Madison Medical Center

All Charges

Charge

Type

Setting

Price

CEFTRIAXONE (ROCEPHIN) 2GM VIAL

Facility

$997.00

Service Code	HCPCS J0696
Hospital Charge Code	2656159
Hospital Revenue Code	250
Min. Negotiated Rate	$358.92
Max. Negotiated Rate	$711.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$590.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$711.86
Rate for Payer: Cash Price	$897.30
Rate for Payer: UnitedHealthcare Commercial	$665.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$358.92

CEFTRIAXONE (ROCEPHIN) 2GM VIAL

Facility

$997.00

Service Code	HCPCS J0696
Hospital Charge Code	2656159
Hospital Revenue Code	250
Rate for Payer: Cash Price	$897.30

CEFTRIAXONE (ROCEPHIN) 500MG VIAL

Facility

$273.00

Service Code	HCPCS J0696
Hospital Charge Code	2618201
Hospital Revenue Code	250
Min. Negotiated Rate	$98.28
Max. Negotiated Rate	$194.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$161.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$194.92
Rate for Payer: Cash Price	$245.70
Rate for Payer: UnitedHealthcare Commercial	$182.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$98.28

CEFTRIAXONE (ROCEPHIN) 500MG VIAL

Facility

$273.00

Service Code	HCPCS J0696
Hospital Charge Code	2618201
Hospital Revenue Code	250
Rate for Payer: Cash Price	$245.70

CEFUROXIME (CEFTIN) 250MG TAB

Facility

$52.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2654437
Hospital Revenue Code	250
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$37.13
Rate for Payer: Cash Price	$46.80
Rate for Payer: UnitedHealthcare Commercial	$34.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.72

CEFUROXIME (CEFTIN) 250MG TAB

Facility

$52.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2654437
Hospital Revenue Code	250
Rate for Payer: Cash Price	$46.80

CELECOXIB 100MG (CELEBREX) CAP

Facility

$22.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2626279
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

CELECOXIB 100MG (CELEBREX) CAP

Facility

$22.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2626279
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

CELECOXIB (CELEBREX) 100MG CAP EMP

Facility

$22.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2623235
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

CELECOXIB (CELEBREX) 100MG CAP EMP

Facility

$22.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2623235
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

CELECOXIB (CELEBREX) 200MG CAP EMP

Facility

$22.00

Service Code	NDC 25152531
Hospital Charge Code	2622531
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

CELECOXIB (CELEBREX) 200MG CAP EMP

Facility

$22.00

Service Code	NDC 25152531
Hospital Charge Code	2622531
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

CELESTONE 3 MG

Facility

$51.00

Service Code	HCPCS J0702
Hospital Charge Code	9100702
Hospital Revenue Code	636
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$36.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$36.41
Rate for Payer: Cash Price	$45.90
Rate for Payer: UnitedHealthcare Commercial	$34.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.36

CELESTONE 3 MG

Facility

$51.00

Service Code	HCPCS J0702
Hospital Charge Code	9100702
Hospital Revenue Code	636
Min. Negotiated Rate	$34.02
Max. Negotiated Rate	$34.02
Rate for Payer: Cash Price	$45.90
Rate for Payer: UnitedHealthcare Commercial	$34.02

CELESTONE 3 MG

Facility

$51.00

Service Code	HCPCS J0702
Hospital Charge Code	9300702
Hospital Revenue Code	636
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$36.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$36.41
Rate for Payer: Cash Price	$45.90
Rate for Payer: UnitedHealthcare Commercial	$34.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.36

CELESTONE 3 MG

Facility

$51.00

Service Code	HCPCS J0702
Hospital Charge Code	9300702
Hospital Revenue Code	636
Min. Negotiated Rate	$34.02
Max. Negotiated Rate	$34.02
Rate for Payer: Cash Price	$45.90
Rate for Payer: UnitedHealthcare Commercial	$34.02

CELIAC HLA DQ ASSOC

Facility

$727.00

Service Code	CPT 81377
Hospital Charge Code	2281377
Hospital Revenue Code	301
Rate for Payer: Cash Price	$654.30

CELIAC HLA DQ ASSOC

Facility

$727.00

Service Code	CPT 81377
Hospital Charge Code	2281377
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$519.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$85.27
Rate for Payer: Aetna Medicare Advantage	$94.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$430.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$519.08
Rate for Payer: Cash Price	$654.30
Rate for Payer: Cash Price	$654.30
Rate for Payer: Cash Price	$654.30
Rate for Payer: Cigna Commercial HMO & PPO	$94.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$85.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$91.24
Rate for Payer: Home State Health Plan Medicare Advantage	$94.74
Rate for Payer: Humana Commercial	$189.48
Rate for Payer: Humana Medicare Advantage	$94.74
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$85.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$261.72

CELL COUNT FLD W/CRYSTALS

Facility

$121.00

Service Code	CPT 89051
Hospital Charge Code	2289051
Hospital Revenue Code	301
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$86.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.04
Rate for Payer: Aetna Medicare Advantage	$5.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$71.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$86.39
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cigna Commercial HMO & PPO	$5.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.39
Rate for Payer: Home State Health Plan Medicare Advantage	$5.60
Rate for Payer: Humana Commercial	$11.20
Rate for Payer: Humana Medicare Advantage	$5.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$43.56

CELL COUNT FLD W/CRYSTALS

Facility

$121.00

Service Code	CPT 89051
Hospital Charge Code	2289051
Hospital Revenue Code	301
Rate for Payer: Cash Price	$108.90

CELL COUNT FLUID

Facility

$125.00

Service Code	CPT 89051
Hospital Charge Code	2227026
Hospital Revenue Code	301
Rate for Payer: Cash Price	$112.50

CELL COUNT FLUID

Facility

$125.00

Service Code	CPT 89051
Hospital Charge Code	2227026
Hospital Revenue Code	301
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$89.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.04
Rate for Payer: Aetna Medicare Advantage	$5.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna Commercial HMO & PPO	$5.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.39
Rate for Payer: Home State Health Plan Medicare Advantage	$5.60
Rate for Payer: Humana Commercial	$11.20
Rate for Payer: Humana Medicare Advantage	$5.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

CELLULITIS AND OTHER SKIN INFECTIONS

Facility

$5,498.48

Service Code	APR-DRG 3831
Min. Negotiated Rate	$5,498.48
Max. Negotiated Rate	$5,498.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,498.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,498.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,498.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,498.48

CELLULITIS AND OTHER SKIN INFECTIONS

Facility

$15,153.53

Service Code	APR-DRG 3833
Min. Negotiated Rate	$15,153.53
Max. Negotiated Rate	$15,153.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,153.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,153.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,153.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,153.53

CELLULITIS AND OTHER SKIN INFECTIONS

Facility

$8,041.84

Service Code	APR-DRG 3832
Min. Negotiated Rate	$8,041.84
Max. Negotiated Rate	$8,041.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,041.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,041.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,041.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,041.84

Know your out-of-pocket cost for care.

All Charges