Madison Medical Center

All Charges

Charge

Type

Setting

Price

ATENOLOL (TENORMIN) 25MG TAB EMP

Facility

$20.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2624381
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

ATENOLOL (TENORMIN) 50MG TAB EMP

Facility

$20.00

Service Code	NDC 5.2427E+10
Hospital Charge Code	2623794
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

ATENOLOL (TENORMIN) 50MG TAB EMP

Facility

$20.00

Service Code	NDC 5.2427E+10
Hospital Charge Code	2623794
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

ATHEROSCLEROSIS WITH MCC

Facility

$22,370.54

Service Code	MSDRG 302
Min. Negotiated Rate	$11,185.27
Max. Negotiated Rate	$22,370.54
Rate for Payer: Aetna Medicare Advantage	$11,185.27
Rate for Payer: Cigna Commercial HMO & PPO	$11,185.27
Rate for Payer: Home State Health Plan Medicare Advantage	$11,185.27
Rate for Payer: Humana Commercial	$22,370.54
Rate for Payer: Humana Medicare Advantage	$11,185.27

ATHEROSCLEROSIS WITHOUT MCC

Facility

$14,184.16

Service Code	MSDRG 303
Min. Negotiated Rate	$7,092.08
Max. Negotiated Rate	$14,184.16
Rate for Payer: Aetna Medicare Advantage	$7,092.08
Rate for Payer: Cigna Commercial HMO & PPO	$7,092.08
Rate for Payer: Home State Health Plan Medicare Advantage	$7,092.08
Rate for Payer: Humana Commercial	$14,184.16
Rate for Payer: Humana Medicare Advantage	$7,092.08

ATN PROFILE

Facility

$767.00

Service Code	CPT 83520
Hospital Charge Code	22283520
Hospital Revenue Code	301
Rate for Payer: Cash Price	$690.30

ATN PROFILE

Facility

$767.00

Service Code	CPT 83520
Hospital Charge Code	22283520
Hospital Revenue Code	301
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$547.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.54
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$454.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$547.64
Rate for Payer: Cash Price	$690.30
Rate for Payer: Cash Price	$690.30
Rate for Payer: Cash Price	$690.30
Rate for Payer: Cigna Commercial HMO & PPO	$17.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.63
Rate for Payer: Home State Health Plan Medicare Advantage	$17.27
Rate for Payer: Humana Commercial	$34.54
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$276.12

ATOMOXETINE (STRATTERA) 25MG CAP EMP

Facility

$18.00

Service Code	NDC 6.498E+10
Hospital Charge Code	2623519
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

ATOMOXETINE (STRATTERA) 25MG CAP EMP

Facility

$18.00

Service Code	NDC 6.498E+10
Hospital Charge Code	2623519
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

ATOMOXETINE (STRATTERA) 40MG CAP EMP

Facility

$18.00

Service Code	NDC 6.498E+10
Hospital Charge Code	2623453
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

ATOMOXETINE (STRATTERA) 40MG CAP EMP

Facility

$18.00

Service Code	NDC 6.498E+10
Hospital Charge Code	2623453
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

ATOMOXETINE (STRATTERA) 60MG CAP EMP

Facility

$18.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2623815
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

ATOMOXETINE (STRATTERA) 60MG CAP EMP

Facility

$18.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2623815
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

ATOMOXETINE (STRATTERA) 80MG CAP EMP

Facility

$18.00

Service Code	NDC 2325030
Hospital Charge Code	2622869
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

ATOMOXETINE (STRATTERA) 80MG CAP EMP

Facility

$18.00

Service Code	NDC 2325030
Hospital Charge Code	2622869
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

ATORVASTATIN 10MG TAB EMP

Facility

$24.00

Service Code	NDC 71015523
Hospital Charge Code	2698225
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

ATORVASTATIN 10MG TAB EMP

Facility

$24.00

Service Code	NDC 71015523
Hospital Charge Code	2698225
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

ATORVASTATIN 20MG TAB EMP

Facility

$39.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2697255
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

ATORVASTATIN 20MG TAB EMP

Facility

$39.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2697255
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

ATORVASTATIN 40MG TAB EMP

Facility

$39.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2697228
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

ATORVASTATIN 40MG TAB EMP

Facility

$39.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2697228
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

ATORVASTATIN 80MG TAB EMP

Facility

$39.00

Service Code	NDC 781538892
Hospital Charge Code	2621142
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

ATORVASTATIN 80MG TAB EMP

Facility

$39.00

Service Code	NDC 781538892
Hospital Charge Code	2621142
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

ATORVASTATIN (LIPITOR) 10MG TAB UD

Facility

$24.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626271
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

ATORVASTATIN (LIPITOR) 10MG TAB UD

Facility

$24.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626271
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

Know your out-of-pocket cost for care.

All Charges