Madison Medical Center

All Charges

Charge

Type

Setting

Price

FLEXIBLE TAUT CATHETER 4.5 FRENCH

Facility

$282.00

Service Code	CPT Y7506
Hospital Charge Code	123060
Hospital Revenue Code	271
Rate for Payer: Cash Price	$253.80

FLEXIBLE TRACH ADAPTER

Facility

$17.00

Hospital Charge Code	4500078
Hospital Revenue Code	272
Rate for Payer: Cash Price	$15.30

FLEXIBLE TRACH ADAPTER

Facility

$17.00

Hospital Charge Code	4500078
Hospital Revenue Code	272
Min. Negotiated Rate	$6.12
Max. Negotiated Rate	$12.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.14
Rate for Payer: Cash Price	$15.30
Rate for Payer: UnitedHealthcare Commercial	$11.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.12

FLOMAX (TAMSULOSIN) 0.4MG CAP

Facility

$11.00

Service Code	NDC 904615661
Hospital Charge Code	2696425
Hospital Revenue Code	250
Rate for Payer: Cash Price	$9.90

FLOMAX (TAMSULOSIN) 0.4MG CAP

Facility

$11.00

Service Code	NDC 904615661
Hospital Charge Code	2696425
Hospital Revenue Code	250
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$7.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.85
Rate for Payer: Cash Price	$9.90
Rate for Payer: UnitedHealthcare Commercial	$7.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.96

FLORASTOR 250MG CAP #20

Facility

$90.00

Service Code	NDC 4142000024
Hospital Charge Code	2697608
Hospital Revenue Code	250
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$64.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.40

FLORASTOR 250MG CAP #20

Facility

$90.00

Service Code	NDC 4142000024
Hospital Charge Code	2697608
Hospital Revenue Code	250
Rate for Payer: Cash Price	$81.00

FLORESCEIN ANGIOGRAPHY

Professional

Both

$696.00

Service Code	CPT 92235
Hospital Charge Code	1865206
Hospital Revenue Code	981
Min. Negotiated Rate	$93.89
Max. Negotiated Rate	$243.60
Rate for Payer: Aetna Commercial/Medicare Advantage	$143.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$93.89
Rate for Payer: Cash Price	$626.40
Rate for Payer: Cash Price	$626.40
Rate for Payer: Cigna Commercial HMO & PPO	$143.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$93.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$103.28
Rate for Payer: Home State Health Plan Medicare Advantage	$143.37
Rate for Payer: Optum Medicare Advantage	$243.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$93.89

FLOURO, NO FILMS

Facility

$81.00

Hospital Charge Code	326153
Hospital Revenue Code	320
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$175.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

FLOURO, NO FILMS

Facility

$81.00

Hospital Charge Code	326153
Hospital Revenue Code	320
Rate for Payer: Cash Price	$72.90

FLOURO W/SPOT FILMS

Facility

$281.00

Service Code	CPT 76000
Hospital Charge Code	326160
Hospital Revenue Code	320
Rate for Payer: Cash Price	$252.90

FLOURO W/SPOT FILMS

Facility

$281.00

Service Code	CPT 76000
Hospital Charge Code	326160
Hospital Revenue Code	320
Min. Negotiated Rate	$101.16
Max. Negotiated Rate	$487.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$166.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$200.63
Rate for Payer: Cash Price	$252.90
Rate for Payer: Cash Price	$252.90
Rate for Payer: Cash Price	$252.90
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$101.16

.FLOW CYTOMETRY CPT 88184

Facility

$809.00

Service Code	CPT 88184
Hospital Charge Code	223110
Hospital Revenue Code	305
Rate for Payer: Cash Price	$728.10

.FLOW CYTOMETRY CPT 88184

Facility

$809.00

Service Code	CPT 88184
Hospital Charge Code	223110
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$732.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$323.12
Rate for Payer: Aetna Medicare Advantage	$366.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$478.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$577.63
Rate for Payer: Cash Price	$728.10
Rate for Payer: Cash Price	$728.10
Rate for Payer: Cash Price	$728.10
Rate for Payer: Cigna Commercial HMO & PPO	$366.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$323.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$345.74
Rate for Payer: Home State Health Plan Medicare Advantage	$366.21
Rate for Payer: Humana Commercial	$732.42
Rate for Payer: Humana Medicare Advantage	$366.21
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$323.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$291.24

.FLOW CYTOMETRY CPT 88185

Facility

$809.00

Service Code	CPT 88185
Hospital Charge Code	223109
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$577.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$478.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$577.63
Rate for Payer: Cash Price	$728.10
Rate for Payer: Cash Price	$728.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$291.24

.FLOW CYTOMETRY CPT 88185

Facility

$809.00

Service Code	CPT 88185
Hospital Charge Code	223109
Hospital Revenue Code	305
Rate for Payer: Cash Price	$728.10

.FLOW CYTOMETRY CPT 88189

Facility

$809.00

Service Code	CPT 88189
Hospital Charge Code	223108
Hospital Revenue Code	305
Rate for Payer: Cash Price	$728.10

.FLOW CYTOMETRY CPT 88189

Facility

$809.00

Service Code	CPT 88189
Hospital Charge Code	223108
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$577.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$478.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$577.63
Rate for Payer: Cash Price	$728.10
Rate for Payer: Cash Price	$728.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$291.24

FLUCONAZOLE 150MG TAB EMP

Facility

$93.00

Service Code	NDC 172541211
Hospital Charge Code	2621910
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

FLUCONAZOLE 150MG TAB EMP

Facility

$93.00

Service Code	NDC 172541211
Hospital Charge Code	2621910
Hospital Revenue Code	250
Rate for Payer: Cash Price	$83.70

FLUCONAZOLE 400MG INJ PREMIX 200ML

Facility

$146.00

Hospital Charge Code	2620696
Hospital Revenue Code	250
Min. Negotiated Rate	$52.56
Max. Negotiated Rate	$104.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$86.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$104.24
Rate for Payer: Cash Price	$131.40
Rate for Payer: UnitedHealthcare Commercial	$97.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$52.56

FLUCONAZOLE 400MG INJ PREMIX 200ML

Facility

$146.00

Hospital Charge Code	2620696
Hospital Revenue Code	250
Rate for Payer: Cash Price	$131.40

FLUCONAZOLE (DIFLUCAN) 100MG TAB

Facility

$65.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2626262
Hospital Revenue Code	250
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

FLUCONAZOLE (DIFLUCAN) 100MG TAB

Facility

$65.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2626262
Hospital Revenue Code	250
Rate for Payer: Cash Price	$58.50

FLUCONAZOLE (DIFLUCAN) 100MG TAB EMP

Facility

$65.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2625476
Hospital Revenue Code	250
Rate for Payer: Cash Price	$58.50

Know your out-of-pocket cost for care.

All Charges