Madison Medical Center

All Charges

Charge

Type

Setting

Price

CALCIUM RANDOM URINE

Facility

$124.00

Service Code	CPT 82340
Hospital Charge Code	223247
Hospital Revenue Code	301
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$88.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.43
Rate for Payer: Aetna Medicare Advantage	$6.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial HMO & PPO	$6.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.81
Rate for Payer: Home State Health Plan Medicare Advantage	$6.03
Rate for Payer: Humana Commercial	$12.06
Rate for Payer: Humana Medicare Advantage	$6.03
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

CALCIUM RANDOM URINE

Facility

$124.00

Service Code	CPT 82340
Hospital Charge Code	223247
Hospital Revenue Code	301
Rate for Payer: Cash Price	$111.60

CALCIUM/VIT D 500/200 (OS-CAL)TAB

Facility

$18.00

Service Code	NDC 904546092
Hospital Charge Code	2697092
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

CALCIUM/VIT D 500/200 (OS-CAL)TAB

Facility

$18.00

Service Code	NDC 904546092
Hospital Charge Code	2697092
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

CALCIUM/VIT D 600/200 TAB

Facility

$18.00

Service Code	NDC 8.0681E+10
Hospital Charge Code	2627010
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

CALCIUM/VIT D 600/200 TAB

Facility

$18.00

Service Code	NDC 8.0681E+10
Hospital Charge Code	2627010
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

CALCULI RISK ASSESSMENT (AEL)

Facility

$316.00

Hospital Charge Code	22306266
Hospital Revenue Code	307
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$225.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$187.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$225.62
Rate for Payer: Cash Price	$284.40
Rate for Payer: Cash Price	$284.40
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$113.76

CALCULI RISK ASSESSMENT (AEL)

Facility

$316.00

Hospital Charge Code	22306266
Hospital Revenue Code	307
Rate for Payer: Cash Price	$284.40

CALMOSEPTINE OINTMENT

Facility

$22.00

Hospital Charge Code	2846876
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

CALMOSEPTINE OINTMENT

Facility

$22.00

Hospital Charge Code	2846876
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

CALPROTECTIN STOOL

Facility

$529.00

Service Code	CPT 83993
Hospital Charge Code	2283993
Hospital Revenue Code	301
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$377.71
Rate for Payer: Aetna Better Health Medicaid/QHP	$17.67
Rate for Payer: Aetna Medicare Advantage	$19.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$313.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$377.71
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cigna Commercial HMO & PPO	$19.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18.91
Rate for Payer: Home State Health Plan Medicare Advantage	$19.63
Rate for Payer: Humana Commercial	$39.26
Rate for Payer: Humana Medicare Advantage	$19.63
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$190.44

CALPROTECTIN STOOL

Facility

$529.00

Service Code	CPT 83993
Hospital Charge Code	2283993
Hospital Revenue Code	301
Rate for Payer: Cash Price	$476.10

CA MALLEABLE TIPFILI

Facility

$174.00

Hospital Charge Code	283051
Hospital Revenue Code	271
Rate for Payer: Cash Price	$156.60

CA MALLEABLE TIPFILI

Facility

$174.00

Hospital Charge Code	283051
Hospital Revenue Code	271
Min. Negotiated Rate	$62.64
Max. Negotiated Rate	$124.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$103.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$124.24
Rate for Payer: Cash Price	$156.60
Rate for Payer: UnitedHealthcare Commercial	$116.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.64

CAMERA

Facility

$815.00

Hospital Charge Code	124902
Hospital Revenue Code	360
Rate for Payer: Cash Price	$733.50

CAMERA

Facility

$815.00

Hospital Charge Code	124902
Hospital Revenue Code	360
Min. Negotiated Rate	$293.40
Max. Negotiated Rate	$543.61
Rate for Payer: Cash Price	$733.50
Rate for Payer: UnitedHealthcare Commercial	$543.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$293.40

CAM WALKER BOOT LARGE

Facility

$408.00

Hospital Charge Code	4002240
Hospital Revenue Code	271
Min. Negotiated Rate	$146.88
Max. Negotiated Rate	$291.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$241.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$291.31
Rate for Payer: Cash Price	$367.20
Rate for Payer: UnitedHealthcare Commercial	$272.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$146.88

CAM WALKER BOOT LARGE

Facility

$408.00

Hospital Charge Code	4002240
Hospital Revenue Code	271
Rate for Payer: Cash Price	$367.20

CAM WALKER BOOT MEDIUM

Facility

$408.00

Hospital Charge Code	4002239
Hospital Revenue Code	271
Min. Negotiated Rate	$146.88
Max. Negotiated Rate	$291.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$241.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$291.31
Rate for Payer: Cash Price	$367.20
Rate for Payer: UnitedHealthcare Commercial	$272.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$146.88

CAM WALKER BOOT MEDIUM

Facility

$408.00

Hospital Charge Code	4002239
Hospital Revenue Code	271
Rate for Payer: Cash Price	$367.20

CAM WALKER BOOT SMALL

Facility

$408.00

Hospital Charge Code	4002238
Hospital Revenue Code	271
Rate for Payer: Cash Price	$367.20

CAM WALKER BOOT SMALL

Facility

$408.00

Hospital Charge Code	4002238
Hospital Revenue Code	271
Min. Negotiated Rate	$146.88
Max. Negotiated Rate	$291.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$241.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$291.31
Rate for Payer: Cash Price	$367.20
Rate for Payer: UnitedHealthcare Commercial	$272.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$146.88

CANDIDA ANTIBODY

Facility

$217.00

Service Code	CPT 86628
Hospital Charge Code	2286628
Hospital Revenue Code	301
Rate for Payer: Cash Price	$195.30

CANDIDA ANTIBODY

Facility

$217.00

Service Code	CPT 86628
Hospital Charge Code	2286628
Hospital Revenue Code	301
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$154.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.81
Rate for Payer: Aetna Medicare Advantage	$12.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$128.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$154.94
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cigna Commercial HMO & PPO	$12.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.57
Rate for Payer: Home State Health Plan Medicare Advantage	$12.01
Rate for Payer: Humana Commercial	$24.02
Rate for Payer: Humana Medicare Advantage	$12.01
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$78.12

CANNULA NASAL ADULT

Facility

$273.00

Hospital Charge Code	1299113
Hospital Revenue Code	271
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$194.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$161.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$194.92
Rate for Payer: Cash Price	$245.70
Rate for Payer: UnitedHealthcare Commercial	$182.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$98.28

Know your out-of-pocket cost for care.

All Charges