Madison Medical Center

All Charges

Charge

Type

Setting

Price

LOSARTAN/HCTZ (HYZAAR)100/12.5MG TAB EMP

Facility

$32.00

Service Code	NDC 93736856
Hospital Charge Code	2626918
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

LOSARTAN/HCTZ (HYZAAR)100/12.5MG TAB EMP

Facility

$32.00

Service Code	NDC 93736856
Hospital Charge Code	2626918
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

LOSARTAN/HCTZ (HYZAAR)100/25MG TAB EMP

Facility

$32.00

Service Code	NDC 93736856
Hospital Charge Code	2697304
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

LOSARTAN/HCTZ (HYZAAR)100/25MG TAB EMP

Facility

$32.00

Service Code	NDC 93736856
Hospital Charge Code	2697304
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

LOSARTAN/HCTZ (HYZAAR)50/12.5MG TAB EMP

Facility

$32.00

Service Code	NDC 1.3668E+10
Hospital Charge Code	2622052
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

LOSARTAN/HCTZ (HYZAAR)50/12.5MG TAB EMP

Facility

$32.00

Service Code	NDC 1.3668E+10
Hospital Charge Code	2622052
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

LOTEMAX OPTH OINT 3.5GM EMP

Facility

$60.00

Service Code	NDC 2.4208E+10
Hospital Charge Code	2623305
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

LOTEMAX OPTH OINT 3.5GM EMP

Facility

$60.00

Service Code	NDC 2.4208E+10
Hospital Charge Code	2623305
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

LOTEPREDNOL OPTH GEL 0.5% 5GM EMP

Facility

$60.00

Service Code	NDC 2.4208E+10
Hospital Charge Code	2624320
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

LOTEPREDNOL OPTH GEL 0.5% 5GM EMP

Facility

$60.00

Service Code	NDC 2.4208E+10
Hospital Charge Code	2624320
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

LOTION INTENSIVE CAR

Facility

$18.00

Hospital Charge Code	2812050
Hospital Revenue Code	271
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

LOTION INTENSIVE CAR

Facility

$18.00

Hospital Charge Code	2812050
Hospital Revenue Code	271
Rate for Payer: Cash Price	$16.20

LOVASTATIN 10MG TAB EMP

Facility

$40.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2622211
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

LOVASTATIN 10MG TAB EMP

Facility

$40.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2622211
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

LOVASTATIN 20MG TAB EMP

Facility

$40.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2698387
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

LOVASTATIN 20MG TAB EMP

Facility

$40.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2698387
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

LOVASTATIN 40MG TAB EMP

Facility

$40.00

Service Code	NDC 185007401
Hospital Charge Code	2697322
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

LOVASTATIN 40MG TAB EMP

Facility

$40.00

Service Code	NDC 185007401
Hospital Charge Code	2697322
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

LOVASTATIN (MEVACOR) 20MG TAB

Facility

$43.00

Service Code	NDC 6073161
Hospital Charge Code	2654253
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

LOVASTATIN (MEVACOR) 20MG TAB

Facility

$43.00

Service Code	NDC 6073161
Hospital Charge Code	2654253
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

LOWER BODY BLANKET-BAIR HUGGER

Facility

$135.00

Hospital Charge Code	122248
Hospital Revenue Code	271
Rate for Payer: Cash Price	$121.50

LOWER BODY BLANKET-BAIR HUGGER

Facility

$135.00

Hospital Charge Code	122248
Hospital Revenue Code	271
Min. Negotiated Rate	$48.60
Max. Negotiated Rate	$96.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$48.60

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC

Facility

$43,448.36

Service Code	MSDRG 493
Min. Negotiated Rate	$21,724.18
Max. Negotiated Rate	$43,448.36
Rate for Payer: Aetna Medicare Advantage	$21,724.18
Rate for Payer: Cigna Commercial HMO & PPO	$21,724.18
Rate for Payer: Home State Health Plan Medicare Advantage	$21,724.18
Rate for Payer: Humana Commercial	$43,448.36
Rate for Payer: Humana Medicare Advantage	$21,724.18

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC

Facility

$61,426.90

Service Code	MSDRG 492
Min. Negotiated Rate	$30,713.45
Max. Negotiated Rate	$61,426.90
Rate for Payer: Aetna Medicare Advantage	$30,713.45
Rate for Payer: Cigna Commercial HMO & PPO	$30,713.45
Rate for Payer: Home State Health Plan Medicare Advantage	$30,713.45
Rate for Payer: Humana Commercial	$61,426.90
Rate for Payer: Humana Medicare Advantage	$30,713.45

LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC

Facility

$35,101.82

Service Code	MSDRG 494
Min. Negotiated Rate	$17,550.91
Max. Negotiated Rate	$35,101.82
Rate for Payer: Aetna Medicare Advantage	$17,550.91
Rate for Payer: Cigna Commercial HMO & PPO	$17,550.91
Rate for Payer: Home State Health Plan Medicare Advantage	$17,550.91
Rate for Payer: Humana Commercial	$35,101.82
Rate for Payer: Humana Medicare Advantage	$17,550.91

Know your out-of-pocket cost for care.

All Charges