Madison Medical Center

All Charges

Charge

Type

Setting

Price

PREDNISONE (DELTASONE) 10MG TAB UD

Facility

$18.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2655997
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

PREDNISONE (DELTASONE) 20MG TABLET

Facility

$18.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2655998
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PREDNISONE (DELTASONE) 20MG TABLET

Facility

$18.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2655998
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

PREDNISONE (DELTASONE) 5MG TABLET

Facility

$18.00

Service Code	NDC 364021801
Hospital Charge Code	2655996
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

PREDNISONE (DELTASONE) 5MG TABLET

Facility

$18.00

Service Code	NDC 364021801
Hospital Charge Code	2655996
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PREGABALIN 75MG CAP C5 EMP

Facility

$40.00

Service Code	NDC 71101468
Hospital Charge Code	2623217
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

PREGABALIN 75MG CAP C5 EMP

Facility

$40.00

Service Code	NDC 71101468
Hospital Charge Code	2623217
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

PREGABALIN (LYRICA) 100MG CAP C5

Facility

$35.00

Service Code	NDC 71101568
Hospital Charge Code	2626600
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

PREGABALIN (LYRICA) 100MG CAP C5

Facility

$35.00

Service Code	NDC 71101568
Hospital Charge Code	2626600
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

PREGABALIN (LYRICA) 100MG CAP C5 EMP

Facility

$35.00

Service Code	NDC 6.9238E+10
Hospital Charge Code	2624150
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

PREGABALIN (LYRICA) 100MG CAP C5 EMP

Facility

$35.00

Service Code	NDC 6.9238E+10
Hospital Charge Code	2624150
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

PREGABALIN (LYRICA) 150MG CAP C5 EMP

Facility

$35.00

Service Code	NDC 71101668
Hospital Charge Code	2624820
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

PREGABALIN (LYRICA) 150MG CAP C5 EMP

Facility

$35.00

Service Code	NDC 71101668
Hospital Charge Code	2624820
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

PREGABALIN (LYRICA) 200MG CAP C5 EMP

Facility

$35.00

Service Code	NDC 5.8151E+10
Hospital Charge Code	2627295
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

PREGABALIN (LYRICA) 200MG CAP C5 EMP

Facility

$35.00

Service Code	NDC 5.8151E+10
Hospital Charge Code	2627295
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

PREGABALIN (LYRICA) 25MG CAP EMP C5

Facility

$40.00

Service Code	NDC 71101268
Hospital Charge Code	2624018
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

PREGABALIN (LYRICA) 25MG CAP EMP C5

Facility

$40.00

Service Code	NDC 71101268
Hospital Charge Code	2624018
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

PREGABALIN (LYRICA) 50MG CAP EMP C5

Facility

$40.00

Service Code	NDC 71101368
Hospital Charge Code	2623559
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

PREGABALIN (LYRICA) 50MG CAP EMP C5

Facility

$40.00

Service Code	NDC 71101368
Hospital Charge Code	2623559
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

PREGABALIN (LYRICA) 75MG CAP C5

Facility

$40.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2626431
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

PREGABALIN (LYRICA) 75MG CAP C5

Facility

$40.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2626431
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

PREGABALIN (LYRICA) 75MG CAP EMP C5

Facility

$40.00

Service Code	NDC 904700061
Hospital Charge Code	2623518
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

PREGABALIN (LYRICA) 75MG CAP EMP C5

Facility

$40.00

Service Code	NDC 904700061
Hospital Charge Code	2623518
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

PREGABALIN, SERUM

Facility

$205.00

Service Code	CPT 80299
Hospital Charge Code	2280289
Hospital Revenue Code	301
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$146.37
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.78
Rate for Payer: Aetna Medicare Advantage	$18.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$18.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.95
Rate for Payer: Home State Health Plan Medicare Advantage	$18.64
Rate for Payer: Humana Commercial	$37.28
Rate for Payer: Humana Medicare Advantage	$18.64
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$73.80

PREGABALIN, SERUM

Facility

$205.00

Service Code	CPT 80299
Hospital Charge Code	2280289
Hospital Revenue Code	301
Rate for Payer: Cash Price	$184.50

Know your out-of-pocket cost for care.

All Charges