Madison Medical Center

All Charges

Charge

Type

Setting

Price

HYDROMORPHONE 1MG/ML ORAL SOL 1ML C2

Facility

$18.00

Service Code	NDC 4.2858E+10
Hospital Charge Code	2698083
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

HYDROMORPHONE 2MG ORAL SOL 2ML C2

Facility

$35.00

Service Code	NDC 4.2858E+10
Hospital Charge Code	2618989
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

HYDROMORPHONE 2MG ORAL SOL 2ML C2

Facility

$35.00

Service Code	NDC 4.2858E+10
Hospital Charge Code	2618989
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

HYDROMORPHONE 4MG TAB C2

Facility

$20.00

Service Code	NDC 4.2858E+10
Hospital Charge Code	2698103
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

HYDROMORPHONE 4MG TAB C2

Facility

$20.00

Service Code	NDC 4.2858E+10
Hospital Charge Code	2698103
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

HYDROMORPHONE (DILAUDID) 2MG/ML INJ C2

Facility

$96.00

Service Code	HCPCS J1171
Hospital Charge Code	2626458
Hospital Revenue Code	250
Rate for Payer: Cash Price	$86.40

HYDROMORPHONE (DILAUDID) 2MG/ML INJ C2

Facility

$96.00

Service Code	HCPCS J1171
Hospital Charge Code	2626458
Hospital Revenue Code	250
Min. Negotiated Rate	$34.56
Max. Negotiated Rate	$68.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$68.54
Rate for Payer: Cash Price	$86.40
Rate for Payer: UnitedHealthcare Commercial	$64.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.56

HYDROMORPHONE (DILAUDID) 4MG/ML INJ C2

Facility

$102.00

Service Code	HCPCS J1170
Hospital Charge Code	2626573
Hospital Revenue Code	250
Rate for Payer: Cash Price	$91.80

HYDROMORPHONE (DILAUDID) 4MG/ML INJ C2

Facility

$102.00

Service Code	HCPCS J1170
Hospital Charge Code	2626573
Hospital Revenue Code	250
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$72.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$60.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.83
Rate for Payer: Cash Price	$91.80
Rate for Payer: UnitedHealthcare Commercial	$68.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.72

HYDROMORPHONE INJ

Facility

$65.00

Service Code	HCPCS J1170
Hospital Charge Code	2058056
Hospital Revenue Code	370
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

HYDROMORPHONE INJ

Facility

$65.00

Service Code	HCPCS J1170
Hospital Charge Code	2058056
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

HYDROXYCHLOROQUINE 200MG TAB EMP

Facility

$48.00

Service Code	NDC 93240101
Hospital Charge Code	2622131
Hospital Revenue Code	250
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

HYDROXYCHLOROQUINE 200MG TAB EMP

Facility

$48.00

Service Code	NDC 93240101
Hospital Charge Code	2622131
Hospital Revenue Code	250
Rate for Payer: Cash Price	$43.20

HYDROXYPROLINE

Facility

$247.00

Service Code	CPT 83500
Hospital Charge Code	2283505
Hospital Revenue Code	301
Min. Negotiated Rate	$20.39
Max. Negotiated Rate	$176.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$20.39
Rate for Payer: Aetna Medicare Advantage	$22.65
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: Cash Price	$222.30
Rate for Payer: Cash Price	$222.30
Rate for Payer: Cigna Commercial HMO & PPO	$22.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21.82
Rate for Payer: Home State Health Plan Medicare Advantage	$22.65
Rate for Payer: Humana Commercial	$45.30
Rate for Payer: Humana Medicare Advantage	$22.65
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$88.92

HYDROXYPROLINE

Facility

$247.00

Service Code	CPT 83500
Hospital Charge Code	2283505
Hospital Revenue Code	301
Rate for Payer: Cash Price	$222.30

HYDROXYZINE 10MG ORAL SYRUP 5ML

Facility

$20.00

Service Code	NDC 6.0432E+10
Hospital Charge Code	2655244
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

HYDROXYZINE 10MG ORAL SYRUP 5ML

Facility

$20.00

Service Code	NDC 6.0432E+10
Hospital Charge Code	2655244
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

HYDROXYZINE 10MG ORAL SYRUP 5ML EMP

Facility

$20.00

Service Code	NDC 5.4838E+10
Hospital Charge Code	2624655
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

HYDROXYZINE 10MG ORAL SYRUP 5ML EMP

Facility

$20.00

Service Code	NDC 5.4838E+10
Hospital Charge Code	2624655
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

HYDROXYZINE 25MG/ML INJ 1ML

Facility

$112.00

Service Code	HCPCS J3410
Hospital Charge Code	2698210
Hospital Revenue Code	250
Rate for Payer: Cash Price	$100.80

HYDROXYZINE 25MG/ML INJ 1ML

Facility

$112.00

Service Code	HCPCS J3410
Hospital Charge Code	2698210
Hospital Revenue Code	250
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$79.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: UnitedHealthcare Commercial	$74.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

HYDROXYZINE (ATARAX) HCL 10MG TAB

Facility

$19.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2655234
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

HYDROXYZINE (ATARAX) HCL 10MG TAB

Facility

$19.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2655234
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

HYDROXYZINE (ATARAX) HCL 10MG TAB EMP

Facility

$20.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2620537
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

HYDROXYZINE (ATARAX) HCL 10MG TAB EMP

Facility

$20.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2620537
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

Know your out-of-pocket cost for care.

All Charges