Madison Medical Center

All Charges

Charge

Type

Setting

Price

VITAMIN B6

Facility

$124.00

Service Code	CPT 84207
Hospital Charge Code	2227115
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$88.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$25.29
Rate for Payer: Aetna Medicare Advantage	$28.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial HMO & PPO	$28.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27.06
Rate for Payer: Home State Health Plan Medicare Advantage	$28.10
Rate for Payer: Humana Commercial	$56.20
Rate for Payer: Humana Medicare Advantage	$28.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

VITAMIN B6

Facility

$124.00

Service Code	CPT 84207
Hospital Charge Code	2227115
Hospital Revenue Code	301
Rate for Payer: Cash Price	$111.60

VITAMIN B7

Facility

$489.00

Service Code	CPT 84591
Hospital Charge Code	228459
Hospital Revenue Code	301
Rate for Payer: Cash Price	$440.10

VITAMIN B7

Facility

$489.00

Service Code	CPT 84591
Hospital Charge Code	228459
Hospital Revenue Code	301
Min. Negotiated Rate	$15.35
Max. Negotiated Rate	$349.15
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.35
Rate for Payer: Aetna Medicare Advantage	$17.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$289.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$349.15
Rate for Payer: Cash Price	$440.10
Rate for Payer: Cash Price	$440.10
Rate for Payer: Cash Price	$440.10
Rate for Payer: Cigna Commercial HMO & PPO	$17.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.42
Rate for Payer: Home State Health Plan Medicare Advantage	$17.06
Rate for Payer: Humana Commercial	$34.12
Rate for Payer: Humana Medicare Advantage	$17.06
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$176.04

VITAMIN C

Facility

$156.00

Service Code	CPT 82180
Hospital Charge Code	2282180
Hospital Revenue Code	301
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$111.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.90
Rate for Payer: Aetna Medicare Advantage	$9.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial HMO & PPO	$9.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.52
Rate for Payer: Home State Health Plan Medicare Advantage	$9.89
Rate for Payer: Humana Commercial	$19.78
Rate for Payer: Humana Medicare Advantage	$9.89
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

VITAMIN C

Facility

$156.00

Service Code	CPT 82180
Hospital Charge Code	2282180
Hospital Revenue Code	301
Rate for Payer: Cash Price	$140.40

VITAMIN D-1,25OH

Facility

$189.00

Service Code	CPT 82652
Hospital Charge Code	2282652
Hospital Revenue Code	301
Rate for Payer: Cash Price	$170.10

VITAMIN D-1,25OH

Facility

$189.00

Service Code	CPT 82652
Hospital Charge Code	2282652
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$134.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$34.65
Rate for Payer: Aetna Medicare Advantage	$38.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$111.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$134.95
Rate for Payer: Cash Price	$170.10
Rate for Payer: Cash Price	$170.10
Rate for Payer: Cash Price	$170.10
Rate for Payer: Cigna Commercial HMO & PPO	$38.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$34.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37.08
Rate for Payer: Home State Health Plan Medicare Advantage	$38.50
Rate for Payer: Humana Commercial	$77.00
Rate for Payer: Humana Medicare Advantage	$38.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$34.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.04

VITAMIN D, 25-HYDROXY (LABCORP)

Facility

$44.00

Service Code	CPT 82306
Hospital Charge Code	2211950
Hospital Revenue Code	301
Rate for Payer: Cash Price	$39.60

VITAMIN D, 25-HYDROXY (LABCORP)

Facility

$44.00

Service Code	CPT 82306
Hospital Charge Code	2211950
Hospital Revenue Code	301
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$59.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$26.64
Rate for Payer: Aetna Medicare Advantage	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cigna Commercial HMO & PPO	$29.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28.50
Rate for Payer: Home State Health Plan Medicare Advantage	$29.60
Rate for Payer: Humana Commercial	$59.20
Rate for Payer: Humana Medicare Advantage	$29.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

VITAMIN E

Facility

$93.00

Service Code	CPT 84446
Hospital Charge Code	2284446
Hospital Revenue Code	301
Min. Negotiated Rate	$12.76
Max. Negotiated Rate	$66.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.76
Rate for Payer: Aetna Medicare Advantage	$14.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cigna Commercial HMO & PPO	$14.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.65
Rate for Payer: Home State Health Plan Medicare Advantage	$14.18
Rate for Payer: Humana Commercial	$28.36
Rate for Payer: Humana Medicare Advantage	$14.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

VITAMIN E

Facility

$93.00

Service Code	CPT 84446
Hospital Charge Code	2284446
Hospital Revenue Code	301
Rate for Payer: Cash Price	$83.70

VITAMIN E 400IU CAP

Facility

$20.00

Service Code	NDC 904027460
Hospital Charge Code	2626275
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

VITAMIN E 400IU CAP

Facility

$20.00

Service Code	NDC 904027460
Hospital Charge Code	2626275
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

VITAMIN K

Facility

$11.00

Service Code	CPT J3430
Hospital Charge Code	4103430
Hospital Revenue Code	636
Min. Negotiated Rate	$7.34
Max. Negotiated Rate	$7.34
Rate for Payer: Cash Price	$9.90
Rate for Payer: UnitedHealthcare Commercial	$7.34

VITAMIN K

Facility

$731.00

Service Code	CPT 84597
Hospital Charge Code	2219160
Hospital Revenue Code	301
Rate for Payer: Cash Price	$657.90

VITAMIN K

Facility

$11.00

Service Code	CPT J3430
Hospital Charge Code	4103430
Hospital Revenue Code	636
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$7.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.85
Rate for Payer: Cash Price	$9.90
Rate for Payer: UnitedHealthcare Commercial	$7.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.96

VITAMIN K

Facility

$731.00

Service Code	CPT 84597
Hospital Charge Code	2219160
Hospital Revenue Code	301
Min. Negotiated Rate	$12.35
Max. Negotiated Rate	$521.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.35
Rate for Payer: Aetna Medicare Advantage	$13.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$432.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$521.93
Rate for Payer: Cash Price	$657.90
Rate for Payer: Cash Price	$657.90
Rate for Payer: Cash Price	$657.90
Rate for Payer: Cigna Commercial HMO & PPO	$13.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.21
Rate for Payer: Home State Health Plan Medicare Advantage	$13.72
Rate for Payer: Humana Commercial	$27.44
Rate for Payer: Humana Medicare Advantage	$13.72
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$263.16

VITAMIN K-1 (PHYTONADIONE) 10MG INJ 1ML

Facility

$256.00

Service Code	NDC 4.3598E+10
Hospital Charge Code	2655888
Hospital Revenue Code	250
Min. Negotiated Rate	$92.16
Max. Negotiated Rate	$182.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$151.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.78
Rate for Payer: Cash Price	$230.40
Rate for Payer: UnitedHealthcare Commercial	$170.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$92.16

VITAMIN K-1 (PHYTONADIONE) 10MG INJ 1ML

Facility

$256.00

Service Code	NDC 4.3598E+10
Hospital Charge Code	2655888
Hospital Revenue Code	250
Rate for Payer: Cash Price	$230.40

VITAMIN K (MEPHYTON) 5MG TAB

Facility

$326.00

Service Code	HCPCS J3430
Hospital Charge Code	2655887
Hospital Revenue Code	250
Min. Negotiated Rate	$117.36
Max. Negotiated Rate	$232.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.76
Rate for Payer: Cash Price	$293.40
Rate for Payer: UnitedHealthcare Commercial	$217.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$117.36

VITAMIN K (MEPHYTON) 5MG TAB

Facility

$326.00

Service Code	HCPCS J3430
Hospital Charge Code	2655887
Hospital Revenue Code	250
Rate for Payer: Cash Price	$293.40

VITASS BB TRAUMA FOAM PACK 2.5CC

Facility

$2,107.00

Hospital Charge Code	123409
Hospital Revenue Code	271
Min. Negotiated Rate	$758.52
Max. Negotiated Rate	$1,504.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,247.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,504.40
Rate for Payer: Cash Price	$1,896.30
Rate for Payer: UnitedHealthcare Commercial	$1,405.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$758.52

VITASS BB TRAUMA FOAM PACK 2.5CC

Facility

$2,107.00

Hospital Charge Code	123409
Hospital Revenue Code	271
Rate for Payer: Cash Price	$1,896.30

VIT D

Facility

$251.00

Service Code	CPT 82306
Hospital Charge Code	2282306
Hospital Revenue Code	301
Rate for Payer: Cash Price	$225.90

Know your out-of-pocket cost for care.

All Charges