Madison Medical Center

All Charges

Charge

Type

Setting

Price

DEXLANSOPRAZOLE (DEXILANT) 30MG CAP EMP

Facility

$28.00

Service Code	NDC 6.4764E+10
Hospital Charge Code	2622585
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

DEXLANSOPRAZOLE (DEXILANT) 60MG CAP EMP

Facility

$28.00

Service Code	NDC 6.4764E+10
Hospital Charge Code	2622166
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

DEXLANSOPRAZOLE (DEXILANT) 60MG CAP EMP

Facility

$28.00

Service Code	NDC 6.4764E+10
Hospital Charge Code	2622166
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

DEXTROSE 50% (25GM) PFS INJ 50ML

Facility

$169.00

Service Code	HCPCS J7060
Hospital Charge Code	2654755
Hospital Revenue Code	250
Min. Negotiated Rate	$60.84
Max. Negotiated Rate	$120.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$120.67
Rate for Payer: Cash Price	$152.10
Rate for Payer: UnitedHealthcare Commercial	$112.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.84

DEXTROSE 50% (25GM) PFS INJ 50ML

Facility

$169.00

Service Code	HCPCS J7060
Hospital Charge Code	2654755
Hospital Revenue Code	250
Rate for Payer: Cash Price	$152.10

DEXTROSTIX

Facility

$62.00

Service Code	CPT 82948
Hospital Charge Code	224179
Hospital Revenue Code	301
Rate for Payer: Cash Price	$55.80

DEXTROSTIX

Facility

$62.00

Service Code	CPT 82948
Hospital Charge Code	224179
Hospital Revenue Code	301
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$44.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.54
Rate for Payer: Aetna Medicare Advantage	$5.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.86
Rate for Payer: Home State Health Plan Medicare Advantage	$5.04
Rate for Payer: Humana Commercial	$10.08
Rate for Payer: Humana Medicare Advantage	$5.04
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

.DGP AB

Facility

$234.00

Service Code	CPT 86258
Hospital Charge Code	221955
Hospital Revenue Code	302
Rate for Payer: Cash Price	$210.60

.DGP AB

Facility

$234.00

Service Code	CPT 86258
Hospital Charge Code	221955
Hospital Revenue Code	302
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$167.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.85
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$138.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.08
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: Cigna Commercial HMO & PPO	$12.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.61
Rate for Payer: Home State Health Plan Medicare Advantage	$12.05
Rate for Payer: Humana Commercial	$24.10
Rate for Payer: Humana Medicare Advantage	$12.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.24

DHEA DEHYDROEPIANDROS

Facility

$113.00

Service Code	CPT 82626
Hospital Charge Code	2227034
Hospital Revenue Code	301
Rate for Payer: Cash Price	$101.70

DHEA DEHYDROEPIANDROS

Facility

$113.00

Service Code	CPT 82626
Hospital Charge Code	2227034
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$80.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$22.74
Rate for Payer: Aetna Medicare Advantage	$25.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial HMO & PPO	$25.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24.33
Rate for Payer: Home State Health Plan Medicare Advantage	$25.27
Rate for Payer: Humana Commercial	$50.54
Rate for Payer: Humana Medicare Advantage	$25.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

DHEAS

Facility

$81.00

Service Code	CPT 82626
Hospital Charge Code	4282626
Hospital Revenue Code	521
Min. Negotiated Rate	$20.47
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$22.74
Rate for Payer: Aetna Medicare Advantage	$25.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna Commercial HMO & PPO	$25.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24.33
Rate for Payer: Home State Health Plan Medicare Advantage	$25.27
Rate for Payer: Humana Commercial	$50.54
Rate for Payer: Humana Medicare Advantage	$25.27
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DHEAS

Facility

$81.00

Service Code	CPT 82626
Hospital Charge Code	4282626
Hospital Revenue Code	521
Rate for Payer: Cash Price	$72.90

DHEA SULFATE

Facility

$178.00

Service Code	CPT 82627
Hospital Charge Code	2282627
Hospital Revenue Code	301
Min. Negotiated Rate	$20.01
Max. Negotiated Rate	$127.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$20.01
Rate for Payer: Aetna Medicare Advantage	$22.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cigna Commercial HMO & PPO	$22.23
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21.41
Rate for Payer: Home State Health Plan Medicare Advantage	$22.23
Rate for Payer: Humana Commercial	$44.46
Rate for Payer: Humana Medicare Advantage	$22.23
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

DHEA SULFATE

Facility

$178.00

Service Code	CPT 82627
Hospital Charge Code	2282627
Hospital Revenue Code	301
Rate for Payer: Cash Price	$160.20

DIABETES

Facility

$13,370.76

Service Code	APR-DRG 4203
Min. Negotiated Rate	$13,370.76
Max. Negotiated Rate	$13,370.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,370.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,370.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,370.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,370.76

DIABETES

Facility

$5,802.48

Service Code	APR-DRG 4201
Min. Negotiated Rate	$5,802.48
Max. Negotiated Rate	$5,802.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,802.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,802.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,802.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,802.48

DIABETES

Facility

$8,443.93

Service Code	APR-DRG 4202
Min. Negotiated Rate	$8,443.93
Max. Negotiated Rate	$8,443.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,443.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,443.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,443.93
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,443.93

DIABETES

Facility

$28,118.57

Service Code	APR-DRG 4204
Min. Negotiated Rate	$28,118.57
Max. Negotiated Rate	$28,118.57
Rate for Payer: Aetna Better Health Medicaid/QHP	$28,118.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28,118.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28,118.57
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28,118.57

DIABETES WITH CC

Facility

$17,669.50

Service Code	MSDRG 638
Min. Negotiated Rate	$8,834.75
Max. Negotiated Rate	$17,669.50
Rate for Payer: Aetna Medicare Advantage	$8,834.75
Rate for Payer: Cigna Commercial HMO & PPO	$8,834.75
Rate for Payer: Home State Health Plan Medicare Advantage	$8,834.75
Rate for Payer: Humana Commercial	$17,669.50
Rate for Payer: Humana Medicare Advantage	$8,834.75

DIABETES WITH MCC

Facility

$26,131.24

Service Code	MSDRG 637
Min. Negotiated Rate	$13,065.62
Max. Negotiated Rate	$26,131.24
Rate for Payer: Aetna Medicare Advantage	$13,065.62
Rate for Payer: Cigna Commercial HMO & PPO	$13,065.62
Rate for Payer: Home State Health Plan Medicare Advantage	$13,065.62
Rate for Payer: Humana Commercial	$26,131.24
Rate for Payer: Humana Medicare Advantage	$13,065.62

DIABETES WITHOUT CC/MCC

Facility

$13,374.50

Service Code	MSDRG 639
Min. Negotiated Rate	$6,687.25
Max. Negotiated Rate	$13,374.50
Rate for Payer: Aetna Medicare Advantage	$6,687.25
Rate for Payer: Cigna Commercial HMO & PPO	$6,687.25
Rate for Payer: Home State Health Plan Medicare Advantage	$6,687.25
Rate for Payer: Humana Commercial	$13,374.50
Rate for Payer: Humana Medicare Advantage	$6,687.25

DIABETIC FOOTCARE HANDLE

Facility

$89.00

Hospital Charge Code	5349014
Hospital Revenue Code	271
Rate for Payer: Cash Price	$80.10

DIABETIC FOOTCARE HANDLE

Facility

$89.00

Hospital Charge Code	5349014
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

DIAG INJ FOR FLU VACCINE

Facility

$8.00

Service Code	CPT G0008
Hospital Charge Code	4200008
Hospital Revenue Code	521
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Medicare Advantage	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.71
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges