Madison Medical Center

All Charges

Charge

Type

Setting

Price

Y BLOOD TUBING

Facility

$58.00

Hospital Charge Code	2858110
Hospital Revenue Code	250
Rate for Payer: Cash Price	$52.20

YEAST, IDENTIFICATION, LAB CHARGE ONLY

Facility

$251.00

Service Code	CPT 87106
Hospital Charge Code	3087106
Hospital Revenue Code	306
Rate for Payer: Cash Price	$225.90

YEAST, IDENTIFICATION, LAB CHARGE ONLY

Facility

$251.00

Service Code	CPT 87106
Hospital Charge Code	3087106
Hospital Revenue Code	306
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$179.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.29
Rate for Payer: Aetna Medicare Advantage	$10.32
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	$10.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.94
Rate for Payer: Home State Health Plan Medicare Advantage	$10.32
Rate for Payer: Humana Commercial	$20.64
Rate for Payer: Humana Medicare Advantage	$10.32
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.36

YEAST SUSCEPTIBILITY PANEL

Facility

$660.00

Service Code	CPT 87186
Hospital Charge Code	22287186
Hospital Revenue Code	306
Rate for Payer: Cash Price	$594.00

YEAST SUSCEPTIBILITY PANEL

Facility

$660.00

Service Code	CPT 87186
Hospital Charge Code	22287186
Hospital Revenue Code	306
Min. Negotiated Rate	$7.79
Max. Negotiated Rate	$471.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.79
Rate for Payer: Aetna Medicare Advantage	$8.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$390.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$471.24
Rate for Payer: Cash Price	$594.00
Rate for Payer: Cash Price	$594.00
Rate for Payer: Cash Price	$594.00
Rate for Payer: Cigna Commercial HMO & PPO	$8.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.34
Rate for Payer: Home State Health Plan Medicare Advantage	$8.65
Rate for Payer: Humana Commercial	$17.30
Rate for Payer: Humana Medicare Advantage	$8.65
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$237.60

YERSINIA STOOL

Facility

$152.00

Service Code	CPT 87046
Hospital Charge Code	3012004
Hospital Revenue Code	306
Rate for Payer: Cash Price	$136.80

YERSINIA STOOL

Facility

$152.00

Service Code	CPT 87046
Hospital Charge Code	3012004
Hospital Revenue Code	306
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$108.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.50
Rate for Payer: Aetna Medicare Advantage	$9.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$108.53
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cigna Commercial HMO & PPO	$9.44
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.10
Rate for Payer: Home State Health Plan Medicare Advantage	$9.44
Rate for Payer: Humana Commercial	$18.88
Rate for Payer: Humana Medicare Advantage	$9.44
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.72

ZALEPLON 10MG CAP EMP C4

Facility

$43.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2624698
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

ZALEPLON 10MG CAP EMP C4

Facility

$43.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2624698
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

ZALEPLON 5MG CAP EMP C4

Facility

$43.00

Service Code	NDC 4.2043E+10
Hospital Charge Code	2624467
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

ZALEPLON 5MG CAP EMP C4

Facility

$43.00

Service Code	NDC 4.2043E+10
Hospital Charge Code	2624467
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

ZEPBOUND 10MG/0.5ML INJ PEN

Facility

$3,944.00

Service Code	NDC 1E+11
Hospital Charge Code	2625873
Hospital Revenue Code	250
Min. Negotiated Rate	$1,419.84
Max. Negotiated Rate	$2,816.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,334.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,816.02
Rate for Payer: Cash Price	$3,549.60
Rate for Payer: UnitedHealthcare Commercial	$2,630.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,419.84

ZEPBOUND 10MG/0.5ML INJ PEN

Facility

$3,944.00

Service Code	NDC 1E+11
Hospital Charge Code	2625873
Hospital Revenue Code	250
Rate for Payer: Cash Price	$3,549.60

ZEPBOUND 12.5MG/0.5ML INJ PEN

Facility

$3,944.00

Service Code	NDC 1E+11
Hospital Charge Code	2625874
Hospital Revenue Code	250
Rate for Payer: Cash Price	$3,549.60

ZEPBOUND 12.5MG/0.5ML INJ PEN

Facility

$3,944.00

Service Code	NDC 1E+11
Hospital Charge Code	2625874
Hospital Revenue Code	250
Min. Negotiated Rate	$1,419.84
Max. Negotiated Rate	$2,816.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,334.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,816.02
Rate for Payer: Cash Price	$3,549.60
Rate for Payer: UnitedHealthcare Commercial	$2,630.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,419.84

ZEPBOUND 15MG/0.5ML INJ PEN

Facility

$3,944.00

Service Code	NDC 1E+11
Hospital Charge Code	2625875
Hospital Revenue Code	250
Rate for Payer: Cash Price	$3,549.60

ZEPBOUND 15MG/0.5ML INJ PEN

Facility

$3,944.00

Service Code	NDC 1E+11
Hospital Charge Code	2625875
Hospital Revenue Code	250
Min. Negotiated Rate	$1,419.84
Max. Negotiated Rate	$2,816.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,334.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,816.02
Rate for Payer: Cash Price	$3,549.60
Rate for Payer: UnitedHealthcare Commercial	$2,630.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,419.84

ZEPBOUND 2.5MG/0.5ML INJ PEN

Facility

$3,944.00

Service Code	NDC 1E+11
Hospital Charge Code	2625870
Hospital Revenue Code	250
Rate for Payer: Cash Price	$3,549.60

ZEPBOUND 2.5MG/0.5ML INJ PEN

Facility

$3,944.00

Service Code	NDC 1E+11
Hospital Charge Code	2625870
Hospital Revenue Code	250
Min. Negotiated Rate	$1,419.84
Max. Negotiated Rate	$2,816.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,334.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,816.02
Rate for Payer: Cash Price	$3,549.60
Rate for Payer: UnitedHealthcare Commercial	$2,630.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,419.84

ZEPBOUND 5MG/0.5ML INJ PEN

Facility

$3,944.00

Service Code	NDC 1E+11
Hospital Charge Code	2625871
Hospital Revenue Code	250
Rate for Payer: Cash Price	$3,549.60

ZEPBOUND 5MG/0.5ML INJ PEN

Facility

$3,944.00

Service Code	NDC 1E+11
Hospital Charge Code	2625871
Hospital Revenue Code	250
Min. Negotiated Rate	$1,419.84
Max. Negotiated Rate	$2,816.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,334.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,816.02
Rate for Payer: Cash Price	$3,549.60
Rate for Payer: UnitedHealthcare Commercial	$2,630.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,419.84

ZEPBOUND 7.5MG/0.5ML INJ PEN

Facility

$3,944.00

Service Code	NDC 1E+11
Hospital Charge Code	2625872
Hospital Revenue Code	250
Rate for Payer: Cash Price	$3,549.60

ZEPBOUND 7.5MG/0.5ML INJ PEN

Facility

$3,944.00

Service Code	NDC 1E+11
Hospital Charge Code	2625872
Hospital Revenue Code	250
Min. Negotiated Rate	$1,419.84
Max. Negotiated Rate	$2,816.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,334.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,816.02
Rate for Payer: Cash Price	$3,549.60
Rate for Payer: UnitedHealthcare Commercial	$2,630.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,419.84

ZIAC 10/6.25MG TAB EMP

Facility

$35.00

Service Code	NDC 5.1285E+10
Hospital Charge Code	2623968
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

ZIAC 10/6.25MG TAB EMP

Facility

$35.00

Service Code	NDC 5.1285E+10
Hospital Charge Code	2623968
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

Know your out-of-pocket cost for care.

All Charges