Madison Medical Center

All Charges

Charge

Type

Setting

Price

ATORVASTATIN (LIPITOR) 40MG TAB UD

Facility

$40.00

Service Code	NDC 904629261
Hospital Charge Code	2626531
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

ATORVASTATIN (LIPITOR) 40MG TAB UD

Facility

$40.00

Service Code	NDC 904629261
Hospital Charge Code	2626531
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

ATRACURIUM INJ

Facility

$75.00

Hospital Charge Code	2020001
Hospital Revenue Code	370
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

ATRACURIUM INJ

Facility

$75.00

Hospital Charge Code	2020001
Hospital Revenue Code	370
Rate for Payer: Cash Price	$67.50

ATROPINE 0.4MG INJ 1ML

Facility

$63.00

Service Code	HCPCS J0461
Hospital Charge Code	2654255
Hospital Revenue Code	250
Rate for Payer: Cash Price	$56.70

ATROPINE 0.4MG INJ 1ML

Facility

$63.00

Service Code	HCPCS J0461
Hospital Charge Code	2654255
Hospital Revenue Code	250
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

ATROPINE 0.4MG INJ 1ML DOSE (20ML MDV)

Facility

$63.00

Service Code	HCPCS J0461
Hospital Charge Code	2620868
Hospital Revenue Code	250
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

ATROPINE 0.4MG INJ 1ML DOSE (20ML MDV)

Facility

$63.00

Service Code	HCPCS J0461
Hospital Charge Code	2620868
Hospital Revenue Code	250
Rate for Payer: Cash Price	$56.70

ATROPINE 1MG/10ML PFS INJ

Facility

$169.00

Service Code	HCPCS J0461
Hospital Charge Code	2654260
Hospital Revenue Code	250
Rate for Payer: Cash Price	$152.10

ATROPINE 1MG/10ML PFS INJ

Facility

$169.00

Service Code	HCPCS J0461
Hospital Charge Code	2654260
Hospital Revenue Code	250
Min. Negotiated Rate	$60.84
Max. Negotiated Rate	$120.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$120.67
Rate for Payer: Cash Price	$152.10
Rate for Payer: UnitedHealthcare Commercial	$112.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.84

ATROPINE 1% OP DROPS 15ML

Facility

$199.00

Service Code	NDC 6.1314E+10
Hospital Charge Code	2626534
Hospital Revenue Code	250
Rate for Payer: Cash Price	$179.10

ATROPINE 1% OP DROPS 15ML

Facility

$199.00

Service Code	NDC 6.1314E+10
Hospital Charge Code	2626534
Hospital Revenue Code	250
Min. Negotiated Rate	$71.64
Max. Negotiated Rate	$142.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.09
Rate for Payer: Cash Price	$179.10
Rate for Payer: UnitedHealthcare Commercial	$132.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.64

ATROPINE 1% OP DROPS 2ML

Facility

$93.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2618977
Hospital Revenue Code	250
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$66.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: UnitedHealthcare Commercial	$62.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

ATROPINE 1% OP DROPS 2ML

Facility

$93.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2618977
Hospital Revenue Code	250
Rate for Payer: Cash Price	$83.70

ATROPINE 1% OP DROPS 5ML

Facility

$199.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2621200
Hospital Revenue Code	250
Min. Negotiated Rate	$71.64
Max. Negotiated Rate	$142.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.09
Rate for Payer: Cash Price	$179.10
Rate for Payer: UnitedHealthcare Commercial	$132.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.64

ATROPINE 1% OP DROPS 5ML

Facility

$199.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2621200
Hospital Revenue Code	250
Rate for Payer: Cash Price	$179.10

ATROPINE INJE .03MG

Facility

$58.00

Service Code	HCPCS J0460
Hospital Charge Code	2058002
Hospital Revenue Code	370
Rate for Payer: Cash Price	$52.20

ATROPINE INJE .03MG

Facility

$58.00

Service Code	HCPCS J0460
Hospital Charge Code	2058002
Hospital Revenue Code	370
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

ATTEND, FITULTRAXXL

Facility

$9.00

Hospital Charge Code	90000051
Hospital Revenue Code	271
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$6.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$6.43
Rate for Payer: Cash Price	$8.10
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.24

ATTEND, FITULTRAXXL

Facility

$9.00

Hospital Charge Code	90000051
Hospital Revenue Code	271
Rate for Payer: Cash Price	$8.10

ATTENDS, FITBASIC EXTRA SMALL

Facility

$9.00

Hospital Charge Code	281850
Hospital Revenue Code	271
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$6.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$6.43
Rate for Payer: Cash Price	$8.10
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.24

ATTENDS, FITBASIC EXTRA SMALL

Facility

$9.00

Hospital Charge Code	281850
Hospital Revenue Code	271
Rate for Payer: Cash Price	$8.10

ATTENDS, FITBASIC REGULAR

Facility

$16.00

Hospital Charge Code	281840
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

ATTENDS, FITBASIC REGULAR

Facility

$16.00

Hospital Charge Code	281840
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

ATTENDS, FITULTRA LARGE

Facility

$20.00

Hospital Charge Code	281842
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

Know your out-of-pocket cost for care.

All Charges