Madison Medical Center

All Charges

Charge

Type

Setting

Price

ROSUVASTATIN 5MG TAB EMP

Facility

$47.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2622695
Hospital Revenue Code	250
Rate for Payer: Cash Price	$42.30

ROSUVASTATIN (CRESTOR) 10MG TAB UD

Facility

$47.00

Service Code	NDC 310075139
Hospital Charge Code	2626463
Hospital Revenue Code	250
Rate for Payer: Cash Price	$42.30

ROSUVASTATIN (CRESTOR) 10MG TAB UD

Facility

$47.00

Service Code	NDC 310075139
Hospital Charge Code	2626463
Hospital Revenue Code	250
Min. Negotiated Rate	$16.92
Max. Negotiated Rate	$33.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$27.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$33.56
Rate for Payer: Cash Price	$42.30
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.92

ROTAVIRUS ANTIGEN

Facility

$187.00

Service Code	CPT 87425
Hospital Charge Code	3086759
Hospital Revenue Code	306
Rate for Payer: Cash Price	$168.30

ROTAVIRUS ANTIGEN

Facility

$187.00

Service Code	CPT 87425
Hospital Charge Code	3086759
Hospital Revenue Code	306
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$133.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.78
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$110.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$133.52
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cigna Commercial HMO & PPO	$11.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.53
Rate for Payer: Home State Health Plan Medicare Advantage	$11.98
Rate for Payer: Humana Commercial	$23.96
Rate for Payer: Humana Medicare Advantage	$11.98
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.32

ROTH RETRIVAL NET

Facility

$352.00

Hospital Charge Code	1299110
Hospital Revenue Code	271
Min. Negotiated Rate	$126.72
Max. Negotiated Rate	$251.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$208.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$251.33
Rate for Payer: Cash Price	$316.80
Rate for Payer: UnitedHealthcare Commercial	$234.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$126.72

ROTH RETRIVAL NET

Facility

$352.00

Hospital Charge Code	1299110
Hospital Revenue Code	271
Rate for Payer: Cash Price	$316.80

ROTICULATOR 170

Facility

$1,594.00

Hospital Charge Code	1219109
Hospital Revenue Code	271
Min. Negotiated Rate	$573.84
Max. Negotiated Rate	$1,138.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$943.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,138.12
Rate for Payer: Cash Price	$1,434.60
Rate for Payer: UnitedHealthcare Commercial	$1,063.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$573.84

ROTICULATOR 170

Facility

$1,594.00

Hospital Charge Code	1219109
Hospital Revenue Code	271
Rate for Payer: Cash Price	$1,434.60

ROTICULATOR 200

Facility

$1,698.00

Hospital Charge Code	1219110
Hospital Revenue Code	271
Rate for Payer: Cash Price	$1,528.20

ROTICULATOR 200

Facility

$1,698.00

Hospital Charge Code	1219110
Hospital Revenue Code	271
Min. Negotiated Rate	$611.28
Max. Negotiated Rate	$1,212.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,005.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,212.37
Rate for Payer: Cash Price	$1,528.20
Rate for Payer: UnitedHealthcare Commercial	$1,132.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$611.28

ROUTINE CULTURE

Facility

$32.00

Service Code	CPT 87070
Hospital Charge Code	5287070
Hospital Revenue Code	521
Min. Negotiated Rate	$6.98
Max. Negotiated Rate	$173.53
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	$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: Cash Price	$28.80
Rate for Payer: Cigna Commercial HMO & PPO	$8.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.98
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	$21.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

ROUTINE CULTURE

Facility

$32.00

Service Code	CPT 87070
Hospital Charge Code	5287070
Hospital Revenue Code	521
Rate for Payer: Cash Price	$28.80

ROUTINE VENIPUNCTURE, SPECIMEN

Professional

Both

$62.00

Service Code	CPT 36415
Hospital Charge Code	1836415
Hospital Revenue Code	981
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$21.70
Rate for Payer: Aetna Commercial/Medicare Advantage	$9.34
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cigna Commercial HMO & PPO	$9.34
Rate for Payer: Home State Health Plan Medicare Advantage	$9.34
Rate for Payer: Optum Medicare Advantage	$21.70

R P R

Facility

$16.00

Service Code	CPT 86592
Hospital Charge Code	4286592
Hospital Revenue Code	521
Rate for Payer: Cash Price	$14.40

R P R

Facility

$16.00

Service Code	CPT 86592
Hospital Charge Code	4286592
Hospital Revenue Code	521
Min. Negotiated Rate	$3.46
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.84
Rate for Payer: Aetna Medicare Advantage	$4.27
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: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna Commercial HMO & PPO	$4.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.11
Rate for Payer: Home State Health Plan Medicare Advantage	$4.27
Rate for Payer: Humana Commercial	$8.54
Rate for Payer: Humana Medicare Advantage	$4.27
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

RPR W/ REFLEX TO CONFIRM

Facility

$75.00

Service Code	CPT 86592
Hospital Charge Code	2219107
Hospital Revenue Code	302
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.84
Rate for Payer: Aetna Medicare Advantage	$4.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$4.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.11
Rate for Payer: Home State Health Plan Medicare Advantage	$4.27
Rate for Payer: Humana Commercial	$8.54
Rate for Payer: Humana Medicare Advantage	$4.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

RPR W/ REFLEX TO CONFIRM

Facility

$75.00

Service Code	CPT 86592
Hospital Charge Code	2219107
Hospital Revenue Code	302
Rate for Payer: Cash Price	$67.50

RSV

Facility

$109.00

Service Code	CPT 87807
Hospital Charge Code	4287807
Hospital Revenue Code	301
Rate for Payer: Cash Price	$98.10

RSV

Facility

$109.00

Service Code	CPT 87807
Hospital Charge Code	9687807
Hospital Revenue Code	301
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$77.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.79
Rate for Payer: Aetna Medicare Advantage	$13.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$64.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$77.83
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cigna Commercial HMO & PPO	$13.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.62
Rate for Payer: Home State Health Plan Medicare Advantage	$13.10
Rate for Payer: Humana Commercial	$26.20
Rate for Payer: Humana Medicare Advantage	$13.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.24

RSV

Facility

$109.00

Service Code	CPT 87807
Hospital Charge Code	4287807
Hospital Revenue Code	301
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$77.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.79
Rate for Payer: Aetna Medicare Advantage	$13.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$64.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$77.83
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cash Price	$98.10
Rate for Payer: Cigna Commercial HMO & PPO	$13.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.62
Rate for Payer: Home State Health Plan Medicare Advantage	$13.10
Rate for Payer: Humana Commercial	$26.20
Rate for Payer: Humana Medicare Advantage	$13.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.24

RSV

Facility

$109.00

Service Code	CPT 87807
Hospital Charge Code	9687807
Hospital Revenue Code	301
Rate for Payer: Cash Price	$98.10

RSV ANTIGEN

Facility

$187.00

Service Code	CPT 87807
Hospital Charge Code	2218196
Hospital Revenue Code	301
Rate for Payer: Cash Price	$168.30

RSV ANTIGEN

Facility

$187.00

Service Code	CPT 87807
Hospital Charge Code	2218196
Hospital Revenue Code	301
Min. Negotiated Rate	$11.79
Max. Negotiated Rate	$133.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.79
Rate for Payer: Aetna Medicare Advantage	$13.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$110.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$133.52
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cigna Commercial HMO & PPO	$13.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.62
Rate for Payer: Home State Health Plan Medicare Advantage	$13.10
Rate for Payer: Humana Commercial	$26.20
Rate for Payer: Humana Medicare Advantage	$13.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.32

.R S V (LC CHARGE)

Facility

$21.00

Service Code	CPT 87280
Hospital Charge Code	2287280
Hospital Revenue Code	305
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$26.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.08
Rate for Payer: Aetna Medicare Advantage	$13.42
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: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cigna Commercial HMO & PPO	$13.42
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.93
Rate for Payer: Home State Health Plan Medicare Advantage	$13.42
Rate for Payer: Humana Commercial	$26.84
Rate for Payer: Humana Medicare Advantage	$13.42
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

Know your out-of-pocket cost for care.

All Charges