Madison Medical Center

All Charges

Charge

Type

Setting

Price

SOLIFENACIN (VESICARE) 10MG TAB EMP

Facility

$51.00

Service Code	NDC 5.0228E+10
Hospital Charge Code	2623900
Hospital Revenue Code	250
Rate for Payer: Cash Price	$45.90

SOLIFENACIN (VESICARE) 5MG TAB

Facility

$51.00

Service Code	NDC 5.0228E+10
Hospital Charge Code	2626357
Hospital Revenue Code	250
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$36.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$36.41
Rate for Payer: Cash Price	$45.90
Rate for Payer: UnitedHealthcare Commercial	$34.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.36

SOLIFENACIN (VESICARE) 5MG TAB

Facility

$51.00

Service Code	NDC 5.0228E+10
Hospital Charge Code	2626357
Hospital Revenue Code	250
Rate for Payer: Cash Price	$45.90

SOLIFENACIN (VESICARE) 5MG TAB EMP

Facility

$51.00

Service Code	NDC 5.0228E+10
Hospital Charge Code	2622694
Hospital Revenue Code	250
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$36.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$36.41
Rate for Payer: Cash Price	$45.90
Rate for Payer: UnitedHealthcare Commercial	$34.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.36

SOLIFENACIN (VESICARE) 5MG TAB EMP

Facility

$51.00

Service Code	NDC 5.0228E+10
Hospital Charge Code	2622694
Hospital Revenue Code	250
Rate for Payer: Cash Price	$45.90

SOLIQUA 100/33 INS PEN 15ML EMP

Facility

$60.00

Service Code	NDC 24576105
Hospital Charge Code	2624504
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

SOLIQUA 100/33 INS PEN 15ML EMP

Facility

$60.00

Service Code	NDC 24576105
Hospital Charge Code	2624504
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

SOLO PLUS GUIDEWIRE

Facility

$171.00

Hospital Charge Code	1299001
Hospital Revenue Code	272
Rate for Payer: Cash Price	$153.90

SOLO PLUS GUIDEWIRE

Facility

$171.00

Hospital Charge Code	1299001
Hospital Revenue Code	272
Min. Negotiated Rate	$61.56
Max. Negotiated Rate	$122.09
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: UnitedHealthcare Commercial	$114.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.56

SOLOSITE WOUND GEL 3OZ/85GM

Facility

$71.00

Service Code	NDC 4.0565E+10
Hospital Charge Code	2620701
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.90

SOLOSITE WOUND GEL 3OZ/85GM

Facility

$71.00

Service Code	NDC 4.0565E+10
Hospital Charge Code	2620701
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

SOLUABLE LIVER ANTIGEN

Facility

$272.00

Service Code	CPT 83516
Hospital Charge Code	2207441
Hospital Revenue Code	301
Rate for Payer: Cash Price	$244.80

SOLUABLE LIVER ANTIGEN

Facility

$272.00

Service Code	CPT 83516
Hospital Charge Code	2207441
Hospital Revenue Code	301
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$194.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$161.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$194.21
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.92

SOLUBLE TRANSFERRIN RECEPTOR

Facility

$489.00

Service Code	CPT 84238
Hospital Charge Code	2284238
Hospital Revenue Code	301
Rate for Payer: Cash Price	$440.10

SOLUBLE TRANSFERRIN RECEPTOR

Facility

$489.00

Service Code	CPT 84238
Hospital Charge Code	2284238
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$349.15
Rate for Payer: Aetna Better Health Medicaid/QHP	$32.91
Rate for Payer: Aetna Medicare Advantage	$36.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$289.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$349.15
Rate for Payer: Cash Price	$440.10
Rate for Payer: Cash Price	$440.10
Rate for Payer: Cash Price	$440.10
Rate for Payer: Cigna Commercial HMO & PPO	$36.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$32.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$35.21
Rate for Payer: Home State Health Plan Medicare Advantage	$36.57
Rate for Payer: Humana Commercial	$73.14
Rate for Payer: Humana Medicare Advantage	$36.57
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$32.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$176.04

SOLU MEDROL 40MG

Facility

$50.00

Service Code	HCPCS J2919
Hospital Charge Code	5202902
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$35.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

SOLU MEDROL 40MG

Facility

$50.00

Service Code	HCPCS J2919
Hospital Charge Code	5202902
Hospital Revenue Code	636
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$33.35
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35

SOLU MEDROL 40MG

Facility

$50.00

Service Code	HCPCS J2919
Hospital Charge Code	9702902
Hospital Revenue Code	636
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$33.35
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35

SOLU MEDROL 40MG

Facility

$50.00

Service Code	HCPCS J2919
Hospital Charge Code	9702902
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$35.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

SOLU MEDROL 40 MG

Facility

$50.00

Hospital Charge Code	9102902
Hospital Revenue Code	521
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SOLU MEDROL 40 MG

Facility

$50.00

Service Code	HCPCS J2919
Hospital Charge Code	9602902
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$35.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

SOLU MEDROL 40 MG

Facility

$50.00

Service Code	HCPCS J2919
Hospital Charge Code	9602902
Hospital Revenue Code	636
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$33.35
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35

SOLU MEDROL 40 MG

Facility

$50.00

Service Code	HCPCS J2919
Hospital Charge Code	4202902
Hospital Revenue Code	636
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$33.35
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35

SOLU MEDROL 40 MG

Facility

$50.00

Hospital Charge Code	9102902
Hospital Revenue Code	521
Rate for Payer: Cash Price	$45.00

SOLU MEDROL 40 MG

Facility

$50.00

Service Code	HCPCS J2919
Hospital Charge Code	4202902
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$35.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

Know your out-of-pocket cost for care.

All Charges