Madison Medical Center

All Charges

Charge

Type

Setting

Price

BIPOLAR PENCIL (EYE)

Facility

$58.00

Hospital Charge Code	126905
Hospital Revenue Code	360
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$38.69
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

BISACODYL (BISCOLAX) 10MG SUPP

Facility

$20.00

Service Code	NDC 904505812
Hospital Charge Code	2654310
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

BISACODYL (BISCOLAX) 10MG SUPP

Facility

$20.00

Service Code	NDC 904505812
Hospital Charge Code	2654310
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

BISACODYL (DULCOLAX) 5MG TAB

Facility

$20.00

Service Code	NDC 5.7896E+10
Hospital Charge Code	2654305
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

BISACODYL (DULCOLAX) 5MG TAB

Facility

$20.00

Service Code	NDC 5.7896E+10
Hospital Charge Code	2654305
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

BISMUTH SUB 525MG/30ML 8OZ BOT

Facility

$28.00

Service Code	NDC 3.7E+10
Hospital Charge Code	2624312
Hospital Revenue Code	250
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

BISMUTH SUB 525MG/30ML 8OZ BOT

Facility

$28.00

Service Code	NDC 3.7E+10
Hospital Charge Code	2624312
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

BITE

Facility

$16.00

Hospital Charge Code	282325
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

BITE

Facility

$16.00

Hospital Charge Code	282325
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

BITE BLOCK (SURGERY)

Facility

$21.00

Hospital Charge Code	122344
Hospital Revenue Code	271
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

BITE BLOCK (SURGERY)

Facility

$21.00

Hospital Charge Code	122344
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

BK VIRUS PLASMA

Facility

$764.00

Service Code	CPT 87799
Hospital Charge Code	2287799
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$545.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$38.56
Rate for Payer: Aetna Medicare Advantage	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$452.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$545.50
Rate for Payer: Cash Price	$687.60
Rate for Payer: Cash Price	$687.60
Rate for Payer: Cash Price	$687.60
Rate for Payer: Cigna Commercial HMO & PPO	$42.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$38.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41.26
Rate for Payer: Home State Health Plan Medicare Advantage	$42.84
Rate for Payer: Humana Commercial	$85.68
Rate for Payer: Humana Medicare Advantage	$42.84
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$38.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$275.04

BK VIRUS PLASMA

Facility

$764.00

Service Code	CPT 87799
Hospital Charge Code	2287799
Hospital Revenue Code	301
Rate for Payer: Cash Price	$687.60

BK VIRUS URINE

Facility

$691.00

Service Code	CPT 87799
Hospital Charge Code	227799
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$493.37
Rate for Payer: Aetna Better Health Medicaid/QHP	$38.56
Rate for Payer: Aetna Medicare Advantage	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$409.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$493.37
Rate for Payer: Cash Price	$621.90
Rate for Payer: Cash Price	$621.90
Rate for Payer: Cash Price	$621.90
Rate for Payer: Cigna Commercial HMO & PPO	$42.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$38.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41.26
Rate for Payer: Home State Health Plan Medicare Advantage	$42.84
Rate for Payer: Humana Commercial	$85.68
Rate for Payer: Humana Medicare Advantage	$42.84
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$38.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$248.76

BK VIRUS URINE

Facility

$691.00

Service Code	CPT 87799
Hospital Charge Code	227799
Hospital Revenue Code	301
Rate for Payer: Cash Price	$621.90

BLADDER EVAC

Facility

$301.00

Hospital Charge Code	285207
Hospital Revenue Code	271
Min. Negotiated Rate	$108.36
Max. Negotiated Rate	$214.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$178.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.91
Rate for Payer: Cash Price	$270.90
Rate for Payer: UnitedHealthcare Commercial	$200.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.36

BLADDER EVAC

Facility

$301.00

Hospital Charge Code	285207
Hospital Revenue Code	271
Rate for Payer: Cash Price	$270.90

BLADDER IRRIGATION,SIMPLE/LAVAGE&/ORINST

Facility

$591.00

Service Code	CPT 51700
Hospital Charge Code	551700
Hospital Revenue Code	260
Rate for Payer: Cash Price	$531.90

BLADDER IRRIGATION,SIMPLE/LAVAGE&/ORINST

Facility

$591.00

Service Code	CPT 51700
Hospital Charge Code	551700
Hospital Revenue Code	260
Min. Negotiated Rate	$212.76
Max. Negotiated Rate	$510.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$225.22
Rate for Payer: Aetna Medicare Advantage	$255.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$349.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$421.97
Rate for Payer: Cash Price	$531.90
Rate for Payer: Cash Price	$531.90
Rate for Payer: Cash Price	$531.90
Rate for Payer: Cigna Commercial HMO & PPO	$255.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$225.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$240.99
Rate for Payer: Home State Health Plan Medicare Advantage	$255.26
Rate for Payer: Humana Commercial	$510.52
Rate for Payer: Humana Medicare Advantage	$255.26
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$225.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$212.76

BLADDER SCANNER

Facility

$100.00

Service Code	CPT 51798
Hospital Charge Code	1824484
Hospital Revenue Code	271
Rate for Payer: Cash Price	$90.00

BLADDER SCANNER

Facility

$100.00

Service Code	CPT 51798
Hospital Charge Code	1824484
Hospital Revenue Code	271
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$120.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$53.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.00

BLADDER U/S NON IMAGING

Facility

$100.00

Service Code	CPT 51798
Hospital Charge Code	9351798
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BLADDER U/S NON IMAGING

Facility

$100.00

Service Code	CPT 51798
Hospital Charge Code	9351798
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

BLADE PODIATRY

Facility

$43.00

Hospital Charge Code	127700
Hospital Revenue Code	271
Rate for Payer: Cash Price	$38.70

BLADE PODIATRY

Facility

$43.00

Hospital Charge Code	127700
Hospital Revenue Code	271
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

Know your out-of-pocket cost for care.

All Charges