Madison Medical Center

All Charges

Charge

Type

Setting

Price

ASPIRIN 325MG EC TAB

Facility

$20.00

Service Code	NDC 5.7896E+10
Hospital Charge Code	2654249
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

ASPIRIN 325MG EC TAB

Facility

$20.00

Service Code	NDC 5.7896E+10
Hospital Charge Code	2654249
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

ASPIRIN 81MG (ER USE) CHEW (4X81MG TABS)

Facility

$21.00

Service Code	NDC 5.7896E+10
Hospital Charge Code	2619689
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

ASPIRIN 81MG (ER USE) CHEW (4X81MG TABS)

Facility

$21.00

Service Code	NDC 5.7896E+10
Hospital Charge Code	2619689
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

ASPIRIN CHEWABLE 81MG TAB

Facility

$20.00

Service Code	NDC 904404073
Hospital Charge Code	2654245
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

ASPIRIN CHEWABLE 81MG TAB

Facility

$20.00

Service Code	NDC 904404073
Hospital Charge Code	2654245
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

ASPIRIN/DIPYR(AGGRENOX)25/200MGTAB

Facility

$33.00

Service Code	NDC 597000160
Hospital Charge Code	2626528
Hospital Revenue Code	250
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$23.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$19.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$23.56
Rate for Payer: Cash Price	$29.70
Rate for Payer: UnitedHealthcare Commercial	$22.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.88

ASPIRIN/DIPYR(AGGRENOX)25/200MGTAB

Facility

$33.00

Service Code	NDC 597000160
Hospital Charge Code	2626528
Hospital Revenue Code	250
Rate for Payer: Cash Price	$29.70

ASPIRIN ENTERIC COATED 81MG TAB

Facility

$20.00

Service Code	NDC 603002622
Hospital Charge Code	2697104
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

ASPIRIN ENTERIC COATED 81MG TAB

Facility

$20.00

Service Code	NDC 603002622
Hospital Charge Code	2697104
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

ASSIST-CHOLESCTESTECTOMY W/EXPLORATION

Facility

$1,056.00

Service Code	CPT 47610
Hospital Charge Code	5247610
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$753.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$625.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$753.98
Rate for Payer: Cash Price	$950.40
Rate for Payer: Cash Price	$950.40
Rate for Payer: UnitedHealthcare Commercial	$704.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ASSIST-CHOLESCTESTECTOMY W/EXPLORATION

Facility

$1,056.00

Service Code	CPT 47610
Hospital Charge Code	5247610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$950.40

ASSIST-ENDOSCOPY BILE DUCT

Facility

$307.00

Service Code	CPT 47550
Hospital Charge Code	5247550
Hospital Revenue Code	521
Rate for Payer: Cash Price	$276.30

ASSIST-ENDOSCOPY BILE DUCT

Facility

$307.00

Service Code	CPT 47550
Hospital Charge Code	5247550
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$219.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$181.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.20
Rate for Payer: Cash Price	$276.30
Rate for Payer: Cash Price	$276.30
Rate for Payer: UnitedHealthcare Commercial	$204.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

.AST CPT 84450

Facility

$55.00

Service Code	CPT 84450
Hospital Charge Code	22284450
Hospital Revenue Code	307
Rate for Payer: Cash Price	$49.50

.AST CPT 84450

Facility

$55.00

Service Code	CPT 84450
Hospital Charge Code	22284450
Hospital Revenue Code	307
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.66
Rate for Payer: Aetna Medicare Advantage	$5.18
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: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$5.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.99
Rate for Payer: Home State Health Plan Medicare Advantage	$5.18
Rate for Payer: Humana Commercial	$10.36
Rate for Payer: Humana Medicare Advantage	$5.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

ASTHMA

Facility

$8,276.79

Service Code	APR-DRG 1412
Min. Negotiated Rate	$8,276.79
Max. Negotiated Rate	$8,276.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,276.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,276.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,276.79
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,276.79

ASTHMA

Facility

$13,334.43

Service Code	APR-DRG 1413
Min. Negotiated Rate	$13,334.43
Max. Negotiated Rate	$13,334.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,334.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,334.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,334.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,334.43

ASTHMA

Facility

$4,736.69

Service Code	APR-DRG 1411
Min. Negotiated Rate	$4,736.69
Max. Negotiated Rate	$4,736.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,736.69
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,736.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,736.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,736.69

ASTHMA

Facility

$19,364.60

Service Code	APR-DRG 1414
Min. Negotiated Rate	$19,364.60
Max. Negotiated Rate	$19,364.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,364.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,364.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,364.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,364.60

AST / SGOT

Facility

$124.00

Service Code	CPT 84450
Hospital Charge Code	2220119
Hospital Revenue Code	301
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$88.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.66
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial HMO & PPO	$5.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.99
Rate for Payer: Home State Health Plan Medicare Advantage	$5.18
Rate for Payer: Humana Commercial	$10.36
Rate for Payer: Humana Medicare Advantage	$5.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

AST / SGOT

Facility

$124.00

Service Code	CPT 84450
Hospital Charge Code	2220119
Hospital Revenue Code	301
Rate for Payer: Cash Price	$111.60

ATENOLOL (TENORMIN) 25MG TAB

Facility

$20.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626295
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

ATENOLOL (TENORMIN) 25MG TAB

Facility

$20.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626295
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

ATENOLOL (TENORMIN) 25MG TAB EMP

Facility

$20.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2624381
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

Know your out-of-pocket cost for care.

All Charges