Madison Medical Center

All Charges

Charge

Type

Setting

Price

NYSTATIN 100 M-U/GM OINT 30GM EMP

Facility

$71.00

Service Code	NDC 472016630
Hospital Charge Code	2622764
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.90

NYSTATIN 100 M-U/GM OINT 30GM EMP

Facility

$71.00

Service Code	NDC 472016630
Hospital Charge Code	2622764
Hospital Revenue Code	250
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$50.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: UnitedHealthcare Commercial	$47.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

NYSTATIN 100MU/ML 5ML SUSP UD

Facility

$20.00

Service Code	NDC 6.8094E+10
Hospital Charge Code	2626465
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

NYSTATIN 100MU/ML 5ML SUSP UD

Facility

$20.00

Service Code	NDC 6.8094E+10
Hospital Charge Code	2626465
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: UnitedHealthcare Commercial	$13.34
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 Medicare Advantage	$7.20

NYSTATIN SUSP (473ML) EMP

Facility

$105.00

Service Code	NDC 6.6689E+10
Hospital Charge Code	2620051
Hospital Revenue Code	250
Rate for Payer: Cash Price	$94.50

NYSTATIN SUSP (473ML) EMP

Facility

$105.00

Service Code	NDC 6.6689E+10
Hospital Charge Code	2620051
Hospital Revenue Code	250
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$74.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: UnitedHealthcare Commercial	$70.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.80

NYSTATIN SUSP 60ML BOTTLE

Facility

$73.00

Service Code	NDC 6.6689E+10
Hospital Charge Code	2655745
Hospital Revenue Code	250
Min. Negotiated Rate	$26.28
Max. Negotiated Rate	$52.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$43.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$52.12
Rate for Payer: Cash Price	$65.70
Rate for Payer: UnitedHealthcare Commercial	$48.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.28

NYSTATIN SUSP 60ML BOTTLE

Facility

$73.00

Service Code	NDC 6.6689E+10
Hospital Charge Code	2655745
Hospital Revenue Code	250
Rate for Payer: Cash Price	$65.70

NYSTATIN SUSP EMP

Facility

$73.00

Service Code	NDC 472132002
Hospital Charge Code	2620050
Hospital Revenue Code	250
Min. Negotiated Rate	$26.28
Max. Negotiated Rate	$52.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$43.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$52.12
Rate for Payer: Cash Price	$65.70
Rate for Payer: UnitedHealthcare Commercial	$48.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.28

NYSTATIN SUSP EMP

Facility

$73.00

Service Code	NDC 472132002
Hospital Charge Code	2620050
Hospital Revenue Code	250
Rate for Payer: Cash Price	$65.70

NYSTATIN TOP POWDER 15GM

Facility

$134.00

Service Code	NDC 6.8308E+10
Hospital Charge Code	2626372
Hospital Revenue Code	250
Min. Negotiated Rate	$48.24
Max. Negotiated Rate	$95.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$95.68
Rate for Payer: Cash Price	$120.60
Rate for Payer: UnitedHealthcare Commercial	$89.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$48.24

NYSTATIN TOP POWDER 15GM

Facility

$134.00

Service Code	NDC 6.8308E+10
Hospital Charge Code	2626372
Hospital Revenue Code	250
Rate for Payer: Cash Price	$120.60

NYSTATIN TOP POWDER 15GM EMP

Facility

$134.00

Service Code	NDC 832046515
Hospital Charge Code	2623425
Hospital Revenue Code	250
Rate for Payer: Cash Price	$120.60

NYSTATIN TOP POWDER 15GM EMP

Facility

$134.00

Service Code	NDC 832046515
Hospital Charge Code	2623425
Hospital Revenue Code	250
Min. Negotiated Rate	$48.24
Max. Negotiated Rate	$95.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$95.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.33
Rate for Payer: Cash Price	$120.60
Rate for Payer: UnitedHealthcare Commercial	$89.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$48.24

NYSTATIN TOP POWDER 30GM

Facility

$134.00

Service Code	NDC 6.9315E+10
Hospital Charge Code	2625716
Hospital Revenue Code	250
Rate for Payer: Cash Price	$120.60

NYSTATIN TOP POWDER 30GM

Facility

$134.00

Service Code	NDC 6.9315E+10
Hospital Charge Code	2625716
Hospital Revenue Code	250
Min. Negotiated Rate	$48.24
Max. Negotiated Rate	$95.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$95.68
Rate for Payer: Cash Price	$120.60
Rate for Payer: UnitedHealthcare Commercial	$89.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$48.24

NYSTATIN TOP POWDER 30GM EMP

Facility

$134.00

Service Code	NDC 6.9315E+10
Hospital Charge Code	2626067
Hospital Revenue Code	250
Min. Negotiated Rate	$48.24
Max. Negotiated Rate	$95.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$95.68
Rate for Payer: Cash Price	$120.60
Rate for Payer: UnitedHealthcare Commercial	$89.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$48.24

NYSTATIN TOP POWDER 30GM EMP

Facility

$134.00

Service Code	NDC 6.9315E+10
Hospital Charge Code	2626067
Hospital Revenue Code	250
Rate for Payer: Cash Price	$120.60

NYSTATIN TOP POWDER 60GM EMP

Facility

$134.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2624502
Hospital Revenue Code	250
Min. Negotiated Rate	$48.24
Max. Negotiated Rate	$95.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$95.68
Rate for Payer: Cash Price	$120.60
Rate for Payer: UnitedHealthcare Commercial	$89.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$48.24

NYSTATIN TOP POWDER 60GM EMP

Facility

$134.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2624502
Hospital Revenue Code	250
Rate for Payer: Cash Price	$120.60

NYSTATIN/TRIAMCINOLONE CRM 60GM

Facility

$670.00

Service Code	NDC 168008130
Hospital Charge Code	2656440
Hospital Revenue Code	250
Min. Negotiated Rate	$241.20
Max. Negotiated Rate	$478.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$396.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$478.38
Rate for Payer: Cash Price	$603.00
Rate for Payer: UnitedHealthcare Commercial	$446.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$241.20

NYSTATIN/TRIAMCINOLONE CRM 60GM

Facility

$670.00

Service Code	NDC 168008130
Hospital Charge Code	2656440
Hospital Revenue Code	250
Rate for Payer: Cash Price	$603.00

NYSTAT/TRIAMCIN (MYCOLOG) 15GM CRM

Facility

$339.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2626493
Hospital Revenue Code	250
Rate for Payer: Cash Price	$305.10

NYSTAT/TRIAMCIN (MYCOLOG) 15GM CRM

Facility

$339.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2626493
Hospital Revenue Code	250
Min. Negotiated Rate	$122.04
Max. Negotiated Rate	$242.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$200.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$242.05
Rate for Payer: Cash Price	$305.10
Rate for Payer: UnitedHealthcare Commercial	$226.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$122.04

NYSTAT/TRIAM(MYCOLOG) 30GM CRM

Facility

$479.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2697083
Hospital Revenue Code	250
Rate for Payer: Cash Price	$431.10

Know your out-of-pocket cost for care.

All Charges