Madison Medical Center

All Charges

Charge

Type

Setting

Price

DESTRUCTION SKIN TAGS

Facility

$87.00

Service Code	CPT 17110
Hospital Charge Code	5217110
Hospital Revenue Code	521
Rate for Payer: Cash Price	$78.30

DESTRUCTION SKIN TAGS

Facility

$87.00

Service Code	CPT 17110
Hospital Charge Code	5217110
Hospital Revenue Code	521
Min. Negotiated Rate	$51.50
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$51.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.12
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$58.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DESVENLAFAXINE ER 100MG TAB EMP

Facility

$67.00

Service Code	NDC 8122230
Hospital Charge Code	2621715
Hospital Revenue Code	250
Rate for Payer: Cash Price	$60.30

DESVENLAFAXINE ER 100MG TAB EMP

Facility

$67.00

Service Code	NDC 8122230
Hospital Charge Code	2621715
Hospital Revenue Code	250
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

DESVENLAFAXINE ER 25MG TAB EMP

Facility

$28.00

Service Code	NDC 8121030
Hospital Charge Code	2623520
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

DESVENLAFAXINE ER 25MG TAB EMP

Facility

$28.00

Service Code	NDC 8121030
Hospital Charge Code	2623520
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

DESVENLAFAXINE ER 50MG TAB EMP

Facility

$28.00

Service Code	NDC 591365930
Hospital Charge Code	2622574
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

DESVENLAFAXINE ER 50MG TAB EMP

Facility

$28.00

Service Code	NDC 591365930
Hospital Charge Code	2622574
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

DEXAMETHASONE

Facility

$308.00

Service Code	CPT 80375
Hospital Charge Code	224252
Hospital Revenue Code	301
Rate for Payer: Cash Price	$277.20

DEXAMETHASONE

Facility

$308.00

Service Code	CPT 80375
Hospital Charge Code	224252
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$219.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$182.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.91
Rate for Payer: Cash Price	$277.20
Rate for Payer: Cash Price	$277.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$110.88

DEXAMETHASONE 10MG/ML INJ 10ML MDV

Facility

$93.00

Service Code	HCPCS J1100
Hospital Charge Code	2626538
Hospital Revenue Code	250
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$66.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: UnitedHealthcare Commercial	$62.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

DEXAMETHASONE 10MG/ML INJ 10ML MDV

Facility

$93.00

Service Code	HCPCS J1100
Hospital Charge Code	2626538
Hospital Revenue Code	250
Rate for Payer: Cash Price	$83.70

DEXAMETHASONE 10MG PF INJ 1ML SDV

Facility

$52.00

Service Code	NDC 7.0069E+10
Hospital Charge Code	2697307
Hospital Revenue Code	250
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$37.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.13
Rate for Payer: Cash Price	$46.80
Rate for Payer: UnitedHealthcare Commercial	$34.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.72

DEXAMETHASONE 10MG PF INJ 1ML SDV

Facility

$52.00

Service Code	NDC 7.0069E+10
Hospital Charge Code	2697307
Hospital Revenue Code	250
Rate for Payer: Cash Price	$46.80

DEXAMETHASONE 4MG INJ 1ML

Facility

$75.00

Service Code	HCPCS J1100
Hospital Charge Code	2654720
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

DEXAMETHASONE 4MG INJ 1ML

Facility

$75.00

Service Code	HCPCS J1100
Hospital Charge Code	2654720
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

DEXAMETHASONE 4MG INJ 30ML MDV

Facility

$75.00

Service Code	HCPCS J1100
Hospital Charge Code	2619291
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

DEXAMETHASONE 4MG INJ 30ML MDV

Facility

$75.00

Service Code	HCPCS J1100
Hospital Charge Code	2619291
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

DEXAMETHASONE 4MG TAB EMP

Facility

$21.00

Service Code	NDC 4.7781E+10
Hospital Charge Code	2625310
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

DEXAMETHASONE 4MG TAB EMP

Facility

$21.00

Service Code	NDC 4.7781E+10
Hospital Charge Code	2625310
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

DEXAMETHASONE (DECADRON) 2MG TAB UD

Facility

$21.00

Service Code	NDC 54817625
Hospital Charge Code	2626606
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

DEXAMETHASONE (DECADRON) 2MG TAB UD

Facility

$21.00

Service Code	NDC 54817625
Hospital Charge Code	2626606
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

DEXAMETHASONE INJ

Facility

$65.00

Service Code	HCPCS J1094
Hospital Charge Code	2058014
Hospital Revenue Code	370
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

DEXAMETHASONE INJ

Facility

$65.00

Service Code	HCPCS J1094
Hospital Charge Code	2058014
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

DEXLANSOPRAZOLE (DEXILANT) 30MG CAP EMP

Facility

$28.00

Service Code	NDC 6.4764E+10
Hospital Charge Code	2622585
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

Know your out-of-pocket cost for care.

All Charges