Madison Medical Center

All Charges

Charge

Type

Setting

Price

FLUOTHANE

Facility

$70.00

Hospital Charge Code	206013
Hospital Revenue Code	370
Rate for Payer: Cash Price	$63.00

FLUOTHANE

Facility

$70.00

Hospital Charge Code	206013
Hospital Revenue Code	370
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

FLUOXETINE

Facility

$126.00

Service Code	CPT 80332
Hospital Charge Code	2282490
Hospital Revenue Code	301
Rate for Payer: Cash Price	$113.40

FLUOXETINE

Facility

$126.00

Service Code	CPT 80332
Hospital Charge Code	2282490
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$89.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$113.40
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

FLUOXETINE 10MG CAP

Facility

$44.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2622106
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

FLUOXETINE 10MG CAP

Facility

$44.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2622106
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

FLUOXETINE 10MG CAP EMP

Facility

$44.00

Service Code	NDC 781282301
Hospital Charge Code	2620055
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

FLUOXETINE 10MG CAP EMP

Facility

$44.00

Service Code	NDC 781282301
Hospital Charge Code	2620055
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

FLUOXETINE (PROZAC) 10MG TAB

Facility

$44.00

Service Code	NDC 5.0111E+10
Hospital Charge Code	2626329
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

FLUOXETINE (PROZAC) 10MG TAB

Facility

$44.00

Service Code	NDC 5.0111E+10
Hospital Charge Code	2626329
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

FLUOXETINE (PROZAC) 20MG CAP

Facility

$45.00

Service Code	NDC 904578561
Hospital Charge Code	2655037
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

FLUOXETINE (PROZAC) 20MG CAP

Facility

$45.00

Service Code	NDC 904578561
Hospital Charge Code	2655037
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

FLUOXETINE (PROZAC) 20MG CAP EMP

Facility

$20.00

Service Code	NDC 6.2332E+10
Hospital Charge Code	2697212
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

FLUOXETINE (PROZAC) 20MG CAP EMP

Facility

$20.00

Service Code	NDC 6.2332E+10
Hospital Charge Code	2697212
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

FLUOXETINE (PROZAC) 20MG TAB EMP

Facility

$38.00

Service Code	NDC 5.0111E+10
Hospital Charge Code	2625132
Hospital Revenue Code	250
Rate for Payer: Cash Price	$34.20

FLUOXETINE (PROZAC) 20MG TAB EMP

Facility

$38.00

Service Code	NDC 5.0111E+10
Hospital Charge Code	2625132
Hospital Revenue Code	250
Min. Negotiated Rate	$13.68
Max. Negotiated Rate	$27.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$22.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.13
Rate for Payer: Cash Price	$34.20
Rate for Payer: UnitedHealthcare Commercial	$25.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.68

FLUOXETINE (PROZAC) 40MG CAP EMP

Facility

$20.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2622868
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

FLUOXETINE (PROZAC) 40MG CAP EMP

Facility

$20.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2622868
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

FLUTICASONE 0.05% TOP CRM 30 GM EMP

Facility

$67.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2624116
Hospital Revenue Code	250
Rate for Payer: Cash Price	$60.30

FLUTICASONE 0.05% TOP CRM 30 GM EMP

Facility

$67.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2624116
Hospital Revenue Code	250
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

FLUTICASONE (FLONASE) NAS SPRAY 16GM

Facility

$282.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2626325
Hospital Revenue Code	250
Rate for Payer: Cash Price	$253.80

FLUTICASONE (FLONASE) NAS SPRAY 16GM

Facility

$282.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2626325
Hospital Revenue Code	250
Min. Negotiated Rate	$101.52
Max. Negotiated Rate	$201.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$166.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$201.35
Rate for Payer: Cash Price	$253.80
Rate for Payer: UnitedHealthcare Commercial	$188.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$101.52

FLUTICASONE (FLONASE) NAS SPRAY 16GM EMP

Facility

$282.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2621911
Hospital Revenue Code	250
Min. Negotiated Rate	$101.52
Max. Negotiated Rate	$201.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$166.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$201.35
Rate for Payer: Cash Price	$253.80
Rate for Payer: UnitedHealthcare Commercial	$188.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$101.52

FLUTICASONE (FLONASE) NAS SPRAY 16GM EMP

Facility

$282.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2621911
Hospital Revenue Code	250
Rate for Payer: Cash Price	$253.80

FLUTICASONE (FLOVENT) 44MCG IHNALER

Facility

$504.00

Service Code	NDC 173071820
Hospital Charge Code	2626378
Hospital Revenue Code	250
Min. Negotiated Rate	$181.44
Max. Negotiated Rate	$359.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$298.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$359.86
Rate for Payer: Cash Price	$453.60
Rate for Payer: UnitedHealthcare Commercial	$336.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$181.44

Know your out-of-pocket cost for care.

All Charges