Madison Medical Center

All Charges

Charge

Type

Setting

Price

AZITHROMYC(ZITHRO)200MG/5MLSUSP15ML

Facility

$208.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2659193
Hospital Revenue Code	250
Rate for Payer: Cash Price	$187.20

AZITHROMYC(ZITHRO)200MG/5MLSUSP15ML

Facility

$208.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2659193
Hospital Revenue Code	250
Min. Negotiated Rate	$74.88
Max. Negotiated Rate	$148.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$123.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$148.51
Rate for Payer: Cash Price	$187.20
Rate for Payer: UnitedHealthcare Commercial	$138.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$74.88

AZOR 10/40MG TAB EMP

Facility

$36.00

Service Code	NDC 6.5597E+10
Hospital Charge Code	2623189
Hospital Revenue Code	250
Rate for Payer: Cash Price	$32.40

AZOR 10/40MG TAB EMP

Facility

$36.00

Service Code	NDC 6.5597E+10
Hospital Charge Code	2623189
Hospital Revenue Code	250
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$25.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$25.70
Rate for Payer: Cash Price	$32.40
Rate for Payer: UnitedHealthcare Commercial	$24.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.96

AZTREONAM (AZACTAM) 1GM IVPB

Facility

$1,443.00

Service Code	HCPCS J0696
Hospital Charge Code	2620695
Hospital Revenue Code	250
Rate for Payer: Cash Price	$1,298.70

AZTREONAM (AZACTAM) 1GM IVPB

Facility

$1,443.00

Service Code	HCPCS J0696
Hospital Charge Code	2620695
Hospital Revenue Code	250
Min. Negotiated Rate	$519.48
Max. Negotiated Rate	$1,030.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$854.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,030.30
Rate for Payer: Cash Price	$1,298.70
Rate for Payer: UnitedHealthcare Commercial	$962.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$519.48

AZTREONAM (AZACTAM) 2GM IVPB

Facility

$494.00

Service Code	HCPCS J0696
Hospital Charge Code	2626477
Hospital Revenue Code	250
Min. Negotiated Rate	$177.84
Max. Negotiated Rate	$352.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$292.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$352.72
Rate for Payer: Cash Price	$444.60
Rate for Payer: UnitedHealthcare Commercial	$329.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$177.84

AZTREONAM (AZACTAM) 2GM IVPB

Facility

$494.00

Service Code	HCPCS J0696
Hospital Charge Code	2626477
Hospital Revenue Code	250
Rate for Payer: Cash Price	$444.60

.BABESIA MICROTI IGG

Facility

$171.00

Service Code	CPT 86753
Hospital Charge Code	228600
Hospital Revenue Code	302
Min. Negotiated Rate	$11.15
Max. Negotiated Rate	$122.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.15
Rate for Payer: Aetna Medicare Advantage	$12.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$101.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$122.09
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cigna Commercial HMO & PPO	$12.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.93
Rate for Payer: Home State Health Plan Medicare Advantage	$12.39
Rate for Payer: Humana Commercial	$24.78
Rate for Payer: Humana Medicare Advantage	$12.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.56

.BABESIA MICROTI IGG

Facility

$171.00

Service Code	CPT 86753
Hospital Charge Code	228600
Hospital Revenue Code	302
Rate for Payer: Cash Price	$153.90

.BABESIA MICROTI IGM

Facility

$163.00

Service Code	CPT 86753
Hospital Charge Code	2286042
Hospital Revenue Code	302
Rate for Payer: Cash Price	$146.70

.BABESIA MICROTI IGM

Facility

$163.00

Service Code	CPT 86753
Hospital Charge Code	2286042
Hospital Revenue Code	302
Min. Negotiated Rate	$11.15
Max. Negotiated Rate	$116.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.15
Rate for Payer: Aetna Medicare Advantage	$12.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$96.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$116.38
Rate for Payer: Cash Price	$146.70
Rate for Payer: Cash Price	$146.70
Rate for Payer: Cash Price	$146.70
Rate for Payer: Cigna Commercial HMO & PPO	$12.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.93
Rate for Payer: Home State Health Plan Medicare Advantage	$12.39
Rate for Payer: Humana Commercial	$24.78
Rate for Payer: Humana Medicare Advantage	$12.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$58.68

BABY WIPES

Facility

$39.00

Hospital Charge Code	282018
Hospital Revenue Code	271
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

BABY WIPES

Facility

$39.00

Hospital Charge Code	282018
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

BACITRACIN 50MU INJ

Facility

$83.00

Service Code	NDC 8290305200
Hospital Charge Code	2620611
Hospital Revenue Code	250
Rate for Payer: Cash Price	$74.70

BACITRACIN 50MU INJ

Facility

$83.00

Service Code	NDC 8290305200
Hospital Charge Code	2620611
Hospital Revenue Code	250
Min. Negotiated Rate	$29.88
Max. Negotiated Rate	$59.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$49.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$59.26
Rate for Payer: Cash Price	$74.70
Rate for Payer: UnitedHealthcare Commercial	$55.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.88

BACITRACIN ZINC 500UN/GM OINT 14GM

Facility

$43.00

Service Code	NDC 168001135
Hospital Charge Code	2697604
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

BACITRACIN ZINC 500UN/GM OINT 14GM

Facility

$43.00

Service Code	NDC 168001135
Hospital Charge Code	2697604
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

BACITRACIN ZINC 500UN/GM OINT 15GM

Facility

$21.00

Service Code	NDC 168001135
Hospital Charge Code	260658
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

BACITRACIN ZINC 500UN/GM OINT 15GM

Facility

$21.00

Service Code	NDC 168001135
Hospital Charge Code	260658
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

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC

Facility

$35,002.56

Service Code	MSDRG 519
Min. Negotiated Rate	$17,501.28
Max. Negotiated Rate	$35,002.56
Rate for Payer: Aetna Medicare Advantage	$17,501.28
Rate for Payer: Cigna Commercial HMO & PPO	$17,501.28
Rate for Payer: Home State Health Plan Medicare Advantage	$17,501.28
Rate for Payer: Humana Commercial	$35,002.56
Rate for Payer: Humana Medicare Advantage	$17,501.28

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR

Facility

$62,468.92

Service Code	MSDRG 518
Min. Negotiated Rate	$31,234.46
Max. Negotiated Rate	$62,468.92
Rate for Payer: Aetna Medicare Advantage	$31,234.46
Rate for Payer: Cigna Commercial HMO & PPO	$31,234.46
Rate for Payer: Home State Health Plan Medicare Advantage	$31,234.46
Rate for Payer: Humana Commercial	$62,468.92
Rate for Payer: Humana Medicare Advantage	$31,234.46

BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC

Facility

$27,028.52

Service Code	MSDRG 520
Min. Negotiated Rate	$13,514.26
Max. Negotiated Rate	$27,028.52
Rate for Payer: Aetna Medicare Advantage	$13,514.26
Rate for Payer: Cigna Commercial HMO & PPO	$13,514.26
Rate for Payer: Home State Health Plan Medicare Advantage	$13,514.26
Rate for Payer: Humana Commercial	$27,028.52
Rate for Payer: Humana Medicare Advantage	$13,514.26

BACLOFEN 10MG TAB EMP

Facility

$20.00

Service Code	NDC 603240621
Hospital Charge Code	2621826
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

BACLOFEN 10MG TAB EMP

Facility

$20.00

Service Code	NDC 603240621
Hospital Charge Code	2621826
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