Madison Medical Center

All Charges

Charge

Type

Setting

Price

PUSTULAR

Facility

$58.00

Service Code	CPT 10040
Hospital Charge Code	5210040
Hospital Revenue Code	521
Min. Negotiated Rate	$34.34
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PYRIDOSTIGMINE INJ

Facility

$111.00

Hospital Charge Code	2018002
Hospital Revenue Code	370
Rate for Payer: Cash Price	$99.90

PYRIDOSTIGMINE INJ

Facility

$111.00

Hospital Charge Code	2018002
Hospital Revenue Code	370
Min. Negotiated Rate	$39.96
Max. Negotiated Rate	$79.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.25
Rate for Payer: Cash Price	$99.90
Rate for Payer: UnitedHealthcare Commercial	$74.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.96

PYRIDOSTIGMINE (MESTINON) 60MG TAB

Facility

$18.00

Service Code	NDC 115351101
Hospital Charge Code	2626525
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

PYRIDOSTIGMINE (MESTINON) 60MG TAB

Facility

$18.00

Service Code	NDC 115351101
Hospital Charge Code	2626525
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PYRUVATE KINASE

Facility

$354.00

Service Code	CPT 84220
Hospital Charge Code	2284220
Hospital Revenue Code	301
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$252.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.50
Rate for Payer: Aetna Medicare Advantage	$9.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$209.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$252.76
Rate for Payer: Cash Price	$318.60
Rate for Payer: Cash Price	$318.60
Rate for Payer: Cash Price	$318.60
Rate for Payer: Cigna Commercial HMO & PPO	$9.44
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.10
Rate for Payer: Home State Health Plan Medicare Advantage	$9.44
Rate for Payer: Humana Commercial	$18.88
Rate for Payer: Humana Medicare Advantage	$9.44
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$127.44

PYRUVATE KINASE

Facility

$354.00

Service Code	CPT 84220
Hospital Charge Code	2284220
Hospital Revenue Code	301
Rate for Payer: Cash Price	$318.60

PYRUVIC ACID

Facility

$147.00

Service Code	CPT 84210
Hospital Charge Code	2284210
Hospital Revenue Code	301
Rate for Payer: Cash Price	$132.30

PYRUVIC ACID

Facility

$147.00

Service Code	CPT 84210
Hospital Charge Code	2284210
Hospital Revenue Code	301
Min. Negotiated Rate	$13.03
Max. Negotiated Rate	$104.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.03
Rate for Payer: Aetna Medicare Advantage	$14.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$87.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$104.96
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cigna Commercial HMO & PPO	$14.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.94
Rate for Payer: Home State Health Plan Medicare Advantage	$14.48
Rate for Payer: Humana Commercial	$28.96
Rate for Payer: Humana Medicare Advantage	$14.48
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$52.92

Q FEVER

Facility

$161.00

Service Code	CPT 86638
Hospital Charge Code	2286638
Hospital Revenue Code	301
Min. Negotiated Rate	$10.91
Max. Negotiated Rate	$114.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.91
Rate for Payer: Aetna Medicare Advantage	$12.12
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	$12.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.67
Rate for Payer: Home State Health Plan Medicare Advantage	$12.12
Rate for Payer: Humana Commercial	$24.24
Rate for Payer: Humana Medicare Advantage	$12.12
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$57.96

Q FEVER

Facility

$161.00

Service Code	CPT 86638
Hospital Charge Code	2286638
Hospital Revenue Code	301
Rate for Payer: Cash Price	$144.90

QUANTIFERON GOLD

Facility

$265.00

Service Code	CPT 86480
Hospital Charge Code	2284680
Hospital Revenue Code	301
Rate for Payer: Cash Price	$238.50

QUANTIFERON GOLD

Facility

$265.00

Service Code	CPT 86480
Hospital Charge Code	2284680
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$189.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$55.78
Rate for Payer: Aetna Medicare Advantage	$61.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$156.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$189.21
Rate for Payer: Cash Price	$238.50
Rate for Payer: Cash Price	$238.50
Rate for Payer: Cash Price	$238.50
Rate for Payer: Cigna Commercial HMO & PPO	$61.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$59.68
Rate for Payer: Home State Health Plan Medicare Advantage	$61.98
Rate for Payer: Humana Commercial	$123.96
Rate for Payer: Humana Medicare Advantage	$61.98
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.40

.QUANTIFERON TB (AEL) (EMPLOYEES ONLY)

Facility

$43.00

Service Code	CPT 86480
Hospital Charge Code	222919
Hospital Revenue Code	302
Rate for Payer: Cash Price	$38.70

.QUANTIFERON TB (AEL) (EMPLOYEES ONLY)

Facility

$43.00

Service Code	CPT 86480
Hospital Charge Code	222919
Hospital Revenue Code	302
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$123.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$55.78
Rate for Payer: Aetna Medicare Advantage	$61.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: Cigna Commercial HMO & PPO	$61.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$59.68
Rate for Payer: Home State Health Plan Medicare Advantage	$61.98
Rate for Payer: Humana Commercial	$123.96
Rate for Payer: Humana Medicare Advantage	$61.98
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

QUANTITATIVE SERUM HCG(84702)

Facility

$19.00

Service Code	CPT 84702
Hospital Charge Code	42847020
Hospital Revenue Code	521
Min. Negotiated Rate	$11.25
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.55
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cigna Commercial HMO & PPO	$15.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.50
Rate for Payer: Home State Health Plan Medicare Advantage	$15.05
Rate for Payer: Humana Commercial	$30.10
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

QUANTITATIVE SERUM HCG(84702)

Facility

$19.00

Service Code	CPT 84702
Hospital Charge Code	42847020
Hospital Revenue Code	521
Rate for Payer: Cash Price	$17.10

QUANTITATIVE SERUM HCG (84703)

Facility

$30.00

Service Code	CPT 84703
Hospital Charge Code	4284703
Hospital Revenue Code	521
Rate for Payer: Cash Price	$27.00

QUANTITATIVE SERUM HCG (84703)

Facility

$30.00

Service Code	CPT 84703
Hospital Charge Code	4284703
Hospital Revenue Code	521
Min. Negotiated Rate	$6.09
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.77
Rate for Payer: Aetna Medicare Advantage	$7.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$7.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.24
Rate for Payer: Home State Health Plan Medicare Advantage	$7.52
Rate for Payer: Humana Commercial	$15.04
Rate for Payer: Humana Medicare Advantage	$7.52
Rate for Payer: UnitedHealthcare Commercial	$20.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

QUANTUM SPIKE SET

Facility

$20.00

Hospital Charge Code	2850600
Hospital Revenue Code	271
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

QUANTUM SPIKE SET

Facility

$20.00

Hospital Charge Code	2850600
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

.QUEST, CULTURE AEROBIC

Facility

$36.00

Service Code	CPT 87070
Hospital Charge Code	223252
Hospital Revenue Code	306
Rate for Payer: Cash Price	$32.40

.QUEST, CULTURE AEROBIC

Facility

$36.00

Service Code	CPT 87070
Hospital Charge Code	223252
Hospital Revenue Code	306
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$25.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.76
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$25.70
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial HMO & PPO	$8.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.30
Rate for Payer: Home State Health Plan Medicare Advantage	$8.62
Rate for Payer: Humana Commercial	$17.24
Rate for Payer: Humana Medicare Advantage	$8.62
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.96

.QUEST, CULTURE ANAEROBIC

Facility

$36.00

Service Code	CPT 87075
Hospital Charge Code	223253
Hospital Revenue Code	306
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$25.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.52
Rate for Payer: Aetna Medicare Advantage	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$25.70
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial HMO & PPO	$9.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.12
Rate for Payer: Home State Health Plan Medicare Advantage	$9.47
Rate for Payer: Humana Commercial	$18.94
Rate for Payer: Humana Medicare Advantage	$9.47
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.96

.QUEST, CULTURE ANAEROBIC

Facility

$36.00

Service Code	CPT 87075
Hospital Charge Code	223253
Hospital Revenue Code	306
Rate for Payer: Cash Price	$32.40

Know your out-of-pocket cost for care.

All Charges