Madison Medical Center

All Charges

Charge

Type

Setting

Price

VARICELLA ZOSTER IGM

Facility

$125.00

Service Code	CPT 86787
Hospital Charge Code	2286788
Hospital Revenue Code	301
Rate for Payer: Cash Price	$112.50

VARICELLA ZOSTER IGM

Facility

$125.00

Service Code	CPT 86787
Hospital Charge Code	2286788
Hospital Revenue Code	301
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$89.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.59
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna Commercial HMO & PPO	$12.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.40
Rate for Payer: Home State Health Plan Medicare Advantage	$12.88
Rate for Payer: Humana Commercial	$25.76
Rate for Payer: Humana Medicare Advantage	$12.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

VARICELLA ZOSTER REAL TIME PCR

Facility

$557.00

Service Code	CPT 87798
Hospital Charge Code	2287700
Hospital Revenue Code	301
Rate for Payer: Cash Price	$501.30

VARICELLA ZOSTER REAL TIME PCR

Facility

$557.00

Service Code	CPT 87798
Hospital Charge Code	2287700
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$397.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.58
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$329.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$397.70
Rate for Payer: Cash Price	$501.30
Rate for Payer: Cash Price	$501.30
Rate for Payer: Cash Price	$501.30
Rate for Payer: Cigna Commercial HMO & PPO	$35.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.79
Rate for Payer: Home State Health Plan Medicare Advantage	$35.09
Rate for Payer: Humana Commercial	$70.18
Rate for Payer: Humana Medicare Advantage	$35.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$200.52

VARICELLA ZOSTER VIRAL CULTURE

Facility

$187.00

Service Code	CPT 87252
Hospital Charge Code	3086789
Hospital Revenue Code	306
Rate for Payer: Cash Price	$168.30

VARICELLA ZOSTER VIRAL CULTURE

Facility

$187.00

Service Code	CPT 87252
Hospital Charge Code	3086789
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$133.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$23.46
Rate for Payer: Aetna Medicare Advantage	$26.07
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	$26.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25.10
Rate for Payer: Home State Health Plan Medicare Advantage	$26.07
Rate for Payer: Humana Commercial	$52.14
Rate for Payer: Humana Medicare Advantage	$26.07
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.32

VASCULAR ACCESS PORT

Facility

$2,077.00

Hospital Charge Code	1269123
Hospital Revenue Code	271
Min. Negotiated Rate	$747.72
Max. Negotiated Rate	$1,482.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,229.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,482.98
Rate for Payer: Cash Price	$1,869.30
Rate for Payer: UnitedHealthcare Commercial	$1,385.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$747.72

VASCULAR ACCESS PORT

Facility

$2,077.00

Hospital Charge Code	1269123
Hospital Revenue Code	271
Rate for Payer: Cash Price	$1,869.30

VASECTOMY

Facility

$653.00

Service Code	CPT 55250
Hospital Charge Code	4155250
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$4,271.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,884.38
Rate for Payer: Aetna Medicare Advantage	$2,135.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$386.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$466.24
Rate for Payer: Cash Price	$587.70
Rate for Payer: Cash Price	$587.70
Rate for Payer: Cash Price	$587.70
Rate for Payer: Cash Price	$587.70
Rate for Payer: Cigna Commercial HMO & PPO	$2,135.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,695.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2,016.29
Rate for Payer: Home State Health Plan Medicare Advantage	$2,135.66
Rate for Payer: Humana Commercial	$4,271.32
Rate for Payer: Humana Medicare Advantage	$2,135.66
Rate for Payer: UnitedHealthcare Commercial	$435.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,884.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

VASECTOMY

Facility

$653.00

Service Code	CPT 55250
Hospital Charge Code	4155250
Hospital Revenue Code	521
Rate for Payer: Cash Price	$587.70

VASECTOMY, UNILATERAL OR BILATERAL

Professional

Both

$1,250.00

Service Code	CPT 55250
Hospital Charge Code	5455250
Hospital Revenue Code	975
Min. Negotiated Rate	$204.74
Max. Negotiated Rate	$437.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$204.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$394.21
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Cigna Commercial HMO & PPO	$204.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$394.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$433.63
Rate for Payer: Home State Health Plan Medicare Advantage	$204.74
Rate for Payer: Optum Medicare Advantage	$437.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$394.21

Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s)

Facility

$4,271.32

Service Code	CPT 55250
Hospital Revenue Code	360
Min. Negotiated Rate	$1,253.00
Max. Negotiated Rate	$4,271.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,884.38
Rate for Payer: Aetna Medicare Advantage	$2,135.66
Rate for Payer: Cigna Commercial HMO & PPO	$2,135.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,884.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2,016.29
Rate for Payer: Home State Health Plan Medicare Advantage	$2,135.66
Rate for Payer: Humana Commercial	$4,271.32
Rate for Payer: Humana Medicare Advantage	$2,135.66
Rate for Payer: UnitedHealthcare Commercial	$1,253.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,884.38

VASELENE GAZE 1/2 72

Facility

$42.00

Hospital Charge Code	2822732
Hospital Revenue Code	271
Rate for Payer: Cash Price	$37.80

VASELENE GAZE 1/2 72

Facility

$42.00

Hospital Charge Code	2822732
Hospital Revenue Code	271
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

VASOPRESSIN 20UNITS INJ 1ML

Facility

$829.00

Service Code	NDC 4.2023E+10
Hospital Charge Code	2619803
Hospital Revenue Code	250
Rate for Payer: Cash Price	$746.10

VASOPRESSIN 20UNITS INJ 1ML

Facility

$829.00

Service Code	NDC 4.2023E+10
Hospital Charge Code	2619803
Hospital Revenue Code	250
Min. Negotiated Rate	$298.44
Max. Negotiated Rate	$591.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$490.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$591.91
Rate for Payer: Cash Price	$746.10
Rate for Payer: UnitedHealthcare Commercial	$552.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$298.44

VECURONIUM (NORCURON) 10MG INJ

Facility

$247.00

Service Code	HCPCS J3490
Hospital Charge Code	2626335
Hospital Revenue Code	250
Rate for Payer: Cash Price	$222.30

VECURONIUM (NORCURON) 10MG INJ

Facility

$247.00

Service Code	HCPCS J3490
Hospital Charge Code	2626335
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

VECURONIUM (NORCURON) 20MG INJ

Facility

$247.00

Service Code	HCPCS J3490
Hospital Charge Code	2620405
Hospital Revenue Code	250
Rate for Payer: Cash Price	$222.30

VECURONIUM (NORCURON) 20MG INJ

Facility

$247.00

Service Code	HCPCS J3490
Hospital Charge Code	2620405
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

VEIN LIGATION AND STRIPPING

Facility

$51,695.36

Service Code	MSDRG 263
Min. Negotiated Rate	$25,847.68
Max. Negotiated Rate	$51,695.36
Rate for Payer: Aetna Medicare Advantage	$25,847.68
Rate for Payer: Cigna Commercial HMO & PPO	$25,847.68
Rate for Payer: Home State Health Plan Medicare Advantage	$25,847.68
Rate for Payer: Humana Commercial	$51,695.36
Rate for Payer: Humana Medicare Advantage	$25,847.68

VENI GUARD IV DRESSING

Facility

$12.00

Hospital Charge Code	287054
Hospital Revenue Code	271
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$8.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8.57
Rate for Payer: Cash Price	$10.80
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

VENI GUARD IV DRESSING

Facility

$12.00

Hospital Charge Code	287054
Hospital Revenue Code	271
Rate for Payer: Cash Price	$10.80

VENIPUNCTURE

Facility

$36.00

Service Code	CPT 36415
Hospital Charge Code	221111
Hospital Revenue Code	300
Rate for Payer: Cash Price	$32.40

VENIPUNCTURE

Facility

$36.00

Service Code	CPT 36415
Hospital Charge Code	221111
Hospital Revenue Code	300
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$25.70
Rate for Payer: Aetna Medicare Advantage	$9.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$25.70
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cash Price	$32.40
Rate for Payer: Cigna Commercial HMO & PPO	$9.34
Rate for Payer: Home State Health Plan Medicare Advantage	$9.34
Rate for Payer: Humana Commercial	$18.68
Rate for Payer: Humana Medicare Advantage	$9.34
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.96

Know your out-of-pocket cost for care.

All Charges