Madison Medical Center

All Charges

Charge

Type

Setting

Price

.RMSF IGM

Facility

$113.00

Service Code	CPT 86757
Hospital Charge Code	2219201
Hospital Revenue Code	302
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$80.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$17.42
Rate for Payer: Aetna Medicare Advantage	$19.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial HMO & PPO	$19.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18.64
Rate for Payer: Home State Health Plan Medicare Advantage	$19.35
Rate for Payer: Humana Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$19.35
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

..RMSF IGM AEL

Facility

$113.00

Service Code	CPT 86757
Hospital Charge Code	2219205
Hospital Revenue Code	302
Rate for Payer: Cash Price	$101.70

..RMSF IGM AEL

Facility

$113.00

Service Code	CPT 86757
Hospital Charge Code	2219205
Hospital Revenue Code	302
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$80.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$17.42
Rate for Payer: Aetna Medicare Advantage	$19.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial HMO & PPO	$19.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18.64
Rate for Payer: Home State Health Plan Medicare Advantage	$19.35
Rate for Payer: Humana Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$19.35
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

RNA POLYMERASE III

Facility

$216.00

Service Code	CPT 83520
Hospital Charge Code	2281334
Hospital Revenue Code	301
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$154.22
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.54
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$127.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$154.22
Rate for Payer: Cash Price	$194.40
Rate for Payer: Cash Price	$194.40
Rate for Payer: Cash Price	$194.40
Rate for Payer: Cigna Commercial HMO & PPO	$17.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.63
Rate for Payer: Home State Health Plan Medicare Advantage	$17.27
Rate for Payer: Humana Commercial	$34.54
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$77.76

RNA POLYMERASE III

Facility

$216.00

Service Code	CPT 83520
Hospital Charge Code	2281334
Hospital Revenue Code	301
Rate for Payer: Cash Price	$194.40

RNP ANTIBODY

Facility

$124.00

Service Code	CPT 86235
Hospital Charge Code	2281333
Hospital Revenue Code	302
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$88.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.14
Rate for Payer: Aetna Medicare Advantage	$17.93
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	$17.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.27
Rate for Payer: Home State Health Plan Medicare Advantage	$17.93
Rate for Payer: Humana Commercial	$35.86
Rate for Payer: Humana Medicare Advantage	$17.93
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

RNP ANTIBODY

Facility

$124.00

Service Code	CPT 86235
Hospital Charge Code	2281333
Hospital Revenue Code	302
Rate for Payer: Cash Price	$111.60

ROCEPHIN PER 250MG

Facility

$200.00

Service Code	CPT J0696
Hospital Charge Code	4100696
Hospital Revenue Code	636
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$142.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$118.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.80
Rate for Payer: Cash Price	$180.00
Rate for Payer: UnitedHealthcare Commercial	$133.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$72.00

ROCEPHIN PER 250MG

Facility

$200.00

Service Code	CPT J0696
Hospital Charge Code	4100696
Hospital Revenue Code	636
Min. Negotiated Rate	$133.40
Max. Negotiated Rate	$133.40
Rate for Payer: Cash Price	$180.00
Rate for Payer: UnitedHealthcare Commercial	$133.40

ROCEPHIN PER 250 MG

Facility

$16.00

Service Code	CPT J0696
Hospital Charge Code	440696
Hospital Revenue Code	636
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

ROCEPHIN PER 250 MG

Facility

$200.00

Service Code	CPT J0696
Hospital Charge Code	9600696
Hospital Revenue Code	636
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$142.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$118.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.80
Rate for Payer: Cash Price	$180.00
Rate for Payer: UnitedHealthcare Commercial	$133.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$72.00

ROCEPHIN PER 250 MG

Facility

$200.00

Service Code	CPT J0696
Hospital Charge Code	9600696
Hospital Revenue Code	636
Min. Negotiated Rate	$133.40
Max. Negotiated Rate	$133.40
Rate for Payer: Cash Price	$180.00
Rate for Payer: UnitedHealthcare Commercial	$133.40

ROCEPHIN PER 250 MG

Facility

$16.00

Service Code	CPT J0696
Hospital Charge Code	440696
Hospital Revenue Code	636
Min. Negotiated Rate	$10.67
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67

ROCURONIUM (ZEMURON) 100MG INJ 10ML VIAL

Facility

$166.00

Service Code	NDC 6.6794E+10
Hospital Charge Code	2626023
Hospital Revenue Code	250
Rate for Payer: Cash Price	$149.40

ROCURONIUM (ZEMURON) 100MG INJ 10ML VIAL

Facility

$166.00

Service Code	NDC 6.6794E+10
Hospital Charge Code	2626023
Hospital Revenue Code	250
Min. Negotiated Rate	$59.76
Max. Negotiated Rate	$118.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$118.52
Rate for Payer: Cash Price	$149.40
Rate for Payer: UnitedHealthcare Commercial	$110.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

ROCURONIUM (ZEMURON) 50MG INJ 5ML VIAL

Facility

$166.00

Service Code	NDC 143925001
Hospital Charge Code	2656557
Hospital Revenue Code	250
Rate for Payer: Cash Price	$149.40

ROCURONIUM (ZEMURON) 50MG INJ 5ML VIAL

Facility

$166.00

Service Code	NDC 143925001
Hospital Charge Code	2656557
Hospital Revenue Code	250
Min. Negotiated Rate	$59.76
Max. Negotiated Rate	$118.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$118.52
Rate for Payer: Cash Price	$149.40
Rate for Payer: UnitedHealthcare Commercial	$110.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

ROFLUMILAST (DALIRESP) 500MCG TAB

Facility

$45.00

Service Code	NDC 456009530
Hospital Charge Code	2626559
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

ROFLUMILAST (DALIRESP) 500MCG TAB

Facility

$45.00

Service Code	NDC 456009530
Hospital Charge Code	2626559
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

ROLL TAPE

Facility

$21.00

Hospital Charge Code	2820468
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

ROLL TAPE

Facility

$21.00

Hospital Charge Code	2820468
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

ROOM HUMIDIFIER S/U

Facility

$152.00

Service Code	CPT 94664
Hospital Charge Code	4500370
Hospital Revenue Code	271
Rate for Payer: Cash Price	$136.80

ROOM HUMIDIFIER S/U

Facility

$152.00

Service Code	CPT 94664
Hospital Charge Code	4500370
Hospital Revenue Code	271
Min. Negotiated Rate	$54.72
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$108.53
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$101.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.72

ROPINIROLE 3MG TAB EMP

Facility

$13.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2619842
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

ROPINIROLE 3MG TAB EMP

Facility

$13.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2619842
Hospital Revenue Code	250
Rate for Payer: Cash Price	$11.70

Know your out-of-pocket cost for care.

All Charges