Madison Medical Center

All Charges

Charge

Type

Setting

Price

DIGESTIVE MALIGNANCY WITH MCC

Facility

$37,184.44

Service Code	MSDRG 374
Min. Negotiated Rate	$18,592.22
Max. Negotiated Rate	$37,184.44
Rate for Payer: Aetna Medicare Advantage	$18,592.22
Rate for Payer: Cigna Commercial HMO & PPO	$18,592.22
Rate for Payer: Home State Health Plan Medicare Advantage	$18,592.22
Rate for Payer: Humana Commercial	$37,184.44
Rate for Payer: Humana Medicare Advantage	$18,592.22

DIGESTIVE MALIGNANCY WITHOUT CC/MCC

Facility

$18,109.22

Service Code	MSDRG 376
Min. Negotiated Rate	$9,054.61
Max. Negotiated Rate	$18,109.22
Rate for Payer: Aetna Medicare Advantage	$9,054.61
Rate for Payer: Cigna Commercial HMO & PPO	$9,054.61
Rate for Payer: Home State Health Plan Medicare Advantage	$9,054.61
Rate for Payer: Humana Commercial	$18,109.22
Rate for Payer: Humana Medicare Advantage	$9,054.61

DIGITOXIN

Facility

$65.00

Service Code	CPT 80299
Hospital Charge Code	2227039
Hospital Revenue Code	301
Rate for Payer: Cash Price	$58.50

DIGITOXIN

Facility

$65.00

Service Code	CPT 80299
Hospital Charge Code	2227039
Hospital Revenue Code	301
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$46.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.78
Rate for Payer: Aetna Medicare Advantage	$18.64
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: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial HMO & PPO	$18.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.95
Rate for Payer: Home State Health Plan Medicare Advantage	$18.64
Rate for Payer: Humana Commercial	$37.28
Rate for Payer: Humana Medicare Advantage	$18.64
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

DIGOXIN INJ

Facility

$65.00

Service Code	HCPCS J1160
Hospital Charge Code	2058020
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

DIGOXIN INJ

Facility

$65.00

Service Code	HCPCS J1160
Hospital Charge Code	2058020
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

DIGOXIN-LABCORP

Facility

$151.00

Service Code	CPT 80162
Hospital Charge Code	224255
Hospital Revenue Code	301
Rate for Payer: Cash Price	$135.90

DIGOXIN-LABCORP

Facility

$151.00

Service Code	CPT 80162
Hospital Charge Code	224255
Hospital Revenue Code	301
Min. Negotiated Rate	$11.95
Max. Negotiated Rate	$107.81
Rate for Payer: Cash Price	$135.90
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.95
Rate for Payer: Aetna Medicare Advantage	$13.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.81
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cigna Commercial HMO & PPO	$13.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.79
Rate for Payer: Home State Health Plan Medicare Advantage	$13.28
Rate for Payer: Humana Commercial	$26.56
Rate for Payer: Humana Medicare Advantage	$13.28
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.36

DIGOXIN (LANOXIN) 0.25MG TAB

Facility

$9.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2654815
Hospital Revenue Code	250
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$6.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$6.43
Rate for Payer: Cash Price	$8.10
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.24

DIGOXIN (LANOXIN) 0.25MG TAB

Facility

$9.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2654815
Hospital Revenue Code	250
Rate for Payer: Cash Price	$8.10

DIGOXIN (LANOXIN) 0.25MG TAB EMP

Facility

$16.00

Service Code	NDC 527132501
Hospital Charge Code	2622132
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

DIGOXIN (LANOXIN) 0.25MG TAB EMP

Facility

$16.00

Service Code	NDC 527132501
Hospital Charge Code	2622132
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

DIGOXIN (LANOXIN) 125MCG TAB

Facility

$21.00

Service Code	NDC 527132401
Hospital Charge Code	2654810
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

DIGOXIN (LANOXIN) 125MCG TAB

Facility

$21.00

Service Code	NDC 527132401
Hospital Charge Code	2654810
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

DIGOXIN (LANOXIN) 125MCG TAB EMP

Facility

$21.00

Service Code	NDC 6.9238E+10
Hospital Charge Code	2624857
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

DIGOXIN (LANOXIN) 125MCG TAB EMP

Facility

$21.00

Service Code	NDC 6.9238E+10
Hospital Charge Code	2624857
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

DIGOXIN (LANOXIN) 500MCG/2ML AMP INJ

Facility

$65.00

Service Code	HCPCS J1160
Hospital Charge Code	2654820
Hospital Revenue Code	250
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

DIGOXIN (LANOXIN) 500MCG/2ML AMP INJ

Facility

$65.00

Service Code	HCPCS J1160
Hospital Charge Code	2654820
Hospital Revenue Code	250
Rate for Payer: Cash Price	$58.50

DIHYDROTESTOSTERONE

Facility

$183.00

Service Code	CPT 82642
Hospital Charge Code	2282651
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$130.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$26.35
Rate for Payer: Aetna Medicare Advantage	$29.28
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	$29.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28.19
Rate for Payer: Home State Health Plan Medicare Advantage	$29.28
Rate for Payer: Humana Commercial	$58.56
Rate for Payer: Humana Medicare Advantage	$29.28
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.88

DIHYDROTESTOSTERONE

Facility

$183.00

Service Code	CPT 82642
Hospital Charge Code	2282651
Hospital Revenue Code	301
Rate for Payer: Cash Price	$164.70

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$30,364.90

Service Code	APR-DRG 5174
Min. Negotiated Rate	$30,364.90
Max. Negotiated Rate	$30,364.90
Rate for Payer: Aetna Better Health Medicaid/QHP	$30,364.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30,364.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$30,364.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$30,364.90

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$12,744.49

Service Code	APR-DRG 5172
Min. Negotiated Rate	$12,744.49
Max. Negotiated Rate	$12,744.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,744.49
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,744.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,744.49
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,744.49

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$10,190.97

Service Code	APR-DRG 5171
Min. Negotiated Rate	$10,190.97
Max. Negotiated Rate	$10,190.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,190.97
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,190.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,190.97
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,190.97

DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES

Facility

$17,016.70

Service Code	APR-DRG 5173
Min. Negotiated Rate	$17,016.70
Max. Negotiated Rate	$17,016.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,016.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,016.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,016.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,016.70

DILATION OF ANAL SPHINCTA

Facility

$274.00

Service Code	CPT 45905
Hospital Charge Code	4145905
Hospital Revenue Code	521
Rate for Payer: Cash Price	$246.60

Know your out-of-pocket cost for care.

All Charges