Madison Medical Center

All Charges

Charge

Type

Setting

Price

HYDROCORTISONE 10MG TAB

Facility

$14.00

Hospital Charge Code	2698098
Hospital Revenue Code	250
Rate for Payer: Cash Price	$12.60

HYDROCORTISONE 10MG TAB

Facility

$14.00

Hospital Charge Code	2698098
Hospital Revenue Code	250
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$10.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.00
Rate for Payer: Cash Price	$12.60
Rate for Payer: UnitedHealthcare Commercial	$9.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04

HYDROCORTISONE 2.5% CRM 30GM EMP

Facility

$75.00

Service Code	NDC 168008031
Hospital Charge Code	2622619
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

HYDROCORTISONE 2.5% CRM 30GM EMP

Facility

$75.00

Service Code	NDC 168008031
Hospital Charge Code	2622619
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

HYDROCORTISONE 25MG SUPP EMP 12

Facility

$77.00

Service Code	NDC 6.9367E+10
Hospital Charge Code	2625559
Hospital Revenue Code	250
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$54.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$45.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.98
Rate for Payer: Cash Price	$69.30
Rate for Payer: UnitedHealthcare Commercial	$51.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.72

HYDROCORTISONE 25MG SUPP EMP 12

Facility

$77.00

Service Code	NDC 6.9367E+10
Hospital Charge Code	2625559
Hospital Revenue Code	250
Rate for Payer: Cash Price	$69.30

HYDROCORTISONE 25MG SUPP EMP 24

Facility

$77.00

Service Code	NDC 713050324
Hospital Charge Code	2623544
Hospital Revenue Code	250
Min. Negotiated Rate	$27.72
Max. Negotiated Rate	$54.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$45.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.98
Rate for Payer: Cash Price	$69.30
Rate for Payer: UnitedHealthcare Commercial	$51.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.72

HYDROCORTISONE 25MG SUPP EMP 24

Facility

$77.00

Service Code	NDC 713050324
Hospital Charge Code	2623544
Hospital Revenue Code	250
Rate for Payer: Cash Price	$69.30

HYDROCORTISONE 2.5% OINT 1OZ EMP

Facility

$75.00

Service Code	NDC 168014630
Hospital Charge Code	2623182
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

HYDROCORTISONE 2.5% OINT 1OZ EMP

Facility

$75.00

Service Code	NDC 168014630
Hospital Charge Code	2623182
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

HYDROCORTISONE 5MG TAB EMP

Facility

$15.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2624489
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

HYDROCORTISONE 5MG TAB EMP

Facility

$15.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2624489
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

HYDROCORTISONE (CORTAID) 1% CREAM

Facility

$60.00

Service Code	NDC 603053550
Hospital Charge Code	2657165
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

HYDROCORTISONE (CORTAID) 1% CREAM

Facility

$60.00

Service Code	NDC 603053550
Hospital Charge Code	2657165
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

HYDROCORTISONE (HYTONE) 2.5% CRM 30GM

Facility

$75.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2686454
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

HYDROCORTISONE (HYTONE) 2.5% CRM 30GM

Facility

$75.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2686454
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

HYDROCORTIS (SOLU-CORTEF) 100MG/2ML INJ

Facility

$124.00

Service Code	HCPCS J1720
Hospital Charge Code	2655215
Hospital Revenue Code	250
Rate for Payer: Cash Price	$111.60

HYDROCORTIS (SOLU-CORTEF) 100MG/2ML INJ

Facility

$124.00

Service Code	HCPCS J1720
Hospital Charge Code	2655215
Hospital Revenue Code	250
Min. Negotiated Rate	$44.64
Max. Negotiated Rate	$88.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: UnitedHealthcare Commercial	$82.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

HYDROGEL WND DRES (CARRASYN) 85GM

Facility

$161.00

Service Code	NDC 5.3303E+10
Hospital Charge Code	2697634
Hospital Revenue Code	250
Rate for Payer: Cash Price	$144.90

HYDROGEL WND DRES (CARRASYN) 85GM

Facility

$161.00

Service Code	NDC 5.3303E+10
Hospital Charge Code	2697634
Hospital Revenue Code	250
Min. Negotiated Rate	$57.96
Max. Negotiated Rate	$114.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$95.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.95
Rate for Payer: Cash Price	$144.90
Rate for Payer: UnitedHealthcare Commercial	$107.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$57.96

HYDROGEN PEROXIDE 3% SOLN

Facility

$21.00

Service Code	NDC 869470610
Hospital Charge Code	2655225
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

HYDROGEN PEROXIDE 3% SOLN

Facility

$21.00

Service Code	NDC 869470610
Hospital Charge Code	2655225
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

HYDROMORPHONE 0.2MG/ML PCA 30ML C2

Facility

$129.00

Service Code	HCPCS J2271
Hospital Charge Code	2697115
Hospital Revenue Code	250
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

HYDROMORPHONE 0.2MG/ML PCA 30ML C2

Facility

$129.00

Service Code	HCPCS J2271
Hospital Charge Code	2697115
Hospital Revenue Code	250
Rate for Payer: Cash Price	$116.10

HYDROMORPHONE 1MG/ML ORAL SOL 1ML C2

Facility

$18.00

Service Code	NDC 4.2858E+10
Hospital Charge Code	2698083
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

Know your out-of-pocket cost for care.

All Charges