Madison Medical Center

All Charges

Charge

Type

Setting

Price

DULOXETINE 30MG CAP EMP

Facility

$55.00

Service Code	NDC 4.3547E+10
Hospital Charge Code	2619086
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

DULOXETINE (CYMBALTA) DR 30MG CAP

Facility

$55.00

Service Code	NDC 4.7335E+10
Hospital Charge Code	2626430
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

DULOXETINE (CYMBALTA) DR 30MG CAP

Facility

$55.00

Service Code	NDC 4.7335E+10
Hospital Charge Code	2626430
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

DULOXETINE (CYMBALTA) DR 60MG CAP UD

Facility

$16.00

Service Code	NDC 904704561
Hospital Charge Code	2625429
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

DULOXETINE (CYMBALTA) DR 60MG CAP UD

Facility

$16.00

Service Code	NDC 904704561
Hospital Charge Code	2625429
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

DULOXETINE DR 20MG CAP EMP

Facility

$16.00

Service Code	NDC 4.7335E+10
Hospital Charge Code	2619394
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

DULOXETINE DR 20MG CAP EMP

Facility

$16.00

Service Code	NDC 4.7335E+10
Hospital Charge Code	2619394
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

DULOXETINE DR 60MG CAP EMP

Facility

$16.00

Service Code	NDC 4.7335E+10
Hospital Charge Code	2619445
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

DULOXETINE DR 60MG CAP EMP

Facility

$16.00

Service Code	NDC 4.7335E+10
Hospital Charge Code	2619445
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

DUO DERM DRESSING

Facility

$48.00

Hospital Charge Code	284900
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

DUO DERM DRESSING

Facility

$48.00

Hospital Charge Code	284900
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

DUO DERM GEL

Facility

$44.00

Hospital Charge Code	284904
Hospital Revenue Code	271
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

DUO DERM GEL

Facility

$44.00

Hospital Charge Code	284904
Hospital Revenue Code	271
Rate for Payer: Cash Price	$39.60

DUO DERM GRANULES

Facility

$65.00

Hospital Charge Code	284903
Hospital Revenue Code	271
Rate for Payer: Cash Price	$58.50

DUO DERM GRANULES

Facility

$65.00

Hospital Charge Code	284903
Hospital Revenue Code	271
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

DUO DERM XTRA THIN DRESS

Facility

$189.00

Hospital Charge Code	284839
Hospital Revenue Code	271
Min. Negotiated Rate	$68.04
Max. Negotiated Rate	$134.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$111.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$134.95
Rate for Payer: Cash Price	$170.10
Rate for Payer: UnitedHealthcare Commercial	$126.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.04

DUO DERM XTRA THIN DRESS

Facility

$189.00

Hospital Charge Code	284839
Hospital Revenue Code	271
Rate for Payer: Cash Price	$170.10

DUO NEB-U-MIST

Facility

$256.00

Service Code	CPT 94640
Hospital Charge Code	4500343
Hospital Revenue Code	412
Min. Negotiated Rate	$92.16
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$151.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.78
Rate for Payer: Cash Price	$230.40
Rate for Payer: Cash Price	$230.40
Rate for Payer: Cash Price	$230.40
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$170.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$92.16

DUO NEB-U-MIST

Facility

$256.00

Service Code	CPT 94640
Hospital Charge Code	4500343
Hospital Revenue Code	412
Rate for Payer: Cash Price	$230.40

DURODERM HYDROACTIVE DRESSING

Facility

$39.00

Hospital Charge Code	284901
Hospital Revenue Code	271
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

DURODERM HYDROACTIVE DRESSING

Facility

$39.00

Hospital Charge Code	284901
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

DUROLANE (HYALURONIC ACID) INJ

Facility

$4,280.00

Service Code	NDC 8.913E+10
Hospital Charge Code	2624220
Hospital Revenue Code	250
Min. Negotiated Rate	$1,540.80
Max. Negotiated Rate	$3,055.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,533.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3,055.92
Rate for Payer: Cash Price	$3,852.00
Rate for Payer: UnitedHealthcare Commercial	$2,854.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,540.80

DUROLANE (HYALURONIC ACID) INJ

Facility

$4,280.00

Service Code	NDC 8.913E+10
Hospital Charge Code	2624220
Hospital Revenue Code	250
Rate for Payer: Cash Price	$3,852.00

DUTASTERIDE (AVODART) 0.5MG CAP

Facility

$39.00

Service Code	NDC 3.1722E+10
Hospital Charge Code	2626424
Hospital Revenue Code	250
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

DUTASTERIDE (AVODART) 0.5MG CAP

Facility

$39.00

Service Code	NDC 3.1722E+10
Hospital Charge Code	2626424
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

Know your out-of-pocket cost for care.

All Charges