Madison Medical Center

All Charges

Charge

Type

Setting

Price

BUFORD URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9281025
Hospital Revenue Code	307
Rate for Payer: Cash Price	$36.00

BUFORD URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9281025
Hospital Revenue Code	307
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.75
Rate for Payer: Aetna Medicare Advantage	$8.61
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	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.29
Rate for Payer: Home State Health Plan Medicare Advantage	$8.61
Rate for Payer: Humana Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$8.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

BULKAMID KIT DISPOSABLE

Facility

$1,622.00

Hospital Charge Code	1289004
Hospital Revenue Code	271
Min. Negotiated Rate	$583.92
Max. Negotiated Rate	$1,158.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$960.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,158.11
Rate for Payer: Cash Price	$1,459.80
Rate for Payer: UnitedHealthcare Commercial	$1,081.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$583.92

BULKAMID KIT DISPOSABLE

Facility

$1,622.00

Hospital Charge Code	1289004
Hospital Revenue Code	271
Rate for Payer: Cash Price	$1,459.80

BULKAMID SCOPE/STERILIZATION TRAY

Facility

$3,242.00

Hospital Charge Code	1281814
Hospital Revenue Code	360
Min. Negotiated Rate	$1,167.12
Max. Negotiated Rate	$2,162.41
Rate for Payer: Cash Price	$2,917.80
Rate for Payer: UnitedHealthcare Commercial	$2,162.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,167.12

BULKAMID SCOPE/STERILIZATION TRAY

Facility

$3,242.00

Hospital Charge Code	1281814
Hospital Revenue Code	360
Rate for Payer: Cash Price	$2,917.80

BULLOUS PEMPHIGOID 180 & 230

Facility

$292.00

Hospital Charge Code	2212405
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$208.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$172.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$208.49
Rate for Payer: Cash Price	$262.80
Rate for Payer: Cash Price	$262.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$105.12

BULLOUS PEMPHIGOID 180 & 230

Facility

$292.00

Hospital Charge Code	2212405
Hospital Revenue Code	301
Rate for Payer: Cash Price	$262.80

BUMETANIDE (BUMEX) 1MG/4ML INJ

Facility

$70.00

Service Code	HCPCS J0592
Hospital Charge Code	2657158
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.00

BUMETANIDE (BUMEX) 1MG/4ML INJ

Facility

$70.00

Service Code	HCPCS J0592
Hospital Charge Code	2657158
Hospital Revenue Code	250
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$49.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

BUMETANIDE (BUMEX) 1MG TAB

Facility

$21.00

Service Code	NDC 4.2799E+10
Hospital Charge Code	2657156
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

BUMETANIDE (BUMEX) 1MG TAB

Facility

$21.00

Service Code	NDC 4.2799E+10
Hospital Charge Code	2657156
Hospital Revenue Code	250
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

BUN

Facility

$118.00

Service Code	CPT 84520
Hospital Charge Code	2221112
Hospital Revenue Code	301
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$84.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.56
Rate for Payer: Aetna Medicare Advantage	$3.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$69.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$84.25
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cash Price	$106.20
Rate for Payer: Cigna Commercial HMO & PPO	$3.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.81
Rate for Payer: Home State Health Plan Medicare Advantage	$3.95
Rate for Payer: Humana Commercial	$7.90
Rate for Payer: Humana Medicare Advantage	$3.95
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.48

BUN

Facility

$118.00

Service Code	CPT 84520
Hospital Charge Code	2221112
Hospital Revenue Code	301
Rate for Payer: Cash Price	$106.20

BUPIVACAI (MARCAINE) 0.5% 50ML INJ

Facility

$166.00

Service Code	HCPCS J3490
Hospital Charge Code	2626494
Hospital Revenue Code	250
Rate for Payer: Cash Price	$149.40

BUPIVACAI (MARCAINE) 0.5% 50ML INJ

Facility

$166.00

Service Code	HCPCS J3490
Hospital Charge Code	2626494
Hospital Revenue Code	250
Min. Negotiated Rate	$59.76
Max. Negotiated Rate	$118.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$118.52
Rate for Payer: Cash Price	$149.40
Rate for Payer: UnitedHealthcare Commercial	$110.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

BUPIVACAINE 0.25% INJ 2.5MG 1ML

Facility

$24.00

Service Code	NDC 409158750
Hospital Charge Code	2619444
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

BUPIVACAINE 0.25% INJ 2.5MG 1ML

Facility

$24.00

Service Code	NDC 409158750
Hospital Charge Code	2619444
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

BUPIVACAINE 0.25% PF INJ 30ML

Facility

$70.00

Service Code	NDC 409115902
Hospital Charge Code	2626201
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.00

BUPIVACAINE 0.25% PF INJ 30ML

Facility

$70.00

Service Code	NDC 409115902
Hospital Charge Code	2626201
Hospital Revenue Code	250
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$49.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

BUPIVACAINE 0.5% MPF INJ 10ML

Facility

$65.00

Service Code	NDC 5.515E+10
Hospital Charge Code	2697505
Hospital Revenue Code	250
Rate for Payer: Cash Price	$58.50

BUPIVACAINE 0.5% MPF INJ 10ML

Facility

$65.00

Service Code	NDC 5.515E+10
Hospital Charge Code	2697505
Hospital Revenue Code	250
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

BUPIVACAINE / EPI 0.5% 50ML INJ

Facility

$166.00

Service Code	HCPCS J3490
Hospital Charge Code	2620747
Hospital Revenue Code	250
Rate for Payer: Cash Price	$149.40

BUPIVACAINE / EPI 0.5% 50ML INJ

Facility

$166.00

Service Code	HCPCS J3490
Hospital Charge Code	2620747
Hospital Revenue Code	250
Min. Negotiated Rate	$59.76
Max. Negotiated Rate	$118.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$118.52
Rate for Payer: Cash Price	$149.40
Rate for Payer: UnitedHealthcare Commercial	$110.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

BUPIVACAINE (MARCAINE) 0.25%PF INJ 10ML

Facility

$65.00

Service Code	NDC 6.3323E+10
Hospital Charge Code	2657150
Hospital Revenue Code	250
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

Know your out-of-pocket cost for care.

All Charges