Madison Medical Center

All Charges

Charge

Type

Setting

Price

SILVASORB WOUND GEL 1.5 OZ

Facility

$92.00

Hospital Charge Code	28021402
Hospital Revenue Code	271
Rate for Payer: Cash Price	$82.80

SILVASORB WOUND GEL 1.5 OZ

Facility

$92.00

Hospital Charge Code	28021402
Hospital Revenue Code	271
Min. Negotiated Rate	$33.12
Max. Negotiated Rate	$65.69
Rate for Payer: Cash Price	$82.80
Rate for Payer: UnitedHealthcare Commercial	$61.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$54.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$65.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.12

SILVER NITRATE APPLICATOR STICK/SWAB 1

Facility

$18.00

Service Code	NDC 1.287E+10
Hospital Charge Code	2656177
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

SILVER NITRATE APPLICATOR STICK/SWAB 1

Facility

$18.00

Service Code	NDC 1.287E+10
Hospital Charge Code	2656177
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

SILVER NITRATE SWAB STICK 10 SWABS

Facility

$182.00

Service Code	NDC 1.287E+10
Hospital Charge Code	2623084
Hospital Revenue Code	250
Rate for Payer: Cash Price	$163.80

SILVER NITRATE SWAB STICK 10 SWABS

Facility

$182.00

Service Code	NDC 1.287E+10
Hospital Charge Code	2623084
Hospital Revenue Code	250
Min. Negotiated Rate	$65.52
Max. Negotiated Rate	$129.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$107.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$129.95
Rate for Payer: Cash Price	$163.80
Rate for Payer: UnitedHealthcare Commercial	$121.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.52

SILVER SERUM

Facility

$373.00

Service Code	CPT 83018
Hospital Charge Code	2283018
Hospital Revenue Code	301
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$266.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.76
Rate for Payer: Aetna Medicare Advantage	$21.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$220.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$266.32
Rate for Payer: Cash Price	$335.70
Rate for Payer: Cash Price	$335.70
Rate for Payer: Cash Price	$335.70
Rate for Payer: Cigna Commercial HMO & PPO	$21.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21.14
Rate for Payer: Home State Health Plan Medicare Advantage	$21.96
Rate for Payer: Humana Commercial	$43.92
Rate for Payer: Humana Medicare Advantage	$21.96
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$134.28

SILVER SERUM

Facility

$373.00

Service Code	CPT 83018
Hospital Charge Code	2283018
Hospital Revenue Code	301
Rate for Payer: Cash Price	$335.70

SILVER SULFAD 1% CRM 25GM EMP

Facility

$80.00

Service Code	NDC 6.157E+10
Hospital Charge Code	2624856
Hospital Revenue Code	250
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$57.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: UnitedHealthcare Commercial	$53.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.80

SILVER SULFAD 1% CRM 25GM EMP

Facility

$80.00

Service Code	NDC 6.157E+10
Hospital Charge Code	2624856
Hospital Revenue Code	250
Rate for Payer: Cash Price	$72.00

SILVER SULFAD 1% CRM 400GM EMP

Facility

$80.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2626085
Hospital Revenue Code	250
Rate for Payer: Cash Price	$72.00

SILVER SULFAD 1% CRM 400GM EMP

Facility

$80.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2626085
Hospital Revenue Code	250
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$57.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: UnitedHealthcare Commercial	$53.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.80

SILVER SULFAD (SILVADENE) 1% CRM 25GM

Facility

$41.00

Service Code	NDC 591081083
Hospital Charge Code	260645
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$29.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.27
Rate for Payer: Cash Price	$36.90
Rate for Payer: UnitedHealthcare Commercial	$27.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.76

SILVER SULFAD (SILVADENE) 1% CRM 25GM

Facility

$80.00

Service Code	NDC 6.7877E+10
Hospital Charge Code	2697272
Hospital Revenue Code	250
Rate for Payer: Cash Price	$72.00

SILVER SULFAD (SILVADENE) 1% CRM 25GM

Facility

$41.00

Service Code	NDC 591081083
Hospital Charge Code	260645
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.90

SILVER SULFAD (SILVADENE) 1% CRM 25GM

Facility

$80.00

Service Code	NDC 6.7877E+10
Hospital Charge Code	2697272
Hospital Revenue Code	250
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$57.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: UnitedHealthcare Commercial	$53.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.80

SILVER SULFA (SILVADENE) 1% CRM 50GM EMP

Facility

$80.00

Service Code	NDC 6.157E+10
Hospital Charge Code	2622536
Hospital Revenue Code	250
Rate for Payer: Cash Price	$72.00

SILVER SULFA (SILVADENE) 1% CRM 50GM EMP

Facility

$80.00

Service Code	NDC 6.157E+10
Hospital Charge Code	2622536
Hospital Revenue Code	250
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$57.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: UnitedHealthcare Commercial	$53.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.80

SILV SULFA 1% CRM 20G

Facility

$76.00

Service Code	NDC 6.157E+10
Hospital Charge Code	2697271
Hospital Revenue Code	250
Min. Negotiated Rate	$27.36
Max. Negotiated Rate	$54.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.26
Rate for Payer: Cash Price	$68.40
Rate for Payer: UnitedHealthcare Commercial	$50.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.36

SILV SULFA 1% CRM 20G

Facility

$76.00

Service Code	NDC 6.157E+10
Hospital Charge Code	2697271
Hospital Revenue Code	250
Rate for Payer: Cash Price	$68.40

SILV SULFAD (SILVADENE) 1% CRM 20G

Facility

$39.00

Service Code	NDC 6.7877E+10
Hospital Charge Code	260649
Hospital Revenue Code	250
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

SILV SULFAD (SILVADENE) 1% CRM 20G

Facility

$39.00

Service Code	NDC 6.7877E+10
Hospital Charge Code	260649
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

SIMETHICONE 125MG/TAB (4 TAB PAK)

Facility

$18.00

Service Code	NDC 6.9618E+10
Hospital Charge Code	2656180
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

SIMETHICONE 125MG/TAB (4 TAB PAK)

Facility

$18.00

Service Code	NDC 6.9618E+10
Hospital Charge Code	2656180
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

SIMETHICONE DROPS 30ML (20MG/0.3ML) SUSP

Facility

$91.00

Service Code	NDC 4.6287E+10
Hospital Charge Code	2656185
Hospital Revenue Code	250
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$64.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: UnitedHealthcare Commercial	$60.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

Know your out-of-pocket cost for care.

All Charges