Madison Medical Center

All Charges

Charge

Type

Setting

Price

NITROGLYCERIN 50MG/D5W 250ML

Facility

$147.00

Service Code	HCPCS J3490
Hospital Charge Code	2626434
Hospital Revenue Code	250
Rate for Payer: Cash Price	$132.30

NITROGLYCERIN (NITRO-BID) 2% OINT 1GM PK

Facility

$18.00

Service Code	NDC 88155249
Hospital Charge Code	2655720
Hospital Revenue Code	250
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

NITROGLYCERIN (NITRO-BID) 2% OINT 1GM PK

Facility

$18.00

Service Code	NDC 88155249
Hospital Charge Code	2655720
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

NITROGLYC (NITROSTAT) 0.4MG 3 TABS

Facility

$60.00

Service Code	NDC 71041813
Hospital Charge Code	2655705
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

NITROGLYC (NITROSTAT) 0.4MG 3 TABS

Facility

$60.00

Service Code	NDC 71041813
Hospital Charge Code	2655705
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

NITROGLYC SL SPRY 0.4MG/SPRY 3 SPRAYS

Facility

$60.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2619393
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

NITROGLYC SL SPRY 0.4MG/SPRY 3 SPRAYS

Facility

$60.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2619393
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

NITROPRUSSIDE SOD 50MG/2ML INJ

Facility

$2,569.00

Service Code	NDC 6.7457E+10
Hospital Charge Code	2697058
Hospital Revenue Code	250
Rate for Payer: Cash Price	$2,312.10

NITROPRUSSIDE SOD 50MG/2ML INJ

Facility

$2,569.00

Service Code	NDC 6.7457E+10
Hospital Charge Code	2697058
Hospital Revenue Code	250
Min. Negotiated Rate	$924.84
Max. Negotiated Rate	$1,834.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,520.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,834.27
Rate for Payer: Cash Price	$2,312.10
Rate for Payer: UnitedHealthcare Commercial	$1,713.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$924.84

NITROPRUSSIDE SOD + D5W : 50MG + 250ML

Facility

$2,691.00

Service Code	NDC 1E+11
Hospital Charge Code	2625935
Hospital Revenue Code	250
Min. Negotiated Rate	$968.76
Max. Negotiated Rate	$1,921.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,593.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,921.37
Rate for Payer: Cash Price	$2,421.90
Rate for Payer: UnitedHealthcare Commercial	$1,794.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$968.76

NITROPRUSSIDE SOD + D5W : 50MG + 250ML

Facility

$2,691.00

Service Code	NDC 1E+11
Hospital Charge Code	2625935
Hospital Revenue Code	250
Rate for Payer: Cash Price	$2,421.90

NITROSTAT 0.4MG TAB 4X25 EMP

Facility

$79.00

Service Code	NDC 71057013
Hospital Charge Code	2698418
Hospital Revenue Code	250
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$56.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$46.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$56.41
Rate for Payer: Cash Price	$71.10
Rate for Payer: UnitedHealthcare Commercial	$52.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.44

NITROSTAT 0.4MG TAB 4X25 EMP

Facility

$79.00

Service Code	NDC 71057013
Hospital Charge Code	2698418
Hospital Revenue Code	250
Rate for Payer: Cash Price	$71.10

NIZORAL A-D SHAMPOO 1% 125ML BOTTLE EMP

Facility

$47.00

Service Code	NDC 1E+11
Hospital Charge Code	2622145
Hospital Revenue Code	250
Rate for Payer: Cash Price	$42.30

NIZORAL A-D SHAMPOO 1% 125ML BOTTLE EMP

Facility

$47.00

Service Code	NDC 1E+11
Hospital Charge Code	2622145
Hospital Revenue Code	250
Min. Negotiated Rate	$16.92
Max. Negotiated Rate	$33.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$27.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$33.56
Rate for Payer: Cash Price	$42.30
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.92

NM ACUTE GI BLOOD LOSS IMAGING

Facility

$1,616.00

Service Code	CPT 78278
Hospital Charge Code	3478278
Hospital Revenue Code	341
Rate for Payer: Cash Price	$1,454.40

NM ACUTE GI BLOOD LOSS IMAGING

Facility

$1,616.00

Service Code	CPT 78278
Hospital Charge Code	3478278
Hospital Revenue Code	341
Min. Negotiated Rate	$360.38
Max. Negotiated Rate	$1,153.82
Rate for Payer: Aetna Better Health Medicaid/QHP	$360.38
Rate for Payer: Aetna Medicare Advantage	$408.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$956.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,153.82
Rate for Payer: Cash Price	$1,454.40
Rate for Payer: Cash Price	$1,454.40
Rate for Payer: Cash Price	$1,454.40
Rate for Payer: Cigna Commercial HMO & PPO	$408.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$360.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$385.61
Rate for Payer: Home State Health Plan Medicare Advantage	$408.43
Rate for Payer: Humana Commercial	$816.86
Rate for Payer: Humana Medicare Advantage	$408.43
Rate for Payer: UnitedHealthcare Commercial	$1,077.87
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$360.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$581.76

NM BONE SCAN 3 PHASE

Facility

$1,739.00

Service Code	CPT 78315
Hospital Charge Code	3478315
Hospital Revenue Code	341
Rate for Payer: Cash Price	$1,565.10

NM BONE SCAN 3 PHASE

Facility

$1,739.00

Service Code	CPT 78315
Hospital Charge Code	3478315
Hospital Revenue Code	341
Min. Negotiated Rate	$360.38
Max. Negotiated Rate	$1,241.65
Rate for Payer: Aetna Better Health Medicaid/QHP	$360.38
Rate for Payer: Aetna Medicare Advantage	$408.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,029.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,241.65
Rate for Payer: Cash Price	$1,565.10
Rate for Payer: Cash Price	$1,565.10
Rate for Payer: Cash Price	$1,565.10
Rate for Payer: Cigna Commercial HMO & PPO	$408.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$360.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$385.61
Rate for Payer: Home State Health Plan Medicare Advantage	$408.43
Rate for Payer: Humana Commercial	$816.86
Rate for Payer: Humana Medicare Advantage	$408.43
Rate for Payer: UnitedHealthcare Commercial	$1,159.91
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$360.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$626.04

NM BONE SCAN FULL BODY

Facility

$1,163.00

Service Code	CPT 78306
Hospital Charge Code	3478306
Hospital Revenue Code	341
Rate for Payer: Cash Price	$1,046.70

NM BONE SCAN FULL BODY

Facility

$1,163.00

Service Code	CPT 78306
Hospital Charge Code	3478306
Hospital Revenue Code	341
Min. Negotiated Rate	$360.38
Max. Negotiated Rate	$830.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$360.38
Rate for Payer: Aetna Medicare Advantage	$408.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$688.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$830.38
Rate for Payer: Cash Price	$1,046.70
Rate for Payer: Cash Price	$1,046.70
Rate for Payer: Cash Price	$1,046.70
Rate for Payer: Cigna Commercial HMO & PPO	$408.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$360.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$385.61
Rate for Payer: Home State Health Plan Medicare Advantage	$408.43
Rate for Payer: Humana Commercial	$816.86
Rate for Payer: Humana Medicare Advantage	$408.43
Rate for Payer: UnitedHealthcare Commercial	$775.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$360.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$418.68

NM BONE SCAN ISOTOPE KIT

Facility

$244.00

Service Code	CPT A4641
Hospital Charge Code	3400201
Hospital Revenue Code	342
Rate for Payer: Cash Price	$219.60

NM BONE SCAN ISOTOPE KIT

Facility

$244.00

Service Code	CPT A4641
Hospital Charge Code	3400201
Hospital Revenue Code	342
Min. Negotiated Rate	$87.84
Max. Negotiated Rate	$174.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$144.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.22
Rate for Payer: Cash Price	$219.60
Rate for Payer: UnitedHealthcare Commercial	$162.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$87.84

NM BONE SPECT

Facility

$1,667.00

Service Code	CPT 78320
Hospital Charge Code	3478320
Hospital Revenue Code	341
Rate for Payer: Cash Price	$1,500.30

NM BONE SPECT

Facility

$1,667.00

Service Code	CPT 78320
Hospital Charge Code	3478320
Hospital Revenue Code	341
Min. Negotiated Rate	$600.12
Max. Negotiated Rate	$1,190.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$986.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,190.24
Rate for Payer: Cash Price	$1,500.30
Rate for Payer: UnitedHealthcare Commercial	$1,111.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$600.12

Know your out-of-pocket cost for care.

All Charges