Madison Medical Center

All Charges

Charge

Type

Setting

Price

CLOBETASOL PROP 0.05% SOL 50ML EMP

Facility

$342.00

Service Code	NDC 472040250
Hospital Charge Code	2623079
Hospital Revenue Code	250
Rate for Payer: Cash Price	$307.80

CLOMIPHENE CIT 50MG TAB EMP

Facility

$22.00

Service Code	NDC 4.9884E+10
Hospital Charge Code	2623215
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

CLOMIPHENE CIT 50MG TAB EMP

Facility

$22.00

Service Code	NDC 4.9884E+10
Hospital Charge Code	2623215
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

CLONAZEPAM

Facility

$138.00

Service Code	CPT 80159
Hospital Charge Code	2280154
Hospital Revenue Code	301
Min. Negotiated Rate	$18.14
Max. Negotiated Rate	$98.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.14
Rate for Payer: Aetna Medicare Advantage	$20.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$81.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$98.53
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cigna Commercial HMO & PPO	$20.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19.41
Rate for Payer: Home State Health Plan Medicare Advantage	$20.15
Rate for Payer: Humana Commercial	$40.30
Rate for Payer: Humana Medicare Advantage	$20.15
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$49.68

CLONAZEPAM

Facility

$138.00

Service Code	CPT 80159
Hospital Charge Code	2280154
Hospital Revenue Code	301
Rate for Payer: Cash Price	$124.20

CLONAZEPAM 0.5MG TAB EMP C4

Facility

$20.00

Service Code	NDC 93083201
Hospital Charge Code	2621958
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

CLONAZEPAM 0.5MG TAB EMP C4

Facility

$20.00

Service Code	NDC 93083201
Hospital Charge Code	2621958
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

CLONAZEPAM 1MG TAB EMP C4

Facility

$20.00

Service Code	NDC 93321201
Hospital Charge Code	2698146
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

CLONAZEPAM 1MG TAB EMP C4

Facility

$20.00

Service Code	NDC 93321201
Hospital Charge Code	2698146
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

CLONAZEPAM (KLONOPIN) 0.5MG TAB C4

Facility

$20.00

Service Code	NDC 904722761
Hospital Charge Code	2626300
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

CLONAZEPAM (KLONOPIN) 0.5MG TAB C4

Facility

$20.00

Service Code	NDC 904722761
Hospital Charge Code	2626300
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

CLONAZEPAM, URINE

Facility

$361.00

Service Code	CPT 80346
Hospital Charge Code	22811903
Hospital Revenue Code	301
Rate for Payer: Cash Price	$324.90

CLONAZEPAM, URINE

Facility

$361.00

Service Code	CPT 80346
Hospital Charge Code	22811903
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$257.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$213.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$257.75
Rate for Payer: Cash Price	$324.90
Rate for Payer: Cash Price	$324.90
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$129.96

CLONIDINE 0.1MG TAB EMP

Facility

$15.00

Service Code	NDC 228212710
Hospital Charge Code	2697226
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

CLONIDINE 0.1MG TAB EMP

Facility

$15.00

Service Code	NDC 228212710
Hospital Charge Code	2697226
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

CLONIDINE 0.2MG TAB EMP

Facility

$15.00

Service Code	NDC 228212810
Hospital Charge Code	2697230
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

CLONIDINE 0.2MG TAB EMP

Facility

$15.00

Service Code	NDC 228212810
Hospital Charge Code	2697230
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

CLONIDINE 0.3MG TAB EMP

Facility

$15.00

Service Code	NDC 228212910
Hospital Charge Code	2697756
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

CLONIDINE 0.3MG TAB EMP

Facility

$12.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2623324
Hospital Revenue Code	250
Rate for Payer: Cash Price	$10.80

CLONIDINE 0.3MG TAB EMP

Facility

$15.00

Service Code	NDC 228212910
Hospital Charge Code	2697756
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

CLONIDINE 0.3MG TAB EMP

Facility

$12.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2623324
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$8.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8.57
Rate for Payer: Cash Price	$10.80
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

CLONIDINE 0.3MG TAB EMP

Facility

$12.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2623323
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$8.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8.57
Rate for Payer: Cash Price	$10.80
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

CLONIDINE 0.3MG TAB EMP

Facility

$12.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2623323
Hospital Revenue Code	250
Rate for Payer: Cash Price	$10.80

CLONIDINE (CATAPRES) 0.1MG TAB

Facility

$20.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2654620
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

CLONIDINE (CATAPRES) 0.1MG TAB

Facility

$20.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2654620
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

Know your out-of-pocket cost for care.

All Charges