Madison Medical Center

All Charges

Charge

Type

Setting

Price

BARBITURATE (LABCORP MEDWATCH)

Facility

$308.00

Service Code	CPT 80345
Hospital Charge Code	2280345
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$219.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$182.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.91
Rate for Payer: Cash Price	$277.20
Rate for Payer: Cash Price	$277.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$110.88

.BARBITURATES REFLEX CONFIRMATION

Facility

$110.00

Service Code	CPT 80345
Hospital Charge Code	221261
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$78.54
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: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

.BARBITURATES REFLEX CONFIRMATION

Facility

$110.00

Service Code	CPT 80345
Hospital Charge Code	221261
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

BARIATRIC CHEWABLE ONE-A-DAY VIT TAB

Facility

$43.00

Service Code	NDC 1E+11
Hospital Charge Code	2697227
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

BARIATRIC CHEWABLE ONE-A-DAY VIT TAB

Facility

$43.00

Service Code	NDC 1E+11
Hospital Charge Code	2697227
Hospital Revenue Code	250
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

BARICITINIB (OLUMIANT) 2MG TAB

Facility

$325.00

Service Code	NDC 2418230
Hospital Charge Code	2624332
Hospital Revenue Code	250
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$232.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.05
Rate for Payer: Cash Price	$292.50
Rate for Payer: UnitedHealthcare Commercial	$216.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$117.00

BARICITINIB (OLUMIANT) 2MG TAB

Facility

$325.00

Service Code	NDC 2418230
Hospital Charge Code	2624332
Hospital Revenue Code	250
Rate for Payer: Cash Price	$292.50

BARIUM ENEMA

Facility

$777.00

Service Code	CPT 74270
Hospital Charge Code	325150
Hospital Revenue Code	320
Rate for Payer: Cash Price	$699.30

BARIUM ENEMA

Facility

$777.00

Service Code	CPT 74270
Hospital Charge Code	325150
Hospital Revenue Code	320
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$554.78
Rate for Payer: Aetna Better Health Medicaid/QHP	$158.12
Rate for Payer: Aetna Medicare Advantage	$179.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$459.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$554.78
Rate for Payer: Cash Price	$699.30
Rate for Payer: Cash Price	$699.30
Rate for Payer: Cash Price	$699.30
Rate for Payer: Cigna Commercial HMO & PPO	$179.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$158.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$169.19
Rate for Payer: Home State Health Plan Medicare Advantage	$179.20
Rate for Payer: Humana Commercial	$358.40
Rate for Payer: Humana Medicare Advantage	$179.20
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$158.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$279.72

BARREL BUR (STRYKER)

Facility

$264.00

Hospital Charge Code	127781
Hospital Revenue Code	271
Rate for Payer: Cash Price	$237.60

BARREL BUR (STRYKER)

Facility

$264.00

Hospital Charge Code	127781
Hospital Revenue Code	271
Min. Negotiated Rate	$95.04
Max. Negotiated Rate	$188.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$156.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$188.50
Rate for Payer: Cash Price	$237.60
Rate for Payer: UnitedHealthcare Commercial	$176.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.04

BARRELL-STD.

Facility

$1,053.00

Hospital Charge Code	282342
Hospital Revenue Code	271
Rate for Payer: Cash Price	$947.70

BARRELL-STD.

Facility

$1,053.00

Hospital Charge Code	282342
Hospital Revenue Code	271
Min. Negotiated Rate	$379.08
Max. Negotiated Rate	$751.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$623.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$751.84
Rate for Payer: Cash Price	$947.70
Rate for Payer: UnitedHealthcare Commercial	$702.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$379.08

BASAGLAR KWIKPEN 5 PEN BOX EMP

Facility

$60.00

Service Code	NDC 2771559
Hospital Charge Code	2624603
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

BASAGLAR KWIKPEN 5 PEN BOX EMP

Facility

$60.00

Service Code	NDC 2771559
Hospital Charge Code	2624603
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
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: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

BASIN STERILE

Facility

$60.00

Hospital Charge Code	282195
Hospital Revenue Code	271
Rate for Payer: Cash Price	$54.00

BASIN STERILE

Facility

$60.00

Hospital Charge Code	282195
Hospital Revenue Code	271
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
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: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

BASIN (WASH) MED ACTION #362-10

Facility

$16.00

Hospital Charge Code	283716
Hospital Revenue Code	271
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

BASIN (WASH) MED ACTION #362-10

Facility

$16.00

Hospital Charge Code	283716
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

BASKETS

Facility

$977.00

Hospital Charge Code	1299109
Hospital Revenue Code	271
Min. Negotiated Rate	$351.72
Max. Negotiated Rate	$697.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$578.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$697.58
Rate for Payer: Cash Price	$879.30
Rate for Payer: UnitedHealthcare Commercial	$651.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$351.72

BASKETS

Facility

$977.00

Hospital Charge Code	1299109
Hospital Revenue Code	271
Rate for Payer: Cash Price	$879.30

BAXTER PUMP

Facility

$198.00

Service Code	NDC 1E+11
Hospital Charge Code	2656570
Hospital Revenue Code	259
Min. Negotiated Rate	$71.28
Max. Negotiated Rate	$141.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$117.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$141.37
Rate for Payer: Cash Price	$178.20
Rate for Payer: UnitedHealthcare Commercial	$132.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.28

BAXTER PUMP

Facility

$198.00

Service Code	NDC 1E+11
Hospital Charge Code	2656570
Hospital Revenue Code	259
Min. Negotiated Rate	$132.07
Max. Negotiated Rate	$132.07
Rate for Payer: Cash Price	$178.20
Rate for Payer: UnitedHealthcare Commercial	$132.07

BB ANTIBODY ID

Facility

$203.00

Service Code	CPT 86870
Hospital Charge Code	221242
Hospital Revenue Code	302
Rate for Payer: Cash Price	$182.70

BB ANTIBODY ID

Facility

$203.00

Service Code	CPT 86870
Hospital Charge Code	221242
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$732.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$323.12
Rate for Payer: Aetna Medicare Advantage	$366.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$120.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$144.94
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cash Price	$182.70
Rate for Payer: Cigna Commercial HMO & PPO	$366.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$323.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$345.74
Rate for Payer: Home State Health Plan Medicare Advantage	$366.21
Rate for Payer: Humana Commercial	$732.42
Rate for Payer: Humana Medicare Advantage	$366.21
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$323.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$73.08

Know your out-of-pocket cost for care.

All Charges