Madison Medical Center

All Charges

Charge

Type

Setting

Price

BALSAM/CAST/TRYPSIN (VENELEX) OINT 60GM

Facility

$247.00

Service Code	NDC 5.898E+10
Hospital Charge Code	2626352
Hospital Revenue Code	250
Rate for Payer: Cash Price	$222.30

BALSAM/CAST/TRYPSIN (VENELEX) OINT 60GM

Facility

$247.00

Service Code	NDC 5.898E+10
Hospital Charge Code	2626352
Hospital Revenue Code	250
Min. Negotiated Rate	$88.92
Max. Negotiated Rate	$176.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$146.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$176.36
Rate for Payer: Cash Price	$222.30
Rate for Payer: UnitedHealthcare Commercial	$164.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$88.92

BAMLANIVIMAB 700MG 20ML IVPB

Facility

$34,672.00

Service Code	HCPCS J9310
Hospital Charge Code	2623853
Hospital Revenue Code	335
Min. Negotiated Rate	$12,481.92
Max. Negotiated Rate	$24,755.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20,525.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24,755.81
Rate for Payer: Cash Price	$31,204.80
Rate for Payer: UnitedHealthcare Commercial	$23,126.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$12,481.92

BAMLANIVIMAB 700MG 20ML IVPB

Facility

$34,672.00

Service Code	HCPCS J9310
Hospital Charge Code	2623853
Hospital Revenue Code	335
Rate for Payer: Cash Price	$31,204.80

BANDAGE, CONFROM31 (KENDALL)

Facility

$15.00

Hospital Charge Code	4002231
Hospital Revenue Code	510
Rate for Payer: Cash Price	$13.50

BANDAGE, CONFROM31 (KENDALL)

Facility

$15.00

Hospital Charge Code	4002231
Hospital Revenue Code	510
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

BANDAGE, CONFROM32 (KENDALL)

Facility

$15.00

Hospital Charge Code	4002232
Hospital Revenue Code	271
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

BANDAGE, CONFROM32 (KENDALL)

Facility

$15.00

Hospital Charge Code	4002232
Hospital Revenue Code	271
Rate for Payer: Cash Price	$13.50

BANDAGE, CONFROM36 (KENDALL)

Facility

$15.00

Hospital Charge Code	4002236
Hospital Revenue Code	271
Rate for Payer: Cash Price	$13.50

BANDAGE, CONFROM36 (KENDALL)

Facility

$15.00

Hospital Charge Code	4002236
Hospital Revenue Code	271
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

BANDAGE, ELASTIC 2 IN.

Facility

$22.00

Hospital Charge Code	282312
Hospital Revenue Code	271
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

BANDAGE, ELASTIC 2 IN.

Facility

$22.00

Hospital Charge Code	282312
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

BANDAGE, ELASTIC 3 IN CONCO

Facility

$22.00

Hospital Charge Code	282313
Hospital Revenue Code	271
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

BANDAGE, ELASTIC 3 IN CONCO

Facility

$22.00

Hospital Charge Code	282313
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

BANDAGE, ELASTIC 4

Facility

$43.00

Hospital Charge Code	282314
Hospital Revenue Code	271
Rate for Payer: Cash Price	$38.70

BANDAGE, ELASTIC 4

Facility

$43.00

Hospital Charge Code	282314
Hospital Revenue Code	271
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
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: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

BANDAGE, ELASTIC 6 IN

Facility

$43.00

Hospital Charge Code	282315
Hospital Revenue Code	271
Rate for Payer: Cash Price	$38.70

BANDAGE, ELASTIC 6 IN

Facility

$43.00

Hospital Charge Code	282315
Hospital Revenue Code	271
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
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: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

BANDAID 1 X3

Facility

$15.00

Hospital Charge Code	80000346
Hospital Revenue Code	272
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

BANDAID 1 X3

Facility

$15.00

Hospital Charge Code	80000346
Hospital Revenue Code	272
Rate for Payer: Cash Price	$13.50

BANDAID X-LARGE

Facility

$15.00

Hospital Charge Code	282337
Hospital Revenue Code	272
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

BANDAID X-LARGE

Facility

$15.00

Hospital Charge Code	282337
Hospital Revenue Code	272
Rate for Payer: Cash Price	$13.50

BARBITUATES CONFIRMATION

Facility

$268.00

Service Code	CPT 80345
Hospital Charge Code	2282205
Hospital Revenue Code	305
Rate for Payer: Cash Price	$241.20

BARBITUATES CONFIRMATION

Facility

$268.00

Service Code	CPT 80345
Hospital Charge Code	2282205
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$191.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$158.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$191.35
Rate for Payer: Cash Price	$241.20
Rate for Payer: Cash Price	$241.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$96.48

BARBITURATE (LABCORP MEDWATCH)

Facility

$308.00

Service Code	CPT 80345
Hospital Charge Code	2280345
Hospital Revenue Code	301
Rate for Payer: Cash Price	$277.20

Know your out-of-pocket cost for care.

All Charges