ABILIFY) 2MG TAB EMP

Facility

$101.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2623787
Hospital Revenue Code	250
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

ARIPIPRAZOLE (ABILIFY) 2MG TAB EMP

Facility

$101.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2623787
Hospital Revenue Code	250
Rate for Payer: Cash Price	$90.90

ARIPIPRAZOLE (ABILIFY) 5MG TAB

Facility

$101.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2626417
Hospital Revenue Code	250
Rate for Payer: Cash Price	$90.90

ARIPIPRAZOLE (ABILIFY) 5MG TAB

Facility

$101.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2626417
Hospital Revenue Code	250
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

ARIPIPRAZOLE (ABILIFY) 5MG TAB EMP

Facility

$101.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2621878
Hospital Revenue Code	250
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

ARIPIPRAZOLE (ABILIFY) 5MG TAB EMP

Facility

$101.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2621878
Hospital Revenue Code	250
Rate for Payer: Cash Price	$90.90

ARMBOARD

Facility

$22.00

Hospital Charge Code	282015
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

ARMBOARD

Facility

$22.00

Hospital Charge Code	282015
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

ARMBOARD PED.

Facility

$21.00

Hospital Charge Code	282010
Hospital Revenue Code	271
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

ARMBOARD PED.

Facility

$21.00

Hospital Charge Code	282010
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

ARM, CAST, SHORT

Facility

$106.00

Hospital Charge Code	282016
Hospital Revenue Code	271
Rate for Payer: Cash Price	$95.40

ARM, CAST, SHORT

Facility

$106.00

Hospital Charge Code	282016
Hospital Revenue Code	271
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$75.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: UnitedHealthcare Commercial	$70.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

ARMOUR THYROID 15MG TAB EMP

Facility

$12.00

Service Code	NDC 456045701
Hospital Charge Code	2623558
Hospital Revenue Code	250
Rate for Payer: Cash Price	$10.80

ARMOUR THYROID 15MG TAB EMP

Facility

$12.00

Service Code	NDC 456045701
Hospital Charge Code	2623558
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$8.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8.57
Rate for Payer: Cash Price	$10.80
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

ARMOUR THYROID 30MG TAB EMP

Facility

$12.00

Service Code	NDC 456045801
Hospital Charge Code	2622371
Hospital Revenue Code	250
Rate for Payer: Cash Price	$10.80

ARMOUR THYROID 30MG TAB EMP

Facility

$12.00

Service Code	NDC 456045801
Hospital Charge Code	2622371
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$8.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8.57
Rate for Payer: Cash Price	$10.80
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

ARMOUR THYROID 60MG TAB EMP

Facility

$12.00

Service Code	NDC 456045901
Hospital Charge Code	2625607
Hospital Revenue Code	250
Rate for Payer: Cash Price	$10.80

ARMOUR THYROID 60MG TAB EMP

Facility

$12.00

Service Code	NDC 456045901
Hospital Charge Code	2625607
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$8.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8.57
Rate for Payer: Cash Price	$10.80
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

ARMSTRONG

Facility

$178.00

Hospital Charge Code	1220721
Hospital Revenue Code	272
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$127.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: UnitedHealthcare Commercial	$118.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

ARMSTRONG

Facility

$178.00

Hospital Charge Code	1220721
Hospital Revenue Code	272
Rate for Payer: Cash Price	$160.20

ARMSTRONG- FLUERO PACIFIC

Facility

$183.00

Hospital Charge Code	1220727
Hospital Revenue Code	272
Min. Negotiated Rate	$65.88
Max. Negotiated Rate	$130.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$108.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$130.66
Rate for Payer: Cash Price	$164.70
Rate for Payer: UnitedHealthcare Commercial	$122.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.88

ARMSTRONG- FLUERO PACIFIC

Facility

$183.00

Hospital Charge Code	1220727
Hospital Revenue Code	272
Rate for Payer: Cash Price	$164.70

ARMSTRONG - ULTRASIL

Facility

$168.00

Hospital Charge Code	1220728
Hospital Revenue Code	272
Min. Negotiated Rate	$60.48
Max. Negotiated Rate	$119.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$99.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$119.95
Rate for Payer: Cash Price	$151.20
Rate for Payer: UnitedHealthcare Commercial	$112.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.48

ARMSTRONG - ULTRASIL

Facility

$168.00

Hospital Charge Code	1220728
Hospital Revenue Code	272
Rate for Payer: Cash Price	$151.20

Know your out-of-pocket cost for care.

All Charges