Madison Medical Center

All Charges

Charge

Type

Setting

Price

CEFDINIR (OMNICEF) 125MG/5ML SUS 60ML

Facility

$325.00

Service Code	NDC 781607761
Hospital Charge Code	2626398
Hospital Revenue Code	250
Rate for Payer: Cash Price	$292.50

CEFDINIR (OMNICEF) 125MG/5ML SUS 60ML

Facility

$325.00

Service Code	NDC 781607761
Hospital Charge Code	2626398
Hospital Revenue Code	250
Min. Negotiated Rate	$117.00
Max. Negotiated Rate	$232.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.05
Rate for Payer: Cash Price	$292.50
Rate for Payer: UnitedHealthcare Commercial	$216.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$117.00

CEFDINIR (OMNICEF) 250MG/5ML SUS 100ML

Facility

$550.00

Service Code	NDC 781607846
Hospital Charge Code	2619229
Hospital Revenue Code	250
Rate for Payer: Cash Price	$495.00

CEFDINIR (OMNICEF) 250MG/5ML SUS 100ML

Facility

$550.00

Service Code	NDC 781607846
Hospital Charge Code	2619229
Hospital Revenue Code	250
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$392.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$325.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$392.70
Rate for Payer: Cash Price	$495.00
Rate for Payer: UnitedHealthcare Commercial	$366.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$198.00

CEFDINIR (OMNICEF) 250MG/5ML SUS 60ML

Facility

$550.00

Service Code	NDC 93413764
Hospital Charge Code	2626439
Hospital Revenue Code	250
Rate for Payer: Cash Price	$495.00

CEFDINIR (OMNICEF) 250MG/5ML SUS 60ML

Facility

$550.00

Service Code	NDC 93413764
Hospital Charge Code	2626439
Hospital Revenue Code	250
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$392.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$325.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$392.70
Rate for Payer: Cash Price	$495.00
Rate for Payer: UnitedHealthcare Commercial	$366.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$198.00

CEFDINIR (OMNICEF) 300MG CAP

Facility

$44.00

Service Code	NDC 781217660
Hospital Charge Code	2626440
Hospital Revenue Code	250
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

CEFDINIR (OMNICEF) 300MG CAP

Facility

$44.00

Service Code	NDC 781217660
Hospital Charge Code	2626440
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

CEFDINIR (OMNICEF) 300MG CAP EMP

Facility

$44.00

Service Code	NDC 781217660
Hospital Charge Code	2622144
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

CEFDINIR (OMNICEF) 300MG CAP EMP

Facility

$44.00

Service Code	NDC 781217660
Hospital Charge Code	2622144
Hospital Revenue Code	250
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

CEFEPIME + NS : 1GM + 100ML MINIBAG

Facility

$142.00

Service Code	HCPCS J0692
Hospital Charge Code	2626491
Hospital Revenue Code	250
Rate for Payer: Cash Price	$127.80

CEFEPIME + NS : 1GM + 100ML MINIBAG

Facility

$142.00

Service Code	HCPCS J0692
Hospital Charge Code	2626491
Hospital Revenue Code	250
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$101.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$84.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$101.39
Rate for Payer: Cash Price	$127.80
Rate for Payer: UnitedHealthcare Commercial	$94.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.12

CEFEPIME + NS : 2GM + 100ML MINIBAG

Facility

$236.00

Service Code	NDC 2.5021E+10
Hospital Charge Code	2697051
Hospital Revenue Code	250
Min. Negotiated Rate	$84.96
Max. Negotiated Rate	$168.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$168.50
Rate for Payer: Cash Price	$212.40
Rate for Payer: UnitedHealthcare Commercial	$157.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.96

CEFEPIME + NS : 2GM + 100ML MINIBAG

Facility

$236.00

Service Code	NDC 2.5021E+10
Hospital Charge Code	2697051
Hospital Revenue Code	250
Rate for Payer: Cash Price	$212.40

CEFOPERAZONE IVPB 1MG

Facility

$263.00

Service Code	HCPCS S0021
Hospital Charge Code	2058090
Hospital Revenue Code	370
Rate for Payer: Cash Price	$236.70

CEFOPERAZONE IVPB 1MG

Facility

$263.00

Service Code	HCPCS S0021
Hospital Charge Code	2058090
Hospital Revenue Code	370
Min. Negotiated Rate	$94.68
Max. Negotiated Rate	$187.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$155.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$187.78
Rate for Payer: Cash Price	$236.70
Rate for Payer: UnitedHealthcare Commercial	$175.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$94.68

CEFPODOXIME PROX(VANTIN) 200MG TAB

Facility

$45.00

Service Code	NDC 781543920
Hospital Charge Code	2626505
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

CEFPODOXIME PROX(VANTIN) 200MG TAB

Facility

$45.00

Service Code	NDC 781543920
Hospital Charge Code	2626505
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

CEFPROZIL(CEFZIL)125MG/5MLSUSP 50ML

Facility

$234.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2624951
Hospital Revenue Code	250
Min. Negotiated Rate	$84.24
Max. Negotiated Rate	$167.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$138.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.08
Rate for Payer: Cash Price	$210.60
Rate for Payer: UnitedHealthcare Commercial	$156.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.24

CEFPROZIL(CEFZIL)125MG/5MLSUSP 50ML

Facility

$234.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2624951
Hospital Revenue Code	250
Rate for Payer: Cash Price	$210.60

CEFPROZIL(CEFZIL)250MG/5MLSUSP 100ML

Facility

$250.00

Service Code	NDC 4.2043E+10
Hospital Charge Code	2620601
Hospital Revenue Code	250
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$178.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.00

CEFPROZIL(CEFZIL)250MG/5MLSUSP 100ML

Facility

$250.00

Service Code	NDC 4.2043E+10
Hospital Charge Code	2620601
Hospital Revenue Code	250
Rate for Payer: Cash Price	$225.00

CEFPROZIL(CEFZIL)250MG/5MLSUSP 75ML

Facility

$250.00

Service Code	NDC 4.2043E+10
Hospital Charge Code	2626547
Hospital Revenue Code	250
Rate for Payer: Cash Price	$225.00

CEFPROZIL(CEFZIL)250MG/5MLSUSP 75ML

Facility

$250.00

Service Code	NDC 4.2043E+10
Hospital Charge Code	2626547
Hospital Revenue Code	250
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$178.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.00

CEFTAROLINE FOSAMIL (TEFLARO) 400MG IVPB

Facility

$943.00

Service Code	NDC 456040010
Hospital Charge Code	2624127
Hospital Revenue Code	250
Min. Negotiated Rate	$339.48
Max. Negotiated Rate	$673.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$558.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$673.30
Rate for Payer: Cash Price	$848.70
Rate for Payer: UnitedHealthcare Commercial	$628.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$339.48

Know your out-of-pocket cost for care.

All Charges