Madison Medical Center

All Charges

Charge

Type

Setting

Price

CHYMOTRYPSIN

Facility

$189.00

Hospital Charge Code	226291
Hospital Revenue Code	301
Rate for Payer: Cash Price	$170.10

CHYMOTRYPSIN

Facility

$189.00

Hospital Charge Code	226291
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$134.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$111.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$134.95
Rate for Payer: Cash Price	$170.10
Rate for Payer: Cash Price	$170.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.04

CICLOPIROX 8% T/S NAIL LAC EMP

Facility

$304.00

Service Code	NDC 4.2192E+10
Hospital Charge Code	2625796
Hospital Revenue Code	250
Rate for Payer: Cash Price	$273.60

CICLOPIROX 8% T/S NAIL LAC EMP

Facility

$304.00

Service Code	NDC 4.2192E+10
Hospital Charge Code	2625796
Hospital Revenue Code	250
Min. Negotiated Rate	$109.44
Max. Negotiated Rate	$217.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$179.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$217.06
Rate for Payer: Cash Price	$273.60
Rate for Payer: UnitedHealthcare Commercial	$202.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$109.44

CILOSTAZOL 100MG TAB EMP

Facility

$20.00

Service Code	NDC 93206406
Hospital Charge Code	2619576
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

CILOSTAZOL 100MG TAB EMP

Facility

$20.00

Service Code	NDC 93206406
Hospital Charge Code	2619576
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

CILOSTAZOL 50MG TAB EMP

Facility

$20.00

Service Code	NDC 93206406
Hospital Charge Code	2698296
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

CILOSTAZOL 50MG TAB EMP

Facility

$20.00

Service Code	NDC 93206406
Hospital Charge Code	2698296
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

CILOSTAZOL (PLETAL) 100MG TAB

Facility

$20.00

Service Code	NDC 93206406
Hospital Charge Code	2626530
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

CILOSTAZOL (PLETAL) 100MG TAB

Facility

$20.00

Service Code	NDC 93206406
Hospital Charge Code	2626530
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

CIMZIA 200MG VIAL KIT 2 X 200MG SDV

Facility

$23,674.00

Service Code	HCPCS J0897
Hospital Charge Code	2623373
Hospital Revenue Code	250
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$16,903.24
Rate for Payer: Aetna Medicare Advantage	$30.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14,015.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$16,903.24
Rate for Payer: Cash Price	$21,306.60
Rate for Payer: Cash Price	$21,306.60
Rate for Payer: Cigna Commercial HMO & PPO	$30.10
Rate for Payer: Home State Health Plan Medicare Advantage	$30.10
Rate for Payer: Humana Commercial	$60.20
Rate for Payer: Humana Medicare Advantage	$30.10
Rate for Payer: UnitedHealthcare Commercial	$15,790.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$8,522.64

CIMZIA 200MG VIAL KIT 2 X 200MG SDV

Facility

$23,674.00

Service Code	HCPCS J0897
Hospital Charge Code	2623373
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21,306.60

CIPRODEX OTIC SUSP 7.5ML EMP

Facility

$612.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2627241
Hospital Revenue Code	250
Min. Negotiated Rate	$220.32
Max. Negotiated Rate	$436.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$362.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$436.97
Rate for Payer: Cash Price	$550.80
Rate for Payer: UnitedHealthcare Commercial	$408.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$220.32

CIPRODEX OTIC SUSP 7.5ML EMP

Facility

$612.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2627241
Hospital Revenue Code	250
Rate for Payer: Cash Price	$550.80

CIPRODEX OTIC SUSP EMP

Facility

$572.00

Hospital Charge Code	2622168
Hospital Revenue Code	250
Rate for Payer: Cash Price	$514.80

CIPRODEX OTIC SUSP EMP

Facility

$572.00

Hospital Charge Code	2622168
Hospital Revenue Code	250
Min. Negotiated Rate	$205.92
Max. Negotiated Rate	$408.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$338.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$408.41
Rate for Payer: Cash Price	$514.80
Rate for Payer: UnitedHealthcare Commercial	$381.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$205.92

CIPROFLOXACIN 500MG TAB EMP

Facility

$15.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2697429
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

CIPROFLOXACIN 500MG TAB EMP

Facility

$15.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2697429
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

CIPROFLOXACIN (CIPRO) 200MG PREMIX 100ML

Facility

$87.00

Service Code	HCPCS J0744
Hospital Charge Code	2626436
Hospital Revenue Code	250
Min. Negotiated Rate	$31.32
Max. Negotiated Rate	$62.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$51.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.12
Rate for Payer: Cash Price	$78.30
Rate for Payer: UnitedHealthcare Commercial	$58.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.32

CIPROFLOXACIN (CIPRO) 200MG PREMIX 100ML

Facility

$87.00

Service Code	HCPCS J0744
Hospital Charge Code	2626436
Hospital Revenue Code	250
Rate for Payer: Cash Price	$78.30

CIPROFLOXACIN (CIPRO) 250MG TAB

Facility

$44.00

Service Code	NDC 5.8657E+10
Hospital Charge Code	2626392
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

CIPROFLOXACIN (CIPRO) 250MG TAB

Facility

$44.00

Service Code	NDC 5.8657E+10
Hospital Charge Code	2626392
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

CIPROFLOXACIN (CIPRO) 250MG TAB EMP

Facility

$44.00

Service Code	NDC 5.8657E+10
Hospital Charge Code	2625666
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

CIPROFLOXACIN (CIPRO) 250MG TAB EMP

Facility

$44.00

Service Code	NDC 5.8657E+10
Hospital Charge Code	2625666
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

CIPROFLOXACIN (CIPRO) 3% OP SOL 2.5ML

Facility

$127.00

Service Code	NDC 6.9315E+10
Hospital Charge Code	2623602
Hospital Revenue Code	250
Rate for Payer: Cash Price	$114.30

Know your out-of-pocket cost for care.

All Charges