Madison Medical Center

All Charges

Charge

Type

Setting

Price

BILIRUBIN DIRECT

Facility

$112.00

Service Code	CPT 82248
Hospital Charge Code	222119
Hospital Revenue Code	301
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.52
Rate for Payer: Aetna Medicare Advantage	$5.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.84
Rate for Payer: Home State Health Plan Medicare Advantage	$5.02
Rate for Payer: Humana Commercial	$10.04
Rate for Payer: Humana Medicare Advantage	$5.02
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

BILIRUBIN DIRECT

Facility

$112.00

Service Code	CPT 82248
Hospital Charge Code	222119
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

BILIRUBIN NEONATE

Facility

$112.00

Service Code	CPT 82247
Hospital Charge Code	222116
Hospital Revenue Code	301
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.52
Rate for Payer: Aetna Medicare Advantage	$5.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.84
Rate for Payer: Home State Health Plan Medicare Advantage	$5.02
Rate for Payer: Humana Commercial	$10.04
Rate for Payer: Humana Medicare Advantage	$5.02
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

BILIRUBIN NEONATE

Facility

$112.00

Service Code	CPT 82247
Hospital Charge Code	222116
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

BILIRUBIN TOTAL

Facility

$112.00

Service Code	CPT 82247
Hospital Charge Code	222117
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

BILIRUBIN TOTAL

Facility

$112.00

Service Code	CPT 82247
Hospital Charge Code	222117
Hospital Revenue Code	301
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.52
Rate for Payer: Aetna Medicare Advantage	$5.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.84
Rate for Payer: Home State Health Plan Medicare Advantage	$5.02
Rate for Payer: Humana Commercial	$10.04
Rate for Payer: Humana Medicare Advantage	$5.02
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

.BILIRUBIN, TOTAL CPT 82247

Facility

$55.00

Service Code	CPT 82247
Hospital Charge Code	22282247
Hospital Revenue Code	307
Rate for Payer: Cash Price	$49.50

.BILIRUBIN, TOTAL CPT 82247

Facility

$55.00

Service Code	CPT 82247
Hospital Charge Code	22282247
Hospital Revenue Code	307
Min. Negotiated Rate	$4.52
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.52
Rate for Payer: Aetna Medicare Advantage	$5.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$5.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.84
Rate for Payer: Home State Health Plan Medicare Advantage	$5.02
Rate for Payer: Humana Commercial	$10.04
Rate for Payer: Humana Medicare Advantage	$5.02
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

BIMATOPROST (LUMIGAN) OP SOL 5ML EMP

Facility

$957.00

Service Code	NDC 23320505
Hospital Charge Code	2626379
Hospital Revenue Code	250
Rate for Payer: Cash Price	$861.30

BIMATOPROST (LUMIGAN) OP SOL 5ML EMP

Facility

$957.00

Service Code	NDC 23320505
Hospital Charge Code	2626379
Hospital Revenue Code	250
Min. Negotiated Rate	$344.52
Max. Negotiated Rate	$683.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$566.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$683.30
Rate for Payer: Cash Price	$861.30
Rate for Payer: UnitedHealthcare Commercial	$638.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$344.52

BIMATOPROST (LUMIGAN) OP SOL 7.5ML EMP

Facility

$957.00

Service Code	NDC 23320505
Hospital Charge Code	2624419
Hospital Revenue Code	250
Min. Negotiated Rate	$344.52
Max. Negotiated Rate	$683.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$566.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$683.30
Rate for Payer: Cash Price	$861.30
Rate for Payer: UnitedHealthcare Commercial	$638.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$344.52

BIMATOPROST (LUMIGAN) OP SOL 7.5ML EMP

Facility

$957.00

Service Code	NDC 23320505
Hospital Charge Code	2624419
Hospital Revenue Code	250
Rate for Payer: Cash Price	$861.30

BINFANTIS (ALIGN) PROBIOTIC 4MG CAP

Facility

$18.00

Service Code	NDC 3.7E+10
Hospital Charge Code	2626595
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

BINFANTIS (ALIGN) PROBIOTIC 4MG CAP

Facility

$18.00

Service Code	NDC 3.7E+10
Hospital Charge Code	2626595
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

BIOGEL GLOVE SIZE 7

Facility

$22.00

Hospital Charge Code	287270
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

BIOGEL GLOVE SIZE 7

Facility

$22.00

Hospital Charge Code	287270
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

BIOGEL GLOVE SIZE 8 1/2

Facility

$22.00

Hospital Charge Code	287386
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

BIOGEL GLOVE SIZE 8 1/2

Facility

$22.00

Hospital Charge Code	287386
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

BIOGEL GLOVE SIZE 8, #30480

Facility

$22.00

Hospital Charge Code	287384
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

BIOGEL GLOVE SIZE 8, #30480

Facility

$22.00

Hospital Charge Code	287384
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

BIOGEL GLOVES SIZE 6

Facility

$22.00

Hospital Charge Code	287274
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

BIOGEL GLOVES SIZE 6

Facility

$22.00

Hospital Charge Code	287274
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

BIOGEL GLOVES SIZE 6-1/2

Facility

$22.00

Hospital Charge Code	287275
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

BIOGEL GLOVES SIZE 6-1/2

Facility

$22.00

Hospital Charge Code	287275
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

BIOGEL GLOVES SIZE 7-1/2

Facility

$22.00

Hospital Charge Code	287273
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

Know your out-of-pocket cost for care.

All Charges