Madison Medical Center

All Charges

Charge

Type

Setting

Price

NICOTINE (NICODERM) 21MG/24H PATCH

Facility

$73.00

Service Code	NDC 766145020
Hospital Charge Code	2655643
Hospital Revenue Code	250
Min. Negotiated Rate	$26.28
Max. Negotiated Rate	$52.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$43.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$52.12
Rate for Payer: Cash Price	$65.70
Rate for Payer: UnitedHealthcare Commercial	$48.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.28

NICOTINE (NICODERM) 21MG/24H PATCH

Facility

$73.00

Service Code	NDC 766145020
Hospital Charge Code	2655643
Hospital Revenue Code	250
Rate for Payer: Cash Price	$65.70

NICOTINE (NICODERM) 7MG/DAY PATCH

Facility

$71.00

Service Code	NDC 67512414
Hospital Charge Code	2697078
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.90

NICOTINE (NICODERM) 7MG/DAY PATCH

Facility

$71.00

Service Code	NDC 67512414
Hospital Charge Code	2697078
Hospital Revenue Code	250
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$50.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: UnitedHealthcare Commercial	$47.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

NICOTINE URINE

Facility

$126.00

Service Code	CPT 80307
Hospital Charge Code	2283880
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$124.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$55.93
Rate for Payer: Aetna Medicare Advantage	$62.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cigna Commercial HMO & PPO	$62.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$59.85
Rate for Payer: Home State Health Plan Medicare Advantage	$62.14
Rate for Payer: Humana Commercial	$124.28
Rate for Payer: Humana Medicare Advantage	$62.14
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

NICOTINE URINE

Facility

$126.00

Service Code	CPT 80307
Hospital Charge Code	2283880
Hospital Revenue Code	301
Rate for Payer: Cash Price	$113.40

NIFEDIPINE (NIFEDICAL) XL 30MG TAB EMP

Facility

$22.00

Hospital Charge Code	2656057
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

NIFEDIPINE (NIFEDICAL) XL 30MG TAB EMP

Facility

$22.00

Hospital Charge Code	2656057
Hospital Revenue Code	250
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

NIFEDIPINE (NIFEDICAL) XL 60MG TAB EMP

Facility

$22.00

Service Code	NDC 5.0742E+10
Hospital Charge Code	2623051
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

NIFEDIPINE (NIFEDICAL) XL 60MG TAB EMP

Facility

$22.00

Service Code	NDC 5.0742E+10
Hospital Charge Code	2623051
Hospital Revenue Code	250
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

NIFEDIPINE (NIFEDICAL) XL 90MG TAB EMP

Facility

$22.00

Service Code	NDC 5.0742E+10
Hospital Charge Code	2623798
Hospital Revenue Code	250
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

NIFEDIPINE (NIFEDICAL) XL 90MG TAB EMP

Facility

$22.00

Service Code	NDC 5.0742E+10
Hospital Charge Code	2623798
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

NIFEDIPINE (PROCARDIA) XL 60MG TAB

Facility

$24.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626381
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

NIFEDIPINE (PROCARDIA) XL 60MG TAB

Facility

$24.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626381
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

NITROFURANTOIN (MACROBID) 100MG CAP

Facility

$22.00

Service Code	NDC 4.7781E+10
Hospital Charge Code	2626263
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

NITROFURANTOIN (MACROBID) 100MG CAP

Facility

$22.00

Service Code	NDC 4.7781E+10
Hospital Charge Code	2626263
Hospital Revenue Code	250
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

NITROFURANTOIN (MACROBID) 100MG CAP EMP

Facility

$22.00

Service Code	NDC 4.7781E+10
Hospital Charge Code	2622122
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

NITROFURANTOIN (MACROBID) 100MG CAP EMP

Facility

$22.00

Service Code	NDC 4.7781E+10
Hospital Charge Code	2622122
Hospital Revenue Code	250
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

NITROGLYCERIN 2% OINT 30GM

Facility

$112.00

Service Code	NDC 281032630
Hospital Charge Code	2627283
Hospital Revenue Code	250
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$79.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: UnitedHealthcare Commercial	$74.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

NITROGLYCERIN 2% OINT 30GM

Facility

$112.00

Service Code	NDC 281032630
Hospital Charge Code	2627283
Hospital Revenue Code	250
Rate for Payer: Cash Price	$100.80

NITROGLYCERIN 2% OINT 30GM EMP

Facility

$112.00

Service Code	NDC 88155249
Hospital Charge Code	2622785
Hospital Revenue Code	250
Rate for Payer: Cash Price	$100.80

NITROGLYCERIN 2% OINT 30GM EMP

Facility

$112.00

Service Code	NDC 88155249
Hospital Charge Code	2622785
Hospital Revenue Code	250
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$79.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: UnitedHealthcare Commercial	$74.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

NITROGLYCERIN 50MG/10ML INJ

Facility

$288.00

Service Code	NDC 517481010
Hospital Charge Code	2655721
Hospital Revenue Code	250
Rate for Payer: Cash Price	$259.20

NITROGLYCERIN 50MG/10ML INJ

Facility

$288.00

Service Code	NDC 517481010
Hospital Charge Code	2655721
Hospital Revenue Code	250
Min. Negotiated Rate	$103.68
Max. Negotiated Rate	$205.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$170.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$205.63
Rate for Payer: Cash Price	$259.20
Rate for Payer: UnitedHealthcare Commercial	$192.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.68

NITROGLYCERIN 50MG/D5W 250ML

Facility

$147.00

Service Code	HCPCS J3490
Hospital Charge Code	2626434
Hospital Revenue Code	250
Min. Negotiated Rate	$52.92
Max. Negotiated Rate	$104.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$87.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$104.96
Rate for Payer: Cash Price	$132.30
Rate for Payer: UnitedHealthcare Commercial	$98.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$52.92

Know your out-of-pocket cost for care.

All Charges