Madison Medical Center

All Charges

Charge

Type

Setting

Price

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$54,813.81

Service Code	APR-DRG 3032
Min. Negotiated Rate	$54,813.81
Max. Negotiated Rate	$54,813.81
Rate for Payer: Aetna Better Health Medicaid/QHP	$54,813.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$54,813.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$54,813.81
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$54,813.81

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$45,922.71

Service Code	APR-DRG 3031
Min. Negotiated Rate	$45,922.71
Max. Negotiated Rate	$45,922.71
Rate for Payer: Aetna Better Health Medicaid/QHP	$45,922.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$45,922.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$45,922.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$45,922.71

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$79,969.97

Service Code	APR-DRG 3033
Min. Negotiated Rate	$79,969.97
Max. Negotiated Rate	$79,969.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$79,969.97
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$79,969.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$79,969.97
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$79,969.97

DORSAL AND LUMBAR FUSION PROCEDURE FOR CURVATURE OF BACK

Facility

$101,924.52

Service Code	APR-DRG 3034
Min. Negotiated Rate	$101,924.52
Max. Negotiated Rate	$101,924.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$101,924.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$101,924.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$101,924.52
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$101,924.52

DORZOLAMIDE 2% OP SOL 10ML EMP

Facility

$58.00

Service Code	NDC 6.1314E+10
Hospital Charge Code	2622570
Hospital Revenue Code	250
Rate for Payer: Cash Price	$52.20

DORZOLAMIDE 2% OP SOL 10ML EMP

Facility

$58.00

Service Code	NDC 6.1314E+10
Hospital Charge Code	2622570
Hospital Revenue Code	250
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

DORZOLAMIDE/TIMOLOL OP SOL 10ML EMP

Facility

$58.00

Service Code	NDC 7.0069E+10
Hospital Charge Code	2697233
Hospital Revenue Code	250
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

DORZOLAMIDE/TIMOLOL OP SOL 10ML EMP

Facility

$58.00

Service Code	NDC 7.0069E+10
Hospital Charge Code	2697233
Hospital Revenue Code	250
Rate for Payer: Cash Price	$52.20

DOXAPRAM INJ

Facility

$326.00

Hospital Charge Code	2058018
Hospital Revenue Code	370
Rate for Payer: Cash Price	$293.40

DOXAPRAM INJ

Facility

$326.00

Hospital Charge Code	2058018
Hospital Revenue Code	370
Min. Negotiated Rate	$117.36
Max. Negotiated Rate	$232.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.76
Rate for Payer: Cash Price	$293.40
Rate for Payer: UnitedHealthcare Commercial	$217.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$117.36

DOXAZOSIN (CARDURA) 1MG TAB EMP

Facility

$24.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2625862
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

DOXAZOSIN (CARDURA) 1MG TAB EMP

Facility

$24.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2625862
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

DOXAZOSIN (CARDURA) 2MG TAB EMP

Facility

$24.00

Service Code	NDC 1.6571E+10
Hospital Charge Code	2627160
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

DOXAZOSIN (CARDURA) 2MG TAB EMP

Facility

$24.00

Service Code	NDC 1.6571E+10
Hospital Charge Code	2627160
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

DOXAZOSIN (CARDURA) 4MG TAB

Facility

$24.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2697065
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

DOXAZOSIN (CARDURA) 4MG TAB

Facility

$24.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2697065
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

DOXAZOSIN (CARDURA) 4MG TAB EMP

Facility

$24.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2697481
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

DOXAZOSIN (CARDURA) 4MG TAB EMP

Facility

$24.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2697481
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

DOXEPIN

Facility

$159.00

Service Code	CPT 80335
Hospital Charge Code	2280166
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$113.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$94.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$113.53
Rate for Payer: Cash Price	$143.10
Rate for Payer: Cash Price	$143.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$57.24

DOXEPIN

Facility

$159.00

Service Code	CPT 80335
Hospital Charge Code	2280166
Hospital Revenue Code	301
Rate for Payer: Cash Price	$143.10

DOXEPIN 10MG CAP EMP

Facility

$45.00

Service Code	NDC 5.9651E+10
Hospital Charge Code	2623959
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

DOXEPIN 10MG CAP EMP

Facility

$45.00

Service Code	NDC 5.9651E+10
Hospital Charge Code	2623959
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

DOXEPIN 25MG CAP EMP

Facility

$45.00

Service Code	NDC 5.9651E+10
Hospital Charge Code	2697258
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

DOXEPIN 25MG CAP EMP

Facility

$45.00

Service Code	NDC 5.9651E+10
Hospital Charge Code	2697258
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

DOXEPIN 3MG TAB EMP

Facility

$45.00

Service Code	NDC 4.4183E+10
Hospital Charge Code	2623646
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

Know your out-of-pocket cost for care.

All Charges