Madison Medical Center

All Charges

Charge

Type

Setting

Price

VIT D

Facility

$251.00

Service Code	CPT 82306
Hospital Charge Code	2282306
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$179.21
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	$148.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$179.21
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cash Price	$225.90
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	$90.36

VLIDO/MINTO/DIPH/SCRLFT ORAL SUSP 160ML

Facility

$244.00

Service Code	NDC 6.6689E+10
Hospital Charge Code	2623876
Hospital Revenue Code	250
Min. Negotiated Rate	$87.84
Max. Negotiated Rate	$174.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$144.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.22
Rate for Payer: Cash Price	$219.60
Rate for Payer: UnitedHealthcare Commercial	$162.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$87.84

VLIDO/MINTO/DIPH/SCRLFT ORAL SUSP 160ML

Facility

$244.00

Service Code	NDC 6.6689E+10
Hospital Charge Code	2623876
Hospital Revenue Code	250
Rate for Payer: Cash Price	$219.60

VMA 24HR URINE

Facility

$96.00

Service Code	CPT 84585
Hospital Charge Code	2284585
Hospital Revenue Code	301
Rate for Payer: Cash Price	$86.40

VMA 24HR URINE

Facility

$96.00

Service Code	CPT 84585
Hospital Charge Code	2284585
Hospital Revenue Code	301
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$68.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.95
Rate for Payer: Aetna Medicare Advantage	$15.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$68.54
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cigna Commercial HMO & PPO	$15.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.93
Rate for Payer: Home State Health Plan Medicare Advantage	$15.50
Rate for Payer: Humana Commercial	$31.00
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.56

VMA RANDOM URINE

Facility

$153.00

Service Code	CPT 84585
Hospital Charge Code	2222206
Hospital Revenue Code	301
Min. Negotiated Rate	$13.95
Max. Negotiated Rate	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.95
Rate for Payer: Aetna Medicare Advantage	$15.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cigna Commercial HMO & PPO	$15.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.93
Rate for Payer: Home State Health Plan Medicare Advantage	$15.50
Rate for Payer: Humana Commercial	$31.00
Rate for Payer: Humana Medicare Advantage	$15.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

VMA RANDOM URINE

Facility

$153.00

Service Code	CPT 84585
Hospital Charge Code	2222206
Hospital Revenue Code	301
Rate for Payer: Cash Price	$137.70

VOIDING CYSTOURETHRO

Facility

$724.00

Service Code	CPT 74455
Hospital Charge Code	3222202
Hospital Revenue Code	320
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$516.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$428.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$516.94
Rate for Payer: Cash Price	$651.60
Rate for Payer: Cash Price	$651.60
Rate for Payer: Cash Price	$651.60
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$260.64

VOIDING CYSTOURETHRO

Facility

$724.00

Service Code	CPT 74455
Hospital Charge Code	3222202
Hospital Revenue Code	320
Rate for Payer: Cash Price	$651.60

VOLATILE LIQ ANESTHESIA

Facility

$189.00

Hospital Charge Code	207001
Hospital Revenue Code	370
Min. Negotiated Rate	$68.04
Max. Negotiated Rate	$134.95
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: UnitedHealthcare Commercial	$126.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.04

VOLATILE LIQ ANESTHESIA

Facility

$189.00

Hospital Charge Code	207001
Hospital Revenue Code	370
Rate for Payer: Cash Price	$170.10

VOMIT & URINE DISP BAG

Facility

$28.00

Hospital Charge Code	2822802
Hospital Revenue Code	271
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

VOMIT & URINE DISP BAG

Facility

$28.00

Hospital Charge Code	2822802
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

VON WILLEBRAND ANTIGEN

Facility

$394.00

Service Code	CPT 85246
Hospital Charge Code	2285246
Hospital Revenue Code	301
Rate for Payer: Cash Price	$354.60

VON WILLEBRAND ANTIGEN

Facility

$394.00

Service Code	CPT 85246
Hospital Charge Code	2285246
Hospital Revenue Code	301
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$281.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$20.65
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$233.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$281.32
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cigna Commercial HMO & PPO	$22.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22.10
Rate for Payer: Home State Health Plan Medicare Advantage	$22.94
Rate for Payer: Humana Commercial	$45.88
Rate for Payer: Humana Medicare Advantage	$22.94
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$141.84

VON WILLEBRAND FACTOR ACTIVITY

Facility

$254.00

Service Code	CPT 85245
Hospital Charge Code	2285240
Hospital Revenue Code	301
Rate for Payer: Cash Price	$228.60

VON WILLEBRAND FACTOR ACTIVITY

Facility

$254.00

Service Code	CPT 85245
Hospital Charge Code	2285240
Hospital Revenue Code	301
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$181.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$20.65
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$181.36
Rate for Payer: Cash Price	$228.60
Rate for Payer: Cash Price	$228.60
Rate for Payer: Cash Price	$228.60
Rate for Payer: Cigna Commercial HMO & PPO	$22.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22.10
Rate for Payer: Home State Health Plan Medicare Advantage	$22.94
Rate for Payer: Humana Commercial	$45.88
Rate for Payer: Humana Medicare Advantage	$22.94
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$91.44

VON WILLEBRAND MULTIMERIC ANALYSIS

Facility

$271.00

Service Code	CPT 85247
Hospital Charge Code	2285247
Hospital Revenue Code	301
Rate for Payer: Cash Price	$243.90

VON WILLEBRAND MULTIMERIC ANALYSIS

Facility

$271.00

Service Code	CPT 85247
Hospital Charge Code	2285247
Hospital Revenue Code	301
Min. Negotiated Rate	$20.65
Max. Negotiated Rate	$193.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$20.65
Rate for Payer: Aetna Medicare Advantage	$22.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$160.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$193.49
Rate for Payer: Cash Price	$243.90
Rate for Payer: Cash Price	$243.90
Rate for Payer: Cash Price	$243.90
Rate for Payer: Cigna Commercial HMO & PPO	$22.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22.10
Rate for Payer: Home State Health Plan Medicare Advantage	$22.94
Rate for Payer: Humana Commercial	$45.88
Rate for Payer: Humana Medicare Advantage	$22.94
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.56

VORICONAZOLE

Facility

$958.00

Service Code	CPT 80299
Hospital Charge Code	2280230
Hospital Revenue Code	301
Rate for Payer: Cash Price	$862.20

VORICONAZOLE

Facility

$958.00

Service Code	CPT 80299
Hospital Charge Code	2280230
Hospital Revenue Code	301
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$684.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.78
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$567.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$684.01
Rate for Payer: Cash Price	$862.20
Rate for Payer: Cash Price	$862.20
Rate for Payer: Cash Price	$862.20
Rate for Payer: Cigna Commercial HMO & PPO	$18.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.95
Rate for Payer: Home State Health Plan Medicare Advantage	$18.64
Rate for Payer: Humana Commercial	$37.28
Rate for Payer: Humana Medicare Advantage	$18.64
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$344.88

V-PATCH LARGE

Facility

$1,374.00

Hospital Charge Code	1219122
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,236.60

V-PATCH LARGE

Facility

$1,374.00

Hospital Charge Code	1219122
Hospital Revenue Code	272
Min. Negotiated Rate	$494.64
Max. Negotiated Rate	$981.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$813.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$981.04
Rate for Payer: Cash Price	$1,236.60
Rate for Payer: UnitedHealthcare Commercial	$916.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$494.64

V-PATCH MEDIUM

Facility

$1,160.00

Hospital Charge Code	1219123
Hospital Revenue Code	272
Min. Negotiated Rate	$417.60
Max. Negotiated Rate	$828.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$686.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$828.24
Rate for Payer: Cash Price	$1,044.00
Rate for Payer: UnitedHealthcare Commercial	$773.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$417.60

V-PATCH MEDIUM

Facility

$1,160.00

Hospital Charge Code	1219123
Hospital Revenue Code	272
Rate for Payer: Cash Price	$1,044.00

Know your out-of-pocket cost for care.

All Charges