Madison Medical Center

All Charges

Charge

Type

Setting

Price

BENZODIAZEPINES CONFIRMATION

Facility

$223.00

Service Code	CPT 80346
Hospital Charge Code	2280155
Hospital Revenue Code	301
Rate for Payer: Cash Price	$200.70

BENZODIAZEPINES CONFIRMATION

Facility

$223.00

Service Code	CPT 80346
Hospital Charge Code	2280155
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$159.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$132.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$159.22
Rate for Payer: Cash Price	$200.70
Rate for Payer: Cash Price	$200.70
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$80.28

BENZODIAZEPINES (LABCORP MEDWATCH)

Facility

$223.00

Service Code	CPT 80346
Hospital Charge Code	2280346
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$159.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$132.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$159.22
Rate for Payer: Cash Price	$200.70
Rate for Payer: Cash Price	$200.70
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$80.28

BENZODIAZEPINES (LABCORP MEDWATCH)

Facility

$223.00

Service Code	CPT 80346
Hospital Charge Code	2280346
Hospital Revenue Code	301
Rate for Payer: Cash Price	$200.70

.BENZODIAZEPINES REFLEX CONFIRMATION

Facility

$110.00

Service Code	CPT 80347
Hospital Charge Code	221269
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

.BENZODIAZEPINES REFLEX CONFIRMATION

Facility

$110.00

Service Code	CPT 80347
Hospital Charge Code	221269
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

BENZOINE TINTURE SWABSTICK

Facility

$15.00

Hospital Charge Code	282147
Hospital Revenue Code	272
Rate for Payer: Cash Price	$13.50

BENZOINE TINTURE SWABSTICK

Facility

$15.00

Hospital Charge Code	282147
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

BENZONATATE (TESSALON) 100MG CAP

Facility

$21.00

Service Code	NDC 47004824
Hospital Charge Code	2657117
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

BENZONATATE (TESSALON) 100MG CAP

Facility

$21.00

Service Code	NDC 47004824
Hospital Charge Code	2657117
Hospital Revenue Code	250
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

BENZONATATE (TESSALON) 100MG CAP EMP

Facility

$21.00

Service Code	NDC 6.7877E+10
Hospital Charge Code	2622277
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

BENZONATATE (TESSALON) 100MG CAP EMP

Facility

$21.00

Service Code	NDC 6.7877E+10
Hospital Charge Code	2622277
Hospital Revenue Code	250
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

BENZONATATE (TESSALON) 200MG CAP EMP

Facility

$21.00

Service Code	NDC 6.7877E+10
Hospital Charge Code	2623817
Hospital Revenue Code	250
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

BENZONATATE (TESSALON) 200MG CAP EMP

Facility

$21.00

Service Code	NDC 6.7877E+10
Hospital Charge Code	2623817
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

BENZ RAPID STREP

Facility

$75.00

Service Code	CPT 87880
Hospital Charge Code	9587880
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

BENZ RAPID STREP

Facility

$75.00

Service Code	CPT 87880
Hospital Charge Code	9587880
Hospital Revenue Code	301
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.88
Rate for Payer: Aetna Medicare Advantage	$16.53
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	$16.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.92
Rate for Payer: Home State Health Plan Medicare Advantage	$16.53
Rate for Payer: Humana Commercial	$33.06
Rate for Payer: Humana Medicare Advantage	$16.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

BENZ TB PPD INTRADERMAL

Facility

$45.00

Service Code	HCPCS 86580
Hospital Charge Code	9586580
Hospital Revenue Code	636
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$59.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$26.07
Rate for Payer: Aetna Medicare Advantage	$29.55
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: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna Commercial HMO & PPO	$29.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27.89
Rate for Payer: Home State Health Plan Medicare Advantage	$29.55
Rate for Payer: Humana Commercial	$59.10
Rate for Payer: Humana Medicare Advantage	$29.55
Rate for Payer: UnitedHealthcare Commercial	$29.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

BENZ TB PPD INTRADERMAL

Facility

$45.00

Service Code	HCPCS 86580
Hospital Charge Code	9586580
Hospital Revenue Code	636
Min. Negotiated Rate	$30.02
Max. Negotiated Rate	$30.02
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02

BENZTROPINE 0.5MG TAB (COGENTIN)

Facility

$15.00

Service Code	NDC 603243721
Hospital Charge Code	2697337
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Cash Price	$13.50
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: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

BENZTROPINE 0.5MG TAB (COGENTIN)

Facility

$15.00

Service Code	NDC 603243721
Hospital Charge Code	2697337
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

BENZ URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9581025
Hospital Revenue Code	307
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.75
Rate for Payer: Aetna Medicare Advantage	$8.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.29
Rate for Payer: Home State Health Plan Medicare Advantage	$8.61
Rate for Payer: Humana Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$8.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

BENZ URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9581025
Hospital Revenue Code	307
Rate for Payer: Cash Price	$36.00

BENZYL ALCOHOL 5% LOTION (ULESFIA) 8OZ

Facility

$612.00

Service Code	NDC 1E+11
Hospital Charge Code	2619554
Hospital Revenue Code	250
Min. Negotiated Rate	$220.32
Max. Negotiated Rate	$436.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$362.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$436.97
Rate for Payer: Cash Price	$550.80
Rate for Payer: UnitedHealthcare Commercial	$408.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$220.32

BENZYL ALCOHOL 5% LOTION (ULESFIA) 8OZ

Facility

$612.00

Service Code	NDC 1E+11
Hospital Charge Code	2619554
Hospital Revenue Code	250
Rate for Payer: Cash Price	$550.80

BETA 2 GLYCOPROTEIN,IGA

Facility

$54.00

Service Code	CPT 86146
Hospital Charge Code	2286150
Hospital Revenue Code	302
Rate for Payer: Cash Price	$48.60

Know your out-of-pocket cost for care.

All Charges