Madison Medical Center

All Charges

Charge

Type

Setting

Price

BUDESONIDE 0.5MG INH SUSP 2ML UD

Facility

$60.00

Service Code	NDC 591376830
Hospital Charge Code	2626448
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

BUDESONIDE 0.5MG INH SUSP #30 EMP

Facility

$60.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2622747
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

BUDESONIDE 0.5MG INH SUSP #30 EMP

Facility

$60.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2622747
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

BUDESONIDE 0.5MG INH SUSP (5 PACK)

Facility

$134.00

Service Code	NDC 115168974
Hospital Charge Code	2624552
Hospital Revenue Code	250
Min. Negotiated Rate	$48.24
Max. Negotiated Rate	$95.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$95.68
Rate for Payer: Cash Price	$120.60
Rate for Payer: UnitedHealthcare Commercial	$89.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$48.24

BUDESONIDE 0.5MG INH SUSP (5 PACK)

Facility

$134.00

Service Code	NDC 115168974
Hospital Charge Code	2624552
Hospital Revenue Code	250
Rate for Payer: Cash Price	$120.60

BUDESONIDE EC DR 3MG CAP EMP

Facility

$19.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2625299
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

BUDESONIDE EC DR 3MG CAP EMP

Facility

$19.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2625299
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

BUFORD GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9282962
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

BUFORD GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9282962
Hospital Revenue Code	301
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$21.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.95
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$3.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.16
Rate for Payer: Home State Health Plan Medicare Advantage	$3.28
Rate for Payer: Humana Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.28
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

BUFORD INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	9287804
Hospital Revenue Code	301
Rate for Payer: Cash Price	$63.90

BUFORD INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	9287804
Hospital Revenue Code	301
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$50.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.90
Rate for Payer: Aetna Medicare Advantage	$16.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.94
Rate for Payer: Home State Health Plan Medicare Advantage	$16.55
Rate for Payer: Humana Commercial	$33.10
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

BUFORD INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	9287502
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$191.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$86.22
Rate for Payer: Aetna Medicare Advantage	$95.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$72.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$87.82
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$95.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$86.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$92.26
Rate for Payer: Home State Health Plan Medicare Advantage	$95.80
Rate for Payer: Humana Commercial	$191.60
Rate for Payer: Humana Medicare Advantage	$95.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$86.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.28

BUFORD INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	9287502
Hospital Revenue Code	301
Rate for Payer: Cash Price	$110.70

BUFORD KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9287210
Hospital Revenue Code	301
Rate for Payer: Cash Price	$36.00

BUFORD KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9287210
Hospital Revenue Code	301
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.24
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$5.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.61
Rate for Payer: Home State Health Plan Medicare Advantage	$5.82
Rate for Payer: Humana Commercial	$11.64
Rate for Payer: Humana Medicare Advantage	$5.82
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

BUFORD OCCULT BLOOD

Facility

$25.00

Service Code	CPT 82270
Hospital Charge Code	9282270
Hospital Revenue Code	301
Rate for Payer: Cash Price	$22.50

BUFORD OCCULT BLOOD

Facility

$25.00

Service Code	CPT 82270
Hospital Charge Code	9282270
Hospital Revenue Code	301
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.94
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna Commercial HMO & PPO	$4.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.22
Rate for Payer: Home State Health Plan Medicare Advantage	$4.38
Rate for Payer: Humana Commercial	$8.76
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.00

BUFORD RAPID STREP

Facility

$75.00

Service Code	CPT 87880
Hospital Charge Code	9287880
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

BUFORD RAPID STREP

Facility

$75.00

Service Code	CPT 87880
Hospital Charge Code	9287880
Hospital Revenue Code	301
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$53.55
Rate for Payer: Humana Commercial	$33.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.88
Rate for Payer: Aetna Medicare Advantage	$16.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$16.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.92
Rate for Payer: Home State Health Plan Medicare Advantage	$16.53
Rate for Payer: Humana Medicare Advantage	$16.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

BUFORD RSV

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	9287634
Hospital Revenue Code	301
Rate for Payer: Cash Price	$110.70

BUFORD RSV

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	9287634
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$63.18
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$72.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$87.82
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$70.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$63.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$67.60
Rate for Payer: Home State Health Plan Medicare Advantage	$70.20
Rate for Payer: Humana Commercial	$140.40
Rate for Payer: Humana Medicare Advantage	$70.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$63.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.28

BUFORD STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	9287651
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

BUFORD STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	9287651
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$70.18
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	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
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	$27.00

BUFORD URINE DIP

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	9281002
Hospital Revenue Code	307
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$15.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.28
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cigna Commercial HMO & PPO	$3.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.35
Rate for Payer: Home State Health Plan Medicare Advantage	$3.48
Rate for Payer: Humana Commercial	$6.96
Rate for Payer: Humana Medicare Advantage	$3.48
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72

BUFORD URINE DIP

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	9281002
Hospital Revenue Code	307
Rate for Payer: Cash Price	$24.30

Know your out-of-pocket cost for care.

All Charges