Madison Medical Center

All Charges

Charge

Type

Setting

Price

BUSPIRONE 5MG TAB EMP

Facility

$24.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2619575
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

BUSPIRONE 7.5MG TAB EMP

Facility

$24.00

Service Code	NDC 5.9651E+10
Hospital Charge Code	2626975
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

BUSPIRONE 7.5MG TAB EMP

Facility

$24.00

Service Code	NDC 5.9651E+10
Hospital Charge Code	2626975
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

BUSPIRONE (BUSPAR) 10MG TAB EMP

Facility

$24.00

Service Code	NDC 93005401
Hospital Charge Code	2654353
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

BUSPIRONE (BUSPAR) 10MG TAB EMP

Facility

$24.00

Service Code	NDC 93005401
Hospital Charge Code	2654353
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

BUSPIRONE (BUSPAR) 15MG TAB

Facility

$24.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2697066
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

BUSPIRONE (BUSPAR) 15MG TAB

Facility

$24.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2697066
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

BUSPIRONE (BUSPAR) 5MG TAB

Facility

$24.00

Service Code	NDC 6.438E+10
Hospital Charge Code	2654352
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

BUSPIRONE (BUSPAR) 5MG TAB

Facility

$24.00

Service Code	NDC 6.438E+10
Hospital Charge Code	2654352
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

BUTAL/ACET/CAFF 50/325/40 TAB EMP

Facility

$20.00

Service Code	NDC 603254421
Hospital Charge Code	2654355
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

BUTAL/ACET/CAFF 50/325/40 TAB EMP

Facility

$20.00

Service Code	NDC 603254421
Hospital Charge Code	2654355
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

BUTTERFLY

Facility

$43.00

Hospital Charge Code	2824456
Hospital Revenue Code	270
Rate for Payer: Cash Price	$38.70

BUTTERFLY

Facility

$43.00

Hospital Charge Code	2824456
Hospital Revenue Code	270
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

BUTTON HOOK

Facility

$20.00

Hospital Charge Code	5349010
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

BUTTON HOOK

Facility

$20.00

Hospital Charge Code	5349010
Hospital Revenue Code	271
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

BUTTON HOOKS

Facility

$20.00

Hospital Charge Code	90000077
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

BUTTON HOOKS

Facility

$20.00

Hospital Charge Code	90000077
Hospital Revenue Code	271
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

BYRNE KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9187210
Hospital Revenue Code	521
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$173.53
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: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$5.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.72
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	$26.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BYRNE KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9187210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$36.00

BYRNE OCCULT BLOOD

Facility

$25.00

Service Code	CPT 82270
Hospital Charge Code	9182270
Hospital Revenue Code	521
Min. Negotiated Rate	$3.55
Max. Negotiated Rate	$173.53
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: Cash Price	$22.50
Rate for Payer: Cigna Commercial HMO & PPO	$4.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.55
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	$16.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BYRNE OCCULT BLOOD

Facility

$25.00

Service Code	CPT 82270
Hospital Charge Code	9182270
Hospital Revenue Code	521
Rate for Payer: Cash Price	$22.50

C1 ESTERASE INHIBITOR

Facility

$112.00

Service Code	CPT 86160
Hospital Charge Code	2286160
Hospital Revenue Code	301
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.80
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$12.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.56
Rate for Payer: Home State Health Plan Medicare Advantage	$12.00
Rate for Payer: Humana Commercial	$24.00
Rate for Payer: Humana Medicare Advantage	$12.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

C1 ESTERASE INHIBITOR

Facility

$112.00

Service Code	CPT 86160
Hospital Charge Code	2286160
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

C1 ESTERASE INHIBITOR FUNCT

Facility

$138.00

Service Code	CPT 86161
Hospital Charge Code	22861610
Hospital Revenue Code	301
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$98.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.80
Rate for Payer: Aetna Medicare Advantage	$12.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$81.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$98.53
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cigna Commercial HMO & PPO	$12.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.56
Rate for Payer: Home State Health Plan Medicare Advantage	$12.00
Rate for Payer: Humana Commercial	$24.00
Rate for Payer: Humana Medicare Advantage	$12.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$49.68

C1 ESTERASE INHIBITOR FUNCT

Facility

$138.00

Service Code	CPT 86161
Hospital Charge Code	22861610
Hospital Revenue Code	301
Rate for Payer: Cash Price	$124.20

Know your out-of-pocket cost for care.

All Charges