Madison Medical Center

All Charges

Charge

Type

Setting

Price

FLUCONAZOLE (DIFLUCAN) 100MG TAB EMP

Facility

$65.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2625476
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) 150MG TAB

Facility

$93.00

Service Code	NDC 5.9763E+10
Hospital Charge Code	2655023
Hospital Revenue Code	250
Rate for Payer: Cash Price	$83.70

FLUCONAZOLE (DIFLUCAN) 150MG TAB

Facility

$93.00

Service Code	NDC 5.9763E+10
Hospital Charge Code	2655023
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 (DIFLUCAN) 200MG TAB EMP

Facility

$65.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2623285
Hospital Revenue Code	250
Rate for Payer: Cash Price	$58.50

FLUCONAZOLE (DIFLUCAN) 200MG TAB EMP

Facility

$65.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2623285
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

FLUDROCORTISONE 0.1MG TAB

Facility

$16.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2697767
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

FLUDROCORTISONE 0.1MG TAB

Facility

$16.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2697767
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

FLUDROCORTISONE 0.1MG TAB HE

Facility

$16.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2626133
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

FLUDROCORTISONE 0.1MG TAB HE

Facility

$16.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2626133
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

FLUMAZENIL (ROMAZICON) 0.1MG/ML 5ML VL

Facility

$70.00

Service Code	NDC 6.3323E+10
Hospital Charge Code	2684667
Hospital Revenue Code	250
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$49.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

FLUMAZENIL (ROMAZICON) 0.1MG/ML 5ML VL

Facility

$70.00

Service Code	NDC 6.3323E+10
Hospital Charge Code	2684667
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.00

FLU MIST NASAL VACCINE

Facility

$63.00

Service Code	CPT 90732
Hospital Charge Code	3900001
Hospital Revenue Code	636
Min. Negotiated Rate	$42.02
Max. Negotiated Rate	$42.02
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02

FLU MIST NASAL VACCINE

Facility

$63.00

Service Code	CPT 90732
Hospital Charge Code	3900001
Hospital Revenue Code	636
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

FLUOCINOLONE 0.01% TOP SOL 60ML EMP

Facility

$63.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2624958
Hospital Revenue Code	250
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

FLUOCINOLONE 0.01% TOP SOL 60ML EMP

Facility

$63.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2624958
Hospital Revenue Code	250
Rate for Payer: Cash Price	$56.70

FLUOCINONIDE 0.05% TOP SOL 60ML EMP

Facility

$238.00

Service Code	NDC 1E+11
Hospital Charge Code	2622256
Hospital Revenue Code	250
Min. Negotiated Rate	$85.68
Max. Negotiated Rate	$169.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$140.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$169.93
Rate for Payer: Cash Price	$214.20
Rate for Payer: UnitedHealthcare Commercial	$158.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.68

FLUOCINONIDE 0.05% TOP SOL 60ML EMP

Facility

$238.00

Service Code	NDC 1E+11
Hospital Charge Code	2622256
Hospital Revenue Code	250
Rate for Payer: Cash Price	$214.20

FLUORESCEIN SOD OPTH STRIPS (BIO GLO)100

Facility

$65.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2697466
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

FLUORESCEIN SOD OPTH STRIPS (BIO GLO)100

Facility

$65.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2697466
Hospital Revenue Code	250
Rate for Payer: Cash Price	$58.50

FLUORO GUIDANCE FOR NEEDLE PLACEMENT PC

Professional

Both

$200.00

Service Code	CPT 77002
Hospital Charge Code	4177002
Hospital Revenue Code	975
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$107.11
Rate for Payer: Aetna Commercial/Medicare Advantage	$107.11
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna Commercial HMO & PPO	$107.11
Rate for Payer: Home State Health Plan Medicare Advantage	$107.11
Rate for Payer: Optum Medicare Advantage	$70.00

FLUORO GUID & LOC NEEDLE/CATH FOR SPINE

Professional

Both

$200.00

Service Code	CPT 77003
Hospital Charge Code	4177003
Hospital Revenue Code	975
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$93.02
Rate for Payer: Aetna Commercial/Medicare Advantage	$93.02
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna Commercial HMO & PPO	$93.02
Rate for Payer: Home State Health Plan Medicare Advantage	$93.02
Rate for Payer: Optum Medicare Advantage	$70.00

FLUOROURACIL 5% CRM 40GM EMP

Facility

$247.00

Service Code	NDC 187320447
Hospital Charge Code	2622748
Hospital Revenue Code	250
Min. Negotiated Rate	$88.92
Max. Negotiated Rate	$176.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$146.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$176.36
Rate for Payer: Cash Price	$222.30
Rate for Payer: UnitedHealthcare Commercial	$164.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$88.92

FLUOROURACIL 5% CRM 40GM EMP

Facility

$247.00

Service Code	NDC 187320447
Hospital Charge Code	2622748
Hospital Revenue Code	250
Rate for Payer: Cash Price	$222.30

FLUORO W/BOIPSY GUIDE

Facility

$725.00

Hospital Charge Code	323141
Hospital Revenue Code	402
Rate for Payer: Cash Price	$652.50

FLUORO W/BOIPSY GUIDE

Facility

$725.00

Hospital Charge Code	323141
Hospital Revenue Code	402
Min. Negotiated Rate	$261.00
Max. Negotiated Rate	$517.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$429.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$517.65
Rate for Payer: Cash Price	$652.50
Rate for Payer: Cash Price	$652.50
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$261.00

Know your out-of-pocket cost for care.

All Charges