Madison Medical Center

All Charges

Charge

Type

Setting

Price

DANTROLENE 20MG INJ

Facility

$408.00

Service Code	NDC 2.7505E+10
Hospital Charge Code	2620735
Hospital Revenue Code	250
Rate for Payer: Cash Price	$367.20

DANTROLENE 20MG INJ

Facility

$408.00

Service Code	NDC 2.7505E+10
Hospital Charge Code	2620735
Hospital Revenue Code	250
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

DAPTOMYCIN 700MG IVP INFUSN (PORT/PICC)

Facility

$851.00

Service Code	HCPCS J0743
Hospital Charge Code	2626999
Hospital Revenue Code	250
Rate for Payer: Cash Price	$765.90

DAPTOMYCIN 700MG IVP INFUSN (PORT/PICC)

Facility

$851.00

Service Code	HCPCS J0743
Hospital Charge Code	2626999
Hospital Revenue Code	250
Min. Negotiated Rate	$306.36
Max. Negotiated Rate	$607.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$503.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$607.61
Rate for Payer: Cash Price	$765.90
Rate for Payer: UnitedHealthcare Commercial	$567.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$306.36

DAPTOMYCIN 750MG IV (3X350MG)

Facility

$75.00

Service Code	HCPCS J0743
Hospital Charge Code	2627155
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
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: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

DAPTOMYCIN 750MG IV (3X350MG)

Facility

$75.00

Service Code	HCPCS J0743
Hospital Charge Code	2627155
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

DAPTOMYCIN (CUBICIN) 375MG INJ FOR IVPB

Facility

$1,945.00

Service Code	HCPCS J0743
Hospital Charge Code	2619194
Hospital Revenue Code	250
Min. Negotiated Rate	$700.20
Max. Negotiated Rate	$1,388.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,151.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,388.73
Rate for Payer: Cash Price	$1,750.50
Rate for Payer: UnitedHealthcare Commercial	$1,297.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$700.20

DAPTOMYCIN (CUBICIN) 375MG INJ FOR IVPB

Facility

$1,945.00

Service Code	HCPCS J0743
Hospital Charge Code	2619194
Hospital Revenue Code	250
Rate for Payer: Cash Price	$1,750.50

DAPTOMYCIN (CUBICIN) 575MG IVPB

Facility

$2,702.00

Service Code	HCPCS J0743
Hospital Charge Code	2697606
Hospital Revenue Code	250
Min. Negotiated Rate	$972.72
Max. Negotiated Rate	$1,929.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,599.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,929.23
Rate for Payer: Cash Price	$2,431.80
Rate for Payer: UnitedHealthcare Commercial	$1,802.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$972.72

DAPTOMYCIN (CUBICIN) 575MG IVPB

Facility

$1,566.00

Service Code	HCPCS J0743
Hospital Charge Code	260647
Hospital Revenue Code	250
Rate for Payer: Cash Price	$1,409.40

DAPTOMYCIN (CUBICIN) 575MG IVPB

Facility

$2,702.00

Service Code	HCPCS J0743
Hospital Charge Code	2697606
Hospital Revenue Code	250
Rate for Payer: Cash Price	$2,431.80

DAPTOMYCIN (CUBICIN) 575MG IVPB

Facility

$1,566.00

Service Code	HCPCS J0743
Hospital Charge Code	260647
Hospital Revenue Code	250
Min. Negotiated Rate	$563.76
Max. Negotiated Rate	$1,118.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$927.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,118.12
Rate for Payer: Cash Price	$1,409.40
Rate for Payer: UnitedHealthcare Commercial	$1,044.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$563.76

DAPTOMYCIN + NS : 750MG + 100ML PICC

Facility

$851.00

Service Code	HCPCS J0743
Hospital Charge Code	2627154
Hospital Revenue Code	250
Rate for Payer: Cash Price	$765.90

DAPTOMYCIN + NS : 750MG + 100ML PICC

Facility

$851.00

Service Code	HCPCS J0743
Hospital Charge Code	2627154
Hospital Revenue Code	250
Min. Negotiated Rate	$306.36
Max. Negotiated Rate	$607.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$503.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$607.61
Rate for Payer: Cash Price	$765.90
Rate for Payer: UnitedHealthcare Commercial	$567.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$306.36

DAPTOMYCIN/NS (CUBICIN) 370MG IVPB

Facility

$1,114.00

Service Code	HCPCS J0743
Hospital Charge Code	2697214
Hospital Revenue Code	250
Rate for Payer: Cash Price	$1,002.60

DAPTOMYCIN/NS (CUBICIN) 370MG IVPB

Facility

$1,114.00

Service Code	HCPCS J0743
Hospital Charge Code	2697214
Hospital Revenue Code	250
Min. Negotiated Rate	$401.04
Max. Negotiated Rate	$795.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$659.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$795.40
Rate for Payer: Cash Price	$1,002.60
Rate for Payer: UnitedHealthcare Commercial	$743.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$401.04

DAPTOMYCIN/NS (CUBICIN) 500MG IVPB

Facility

$2,439.00

Service Code	HCPCS J0743
Hospital Charge Code	2626449
Hospital Revenue Code	250
Min. Negotiated Rate	$878.04
Max. Negotiated Rate	$1,741.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,443.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,741.45
Rate for Payer: Cash Price	$2,195.10
Rate for Payer: UnitedHealthcare Commercial	$1,626.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$878.04

DAPTOMYCIN/NS (CUBICIN) 500MG IVPB

Facility

$2,439.00

Service Code	HCPCS J0743
Hospital Charge Code	2626449
Hospital Revenue Code	250
Rate for Payer: Cash Price	$2,195.10

DARBEPOETIN ALFA 300MCG/0.6ML INJ

Facility

$23,546.00

Service Code	NDC 5.5513E+10
Hospital Charge Code	2698380
Hospital Revenue Code	335
Rate for Payer: Cash Price	$21,191.40

DARBEPOETIN ALFA 300MCG/0.6ML INJ

Facility

$23,546.00

Service Code	NDC 5.5513E+10
Hospital Charge Code	2698380
Hospital Revenue Code	335
Min. Negotiated Rate	$8,476.56
Max. Negotiated Rate	$16,811.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13,939.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$16,811.84
Rate for Payer: Cash Price	$21,191.40
Rate for Payer: UnitedHealthcare Commercial	$15,705.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,476.56

DARBEPOETIN ALFA 60MCG INJ 0.3ML

Facility

$3,954.00

Service Code	HCPCS J0881
Hospital Charge Code	2620315
Hospital Revenue Code	331
Min. Negotiated Rate	$2.92
Max. Negotiated Rate	$2,823.16
Rate for Payer: Aetna Medicare Advantage	$2.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,340.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,823.16
Rate for Payer: Cash Price	$3,558.60
Rate for Payer: Cash Price	$3,558.60
Rate for Payer: Cigna Commercial HMO & PPO	$2.92
Rate for Payer: Home State Health Plan Medicare Advantage	$2.92
Rate for Payer: Humana Commercial	$5.84
Rate for Payer: Humana Medicare Advantage	$2.92
Rate for Payer: UnitedHealthcare Commercial	$2,637.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,423.44

DARBEPOETIN ALFA 60MCG INJ 0.3ML

Facility

$3,954.00

Service Code	HCPCS J0881
Hospital Charge Code	2620315
Hospital Revenue Code	331
Rate for Payer: Cash Price	$3,558.60

DAVIS ANTIGEN COVID TEST

Facility

$35.00

Hospital Charge Code	9887504
Hospital Revenue Code	307
Rate for Payer: Cash Price	$31.50

DAVIS ANTIGEN COVID TEST

Facility

$35.00

Hospital Charge Code	9887504
Hospital Revenue Code	307
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

DAVIS GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9882962
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

Know your out-of-pocket cost for care.

All Charges