Madison Medical Center

All Charges

Charge

Type

Setting

Price

C3D CIRCULATING ANTIBODIES

Facility

$385.00

Service Code	CPT 86332
Hospital Charge Code	2286332
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$274.89
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.93
Rate for Payer: Aetna Medicare Advantage	$24.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$227.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$274.89
Rate for Payer: Cash Price	$346.50
Rate for Payer: Cash Price	$346.50
Rate for Payer: Cash Price	$346.50
Rate for Payer: Cigna Commercial HMO & PPO	$24.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.47
Rate for Payer: Home State Health Plan Medicare Advantage	$24.37
Rate for Payer: Humana Commercial	$48.74
Rate for Payer: Humana Medicare Advantage	$24.37
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$138.60

C3D CIRCULATING ANTIBODIES

Facility

$385.00

Service Code	CPT 86332
Hospital Charge Code	2286332
Hospital Revenue Code	301
Rate for Payer: Cash Price	$346.50

CA125

Facility

$79.00

Service Code	CPT 86316
Hospital Charge Code	4286316
Hospital Revenue Code	521
Min. Negotiated Rate	$16.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.73
Rate for Payer: Aetna Medicare Advantage	$20.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$46.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$56.41
Rate for Payer: Cash Price	$71.10
Rate for Payer: Cash Price	$71.10
Rate for Payer: Cash Price	$71.10
Rate for Payer: Cash Price	$71.10
Rate for Payer: Cigna Commercial HMO & PPO	$20.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.04
Rate for Payer: Home State Health Plan Medicare Advantage	$20.81
Rate for Payer: Humana Commercial	$41.62
Rate for Payer: Humana Medicare Advantage	$20.81
Rate for Payer: UnitedHealthcare Commercial	$52.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CA125

Facility

$79.00

Service Code	CPT 86316
Hospital Charge Code	4286316
Hospital Revenue Code	521
Rate for Payer: Cash Price	$71.10

CA 125

Facility

$190.00

Service Code	CPT 86304
Hospital Charge Code	223907
Hospital Revenue Code	301
Rate for Payer: Cash Price	$171.00

CA 125

Facility

$190.00

Service Code	CPT 86304
Hospital Charge Code	223907
Hospital Revenue Code	301
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$135.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.73
Rate for Payer: Aetna Medicare Advantage	$20.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cigna Commercial HMO & PPO	$20.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.04
Rate for Payer: Home State Health Plan Medicare Advantage	$20.81
Rate for Payer: Humana Commercial	$41.62
Rate for Payer: Humana Medicare Advantage	$20.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.40

CA 15-3

Facility

$156.00

Service Code	CPT 86300
Hospital Charge Code	223909
Hospital Revenue Code	301
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$111.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.73
Rate for Payer: Aetna Medicare Advantage	$20.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial HMO & PPO	$20.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.04
Rate for Payer: Home State Health Plan Medicare Advantage	$20.81
Rate for Payer: Humana Commercial	$41.62
Rate for Payer: Humana Medicare Advantage	$20.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

CA 15-3

Facility

$156.00

Service Code	CPT 86300
Hospital Charge Code	223909
Hospital Revenue Code	301
Rate for Payer: Cash Price	$140.40

CA 19-9

Facility

$183.00

Service Code	CPT 86301
Hospital Charge Code	223903
Hospital Revenue Code	301
Rate for Payer: Cash Price	$164.70

CA 19-9

Facility

$183.00

Service Code	CPT 86301
Hospital Charge Code	223903
Hospital Revenue Code	301
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$130.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.73
Rate for Payer: Aetna Medicare Advantage	$20.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$108.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$130.66
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cigna Commercial HMO & PPO	$20.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.04
Rate for Payer: Home State Health Plan Medicare Advantage	$20.81
Rate for Payer: Humana Commercial	$41.62
Rate for Payer: Humana Medicare Advantage	$20.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.88

CA 27.29

Facility

$156.00

Service Code	CPT 86300
Hospital Charge Code	223904
Hospital Revenue Code	301
Rate for Payer: Cash Price	$140.40

CA 27.29

Facility

$156.00

Service Code	CPT 86300
Hospital Charge Code	223904
Hospital Revenue Code	301
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$111.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.73
Rate for Payer: Aetna Medicare Advantage	$20.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial HMO & PPO	$20.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.04
Rate for Payer: Home State Health Plan Medicare Advantage	$20.81
Rate for Payer: Humana Commercial	$41.62
Rate for Payer: Humana Medicare Advantage	$20.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

CABLE-HOLDER-COBE

Facility

$89.00

Hospital Charge Code	283004
Hospital Revenue Code	271
Rate for Payer: Cash Price	$80.10

CABLE-HOLDER-COBE

Facility

$89.00

Hospital Charge Code	283004
Hospital Revenue Code	271
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$63.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: UnitedHealthcare Commercial	$59.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

CADMIUM

Facility

$166.00

Service Code	CPT 82300
Hospital Charge Code	223908
Hospital Revenue Code	301
Rate for Payer: Cash Price	$149.40

CADMIUM

Facility

$166.00

Service Code	CPT 82300
Hospital Charge Code	223908
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$118.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.28
Rate for Payer: Aetna Medicare Advantage	$23.64
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: Cash Price	$149.40
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cigna Commercial HMO & PPO	$23.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22.77
Rate for Payer: Home State Health Plan Medicare Advantage	$23.64
Rate for Payer: Humana Commercial	$47.28
Rate for Payer: Humana Medicare Advantage	$23.64
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

CADMIUM URINE

Facility

$185.00

Service Code	CPT 82300
Hospital Charge Code	223910
Hospital Revenue Code	301
Rate for Payer: Cash Price	$166.50

CADMIUM URINE

Facility

$185.00

Service Code	CPT 82300
Hospital Charge Code	223910
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$132.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.28
Rate for Payer: Aetna Medicare Advantage	$23.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$109.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.09
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cigna Commercial HMO & PPO	$23.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22.77
Rate for Payer: Home State Health Plan Medicare Advantage	$23.64
Rate for Payer: Humana Commercial	$47.28
Rate for Payer: Humana Medicare Advantage	$23.64
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.60

CALC CARB (TUMS) 500MG (4 TAB=2000MG)

Facility

$18.00

Service Code	NDC 2.4385E+10
Hospital Charge Code	2626516
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

CALC CARB (TUMS) 500MG (4 TAB=2000MG)

Facility

$18.00

Service Code	NDC 2.4385E+10
Hospital Charge Code	2626516
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

CALCITONIN

Facility

$58.00

Service Code	CPT 82308
Hospital Charge Code	2282308
Hospital Revenue Code	301
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$53.58
Rate for Payer: Humana Medicare Advantage	$26.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$24.11
Rate for Payer: Aetna Medicare Advantage	$26.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cigna Commercial HMO & PPO	$26.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25.80
Rate for Payer: Home State Health Plan Medicare Advantage	$26.79
Rate for Payer: Humana Commercial	$53.58
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

CALCITONIN

Facility

$58.00

Service Code	CPT 82308
Hospital Charge Code	2282308
Hospital Revenue Code	301
Rate for Payer: Cash Price	$52.20

CALCITRIOL (ROCALTROL) 0.25MCG CAP

Facility

$20.00

Service Code	NDC 6.9452E+10
Hospital Charge Code	2626484
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

CALCITRIOL (ROCALTROL) 0.25MCG CAP

Facility

$20.00

Service Code	NDC 6.9452E+10
Hospital Charge Code	2626484
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

CALCITRIOL (ROCALTROL) 0.25MCG CAP EMP

Facility

$20.00

Service Code	NDC 6.438E+10
Hospital Charge Code	2623040
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

Know your out-of-pocket cost for care.

All Charges