Madison Medical Center

All Charges

Charge

Type

Setting

Price

AVULSION OF NAIL COMPLETE SINGLE

Professional

Both

$384.00

Service Code	CPT 11730
Hospital Charge Code	1811730
Hospital Revenue Code	981
Min. Negotiated Rate	$47.04
Max. Negotiated Rate	$134.40
Rate for Payer: Aetna Commercial/Medicare Advantage	$47.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$87.34
Rate for Payer: Cash Price	$345.60
Rate for Payer: Cash Price	$345.60
Rate for Payer: Cigna Commercial HMO & PPO	$47.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$87.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$96.07
Rate for Payer: Home State Health Plan Medicare Advantage	$47.04
Rate for Payer: Optum Medicare Advantage	$134.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$87.34

AVULSION OF NAIL PLATE

Facility

$200.00

Service Code	CPT 11730
Hospital Charge Code	9311730
Hospital Revenue Code	521
Rate for Payer: Cash Price	$180.00

AVULSION OF NAIL PLATE

Facility

$200.00

Service Code	CPT 11730
Hospital Charge Code	9311730
Hospital Revenue Code	521
Min. Negotiated Rate	$118.40
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$118.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.80
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$133.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

AVULSION OF NAIL PLATE PARTIAL OR COMPLE

Facility

$250.00

Service Code	CPT 11730
Hospital Charge Code	5411730
Hospital Revenue Code	521
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

AVULSION OF NAIL PLATE PARTIAL OR COMPLE

Facility

$250.00

Service Code	CPT 11730
Hospital Charge Code	5411730
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

AZATHIOPRINE 50MG TAB EMP

Facility

$18.00

Service Code	NDC 378100501
Hospital Charge Code	2621906
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

AZATHIOPRINE 50MG TAB EMP

Facility

$18.00

Service Code	NDC 378100501
Hospital Charge Code	2621906
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

AZELASTINE NA SP 137MCG 30ML EMP

Facility

$255.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2622257
Hospital Revenue Code	250
Rate for Payer: Cash Price	$229.50

AZELASTINE NA SP 137MCG 30ML EMP

Facility

$255.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2622257
Hospital Revenue Code	250
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$182.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.07
Rate for Payer: Cash Price	$229.50
Rate for Payer: UnitedHealthcare Commercial	$170.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$91.80

AZITHRMYCN + NS: 500 MG + 250 ML IVPB

Facility

$551.00

Service Code	NDC 1E+11
Hospital Charge Code	2623913
Hospital Revenue Code	250
Min. Negotiated Rate	$198.36
Max. Negotiated Rate	$393.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$326.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$393.41
Rate for Payer: Cash Price	$495.90
Rate for Payer: UnitedHealthcare Commercial	$367.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$198.36

AZITHRMYCN + NS: 500 MG + 250 ML IVPB

Facility

$551.00

Service Code	NDC 1E+11
Hospital Charge Code	2623913
Hospital Revenue Code	250
Rate for Payer: Cash Price	$495.90

AZITHROMYCIN 100MG/5ML SUSP 15ML

Facility

$199.00

Service Code	NDC 93202723
Hospital Charge Code	2659191
Hospital Revenue Code	250
Rate for Payer: Cash Price	$179.10

AZITHROMYCIN 100MG/5ML SUSP 15ML

Facility

$199.00

Service Code	NDC 93202723
Hospital Charge Code	2659191
Hospital Revenue Code	250
Min. Negotiated Rate	$71.64
Max. Negotiated Rate	$142.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.09
Rate for Payer: Cash Price	$179.10
Rate for Payer: UnitedHealthcare Commercial	$132.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$71.64

AZITHROMYCIN 250MG TAB EMP

Facility

$113.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2622439
Hospital Revenue Code	250
Rate for Payer: Cash Price	$101.70

AZITHROMYCIN 250MG TAB EMP

Facility

$113.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2622439
Hospital Revenue Code	250
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$80.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: UnitedHealthcare Commercial	$75.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

AZITHROMYCIN 500MG TAB EMP

Facility

$113.00

Service Code	NDC 5.0111E+10
Hospital Charge Code	2623360
Hospital Revenue Code	250
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$80.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: UnitedHealthcare Commercial	$75.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

AZITHROMYCIN 500MG TAB EMP

Facility

$113.00

Service Code	NDC 5.0111E+10
Hospital Charge Code	2623360
Hospital Revenue Code	250
Rate for Payer: Cash Price	$101.70

AZITHROMYCIN OP SOL 1% 2.5ML EMP

Facility

$439.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2622287
Hospital Revenue Code	250
Min. Negotiated Rate	$158.04
Max. Negotiated Rate	$313.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$259.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$313.45
Rate for Payer: Cash Price	$395.10
Rate for Payer: UnitedHealthcare Commercial	$292.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$158.04

AZITHROMYCIN OP SOL 1% 2.5ML EMP

Facility

$439.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2622287
Hospital Revenue Code	250
Rate for Payer: Cash Price	$395.10

AZITHROMYCIN (ZITHROMAX) 250MG TAB

Facility

$113.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2659149
Hospital Revenue Code	250
Rate for Payer: Cash Price	$101.70

AZITHROMYCIN (ZITHROMAX) 250MG TAB

Facility

$113.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2659149
Hospital Revenue Code	250
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$80.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: UnitedHealthcare Commercial	$75.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

AZITHROMYCIN (ZITHROMAX) 500MG VIAL

Facility

$312.00

Service Code	HCPCS J0456
Hospital Charge Code	2626267
Hospital Revenue Code	250
Rate for Payer: Cash Price	$280.80

AZITHROMYCIN (ZITHROMAX) 500MG VIAL

Facility

$312.00

Service Code	HCPCS J0456
Hospital Charge Code	2626267
Hospital Revenue Code	250
Min. Negotiated Rate	$112.32
Max. Negotiated Rate	$222.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$184.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$222.77
Rate for Payer: Cash Price	$280.80
Rate for Payer: UnitedHealthcare Commercial	$208.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$112.32

AZITHROMYCIN (Z-PAK) 250MG TAB EMP

Facility

$42.00

Service Code	NDC 781149668
Hospital Charge Code	2697282
Hospital Revenue Code	250
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

AZITHROMYCIN (Z-PAK) 250MG TAB EMP

Facility

$42.00

Service Code	NDC 781149668
Hospital Charge Code	2697282
Hospital Revenue Code	250
Rate for Payer: Cash Price	$37.80

Know your out-of-pocket cost for care.

All Charges