Madison Medical Center

All Charges

Charge

Type

Setting

Price

.QUEST, CULTURE BLOOD 1ST SET

Facility

$32.00

Service Code	CPT 87040
Hospital Charge Code	223257
Hospital Revenue Code	306
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.29
Rate for Payer: Aetna Medicare Advantage	$10.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna Commercial HMO & PPO	$10.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.94
Rate for Payer: Home State Health Plan Medicare Advantage	$10.32
Rate for Payer: Humana Commercial	$20.64
Rate for Payer: Humana Medicare Advantage	$10.32
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

.QUEST, CULTURE BLOOD 1ST SET

Facility

$32.00

Service Code	CPT 87040
Hospital Charge Code	223257
Hospital Revenue Code	306
Rate for Payer: Cash Price	$28.80

.QUEST, CULTURE BLOOD 2ND SET

Facility

$32.00

Service Code	CPT 87040
Hospital Charge Code	223258
Hospital Revenue Code	306
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$22.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.29
Rate for Payer: Aetna Medicare Advantage	$10.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna Commercial HMO & PPO	$10.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.94
Rate for Payer: Home State Health Plan Medicare Advantage	$10.32
Rate for Payer: Humana Commercial	$20.64
Rate for Payer: Humana Medicare Advantage	$10.32
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

.QUEST, CULTURE BLOOD 2ND SET

Facility

$32.00

Service Code	CPT 87040
Hospital Charge Code	223258
Hospital Revenue Code	306
Rate for Payer: Cash Price	$28.80

QUEST URINE CULTURE

Facility

$60.00

Service Code	CPT 87088
Hospital Charge Code	223256
Hospital Revenue Code	306
Min. Negotiated Rate	$7.28
Max. Negotiated Rate	$42.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.28
Rate for Payer: Aetna Medicare Advantage	$8.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$8.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.79
Rate for Payer: Home State Health Plan Medicare Advantage	$8.09
Rate for Payer: Humana Commercial	$16.18
Rate for Payer: Humana Medicare Advantage	$8.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

QUEST URINE CULTURE

Facility

$60.00

Service Code	CPT 87088
Hospital Charge Code	223256
Hospital Revenue Code	306
Rate for Payer: Cash Price	$54.00

QUETIAPINE (SEROQUEL) 100MG TAB EMP

Facility

$22.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2624488
Hospital Revenue Code	250
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

QUETIAPINE (SEROQUEL) 100MG TAB EMP

Facility

$22.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2624488
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

QUETIAPINE (SEROQUEL) 100MG TAB UD

Facility

$39.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2626344
Hospital Revenue Code	250
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

QUETIAPINE (SEROQUEL) 100MG TAB UD

Facility

$39.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2626344
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

QUETIAPINE (SEROQUEL) 25MG TAB EMP

Facility

$22.00

Service Code	NDC 310027539
Hospital Charge Code	2697978
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

QUETIAPINE (SEROQUEL) 25MG TAB EMP

Facility

$22.00

Service Code	NDC 310027539
Hospital Charge Code	2697978
Hospital Revenue Code	250
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

QUETIAPINE (SEROQUEL) 25MG TAB UD

Facility

$22.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2626343
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

QUETIAPINE (SEROQUEL) 25MG TAB UD

Facility

$22.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2626343
Hospital Revenue Code	250
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

QUETIAPINE (SEROQUEL) 400MG TAB EMP

Facility

$22.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2625771
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

QUETIAPINE (SEROQUEL) 400MG TAB EMP

Facility

$22.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2625771
Hospital Revenue Code	250
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

QUETIAPINE (SEROQUEL) 50MG TAB EMP

Facility

$22.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2623502
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

QUETIAPINE (SEROQUEL) 50MG TAB EMP

Facility

$22.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2623502
Hospital Revenue Code	250
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

QUINAPRIL 40MG TAB EMP

Facility

$45.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2697338
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

QUINAPRIL 40MG TAB EMP

Facility

$45.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2697338
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

QUINIDINE LEVEL

Facility

$110.00

Service Code	CPT 80194
Hospital Charge Code	2217100
Hospital Revenue Code	301
Min. Negotiated Rate	$13.14
Max. Negotiated Rate	$78.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.14
Rate for Payer: Aetna Medicare Advantage	$14.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$14.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.06
Rate for Payer: Home State Health Plan Medicare Advantage	$14.60
Rate for Payer: Humana Commercial	$29.20
Rate for Payer: Humana Medicare Advantage	$14.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

QUINIDINE LEVEL

Facility

$110.00

Service Code	CPT 80194
Hospital Charge Code	2217100
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

RABAVERT INJ (VACCINE FOR RABIES)

Facility

$2,330.00

Service Code	HCPCS 90675
Hospital Charge Code	2603960
Hospital Revenue Code	250
Min. Negotiated Rate	$331.98
Max. Negotiated Rate	$1,663.62
Rate for Payer: Aetna Medicare Advantage	$331.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,379.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,663.62
Rate for Payer: Cash Price	$2,097.00
Rate for Payer: Cash Price	$2,097.00
Rate for Payer: Cigna Commercial HMO & PPO	$331.98
Rate for Payer: Home State Health Plan Medicare Advantage	$331.98
Rate for Payer: Humana Commercial	$663.96
Rate for Payer: Humana Medicare Advantage	$331.98
Rate for Payer: UnitedHealthcare Commercial	$1,554.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$838.80

RABAVERT INJ (VACCINE FOR RABIES)

Facility

$2,330.00

Service Code	HCPCS 90675
Hospital Charge Code	2603960
Hospital Revenue Code	250
Rate for Payer: Cash Price	$2,097.00

RABEPRAZOLE 20MG TAB EMP

Facility

$10.00

Service Code	NDC 7.2888E+10
Hospital Charge Code	2627065
Hospital Revenue Code	250
Rate for Payer: Cash Price	$9.00

Know your out-of-pocket cost for care.

All Charges