Madison Medical Center

All Charges

Charge

Type

Setting

Price

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC

Facility

$46,944.60

Service Code	MSDRG 061
Min. Negotiated Rate	$23,472.30
Max. Negotiated Rate	$46,944.60
Rate for Payer: Aetna Medicare Advantage	$23,472.30
Rate for Payer: Cigna Commercial HMO & PPO	$23,472.30
Rate for Payer: Home State Health Plan Medicare Advantage	$23,472.30
Rate for Payer: Humana Commercial	$46,944.60
Rate for Payer: Humana Medicare Advantage	$23,472.30

ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC

Facility

$25,615.12

Service Code	MSDRG 063
Min. Negotiated Rate	$12,807.56
Max. Negotiated Rate	$25,615.12
Rate for Payer: Aetna Medicare Advantage	$12,807.56
Rate for Payer: Cigna Commercial HMO & PPO	$12,807.56
Rate for Payer: Home State Health Plan Medicare Advantage	$12,807.56
Rate for Payer: Humana Commercial	$25,615.12
Rate for Payer: Humana Medicare Advantage	$12,807.56

ISLET CELL AB

Facility

$107.00

Service Code	CPT 86341
Hospital Charge Code	2227060
Hospital Revenue Code	301
Rate for Payer: Cash Price	$96.30

ISLET CELL AB

Facility

$107.00

Service Code	CPT 86341
Hospital Charge Code	2227060
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$76.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.21
Rate for Payer: Aetna Medicare Advantage	$23.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cigna Commercial HMO & PPO	$23.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22.69
Rate for Payer: Home State Health Plan Medicare Advantage	$23.57
Rate for Payer: Humana Commercial	$47.14
Rate for Payer: Humana Medicare Advantage	$23.57
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

ISOCYANATE MDI (K76) IGE

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	2286005
Hospital Revenue Code	301
Rate for Payer: Cash Price	$58.50

ISOCYANATE MDI (K76) IGE

Facility

$65.00

Service Code	CPT 86003
Hospital Charge Code	2286005
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$46.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

ISO EQUIP CHG

Facility

$62.00

Hospital Charge Code	4500325
Hospital Revenue Code	271
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$44.27
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: UnitedHealthcare Commercial	$41.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

ISO EQUIP CHG

Facility

$62.00

Hospital Charge Code	4500325
Hospital Revenue Code	271
Rate for Payer: Cash Price	$55.80

ISONIAZID 300MG TAB

Facility

$21.00

Service Code	NDC 1E+11
Hospital Charge Code	2619530
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

ISONIAZID 300MG TAB

Facility

$21.00

Service Code	NDC 1E+11
Hospital Charge Code	2619530
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

ISOSORBIDE DIN (ISORDIL) 10MG TAB

Facility

$20.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2655359
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

ISOSORBIDE DIN (ISORDIL) 10MG TAB

Facility

$20.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2655359
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

ISOSORBIDE MONO 30MG ER TAB EMP

Facility

$48.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2697348
Hospital Revenue Code	250
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

ISOSORBIDE MONO 30MG ER TAB EMP

Facility

$48.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2697348
Hospital Revenue Code	250
Rate for Payer: Cash Price	$43.20

ISOSORBIDE MONO (IMDUR) 30MG ER TAB

Facility

$21.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2626286
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

ISOSORBIDE MONO (IMDUR) 30MG ER TAB

Facility

$21.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2626286
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

ISOSORBIDE MONO (IMDUR) 60MG ER TAB

Facility

$21.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2626615
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

ISOSORBIDE MONO (IMDUR) 60MG ER TAB

Facility

$21.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2626615
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

ISOSORBIDE MONO (IMDUR) 60MG ER TAB EMP

Facility

$21.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2624551
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

ISOSORBIDE MONO (IMDUR) 60MG ER TAB EMP

Facility

$21.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2624551
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

ITRACONAZOLE

Facility

$382.00

Service Code	CPT 80189
Hospital Charge Code	2282400
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$272.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$24.40
Rate for Payer: Aetna Medicare Advantage	$27.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$226.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$272.75
Rate for Payer: Cash Price	$343.80
Rate for Payer: Cash Price	$343.80
Rate for Payer: Cash Price	$343.80
Rate for Payer: Cigna Commercial HMO & PPO	$27.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.11
Rate for Payer: Home State Health Plan Medicare Advantage	$27.11
Rate for Payer: Humana Commercial	$54.22
Rate for Payer: Humana Medicare Advantage	$27.11
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$137.52

ITRACONAZOLE

Facility

$382.00

Service Code	CPT 80189
Hospital Charge Code	2282400
Hospital Revenue Code	301
Rate for Payer: Cash Price	$343.80

ITRACONAZOLE 100MG CAP EMP

Facility

$65.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2624101
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

ITRACONAZOLE 100MG CAP EMP

Facility

$65.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2624101
Hospital Revenue Code	250
Rate for Payer: Cash Price	$58.50

IUD INSERTION

Facility

$314.00

Service Code	CPT 58300
Hospital Charge Code	4258300
Hospital Revenue Code	521
Min. Negotiated Rate	$150.07
Max. Negotiated Rate	$224.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$166.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$185.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$224.20
Rate for Payer: Cash Price	$282.60
Rate for Payer: Cash Price	$282.60
Rate for Payer: Cash Price	$282.60
Rate for Payer: Cash Price	$282.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$150.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$178.42
Rate for Payer: UnitedHealthcare Commercial	$209.44
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$166.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges