Madison Medical Center

All Charges

Charge

Type

Setting

Price

SOLU-MEDROL 40 MG

Facility

$24.00

Service Code	HCPCS J2919
Hospital Charge Code	4402920
Hospital Revenue Code	636
Min. Negotiated Rate	$16.01
Max. Negotiated Rate	$16.01
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01

SOLU-MEDROL 40 MG

Facility

$24.00

Service Code	HCPCS J2919
Hospital Charge Code	4402920
Hospital Revenue Code	636
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

SOLUMEDROL 40MG

Facility

$50.00

Service Code	CPT J2919
Hospital Charge Code	4102902
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

SOLUMEDROL 40MG

Facility

$50.00

Service Code	CPT J2919
Hospital Charge Code	4102902
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 UP TO 125MG

Facility

$88.00

Service Code	HCPCS J2919
Hospital Charge Code	4202930
Hospital Revenue Code	636
Min. Negotiated Rate	$58.70
Max. Negotiated Rate	$58.70
Rate for Payer: Cash Price	$79.20
Rate for Payer: UnitedHealthcare Commercial	$58.70

SOLU-MEDROL UP TO 125MG

Facility

$88.00

Service Code	HCPCS J2919
Hospital Charge Code	4202930
Hospital Revenue Code	636
Min. Negotiated Rate	$31.68
Max. Negotiated Rate	$62.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.83
Rate for Payer: Cash Price	$79.20
Rate for Payer: UnitedHealthcare Commercial	$58.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.68

SOLU MEDROL UP TO 40MG

Facility

$47.00

Service Code	CPT J2919
Hospital Charge Code	3902920
Hospital Revenue Code	636
Min. Negotiated Rate	$16.92
Max. Negotiated Rate	$33.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$27.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$33.56
Rate for Payer: Cash Price	$42.30
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.92

SOLU MEDROL UP TO 40MG

Facility

$47.00

Service Code	CPT J2919
Hospital Charge Code	3902920
Hospital Revenue Code	636
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$31.35
Rate for Payer: Cash Price	$42.30
Rate for Payer: UnitedHealthcare Commercial	$31.35

SOLU-MEDROL UP TO 40 MG

Facility

$47.00

Service Code	HCPCS J2919
Hospital Charge Code	4202920
Hospital Revenue Code	636
Min. Negotiated Rate	$16.92
Max. Negotiated Rate	$33.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$27.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$33.56
Rate for Payer: Cash Price	$42.30
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.92

SOLU-MEDROL UP TO 40 MG

Facility

$47.00

Service Code	HCPCS J2919
Hospital Charge Code	4202920
Hospital Revenue Code	636
Min. Negotiated Rate	$31.35
Max. Negotiated Rate	$31.35
Rate for Payer: Cash Price	$42.30
Rate for Payer: UnitedHealthcare Commercial	$31.35

SOMATOSTATIN

Facility

$694.00

Service Code	CPT 84307
Hospital Charge Code	2284307
Hospital Revenue Code	301
Min. Negotiated Rate	$16.45
Max. Negotiated Rate	$495.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.45
Rate for Payer: Aetna Medicare Advantage	$18.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$410.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$495.52
Rate for Payer: Cash Price	$624.60
Rate for Payer: Cash Price	$624.60
Rate for Payer: Cash Price	$624.60
Rate for Payer: Cigna Commercial HMO & PPO	$18.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.60
Rate for Payer: Home State Health Plan Medicare Advantage	$18.28
Rate for Payer: Humana Commercial	$36.56
Rate for Payer: Humana Medicare Advantage	$18.28
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$249.84

SOMATOSTATIN

Facility

$694.00

Service Code	CPT 84307
Hospital Charge Code	2284307
Hospital Revenue Code	301
Rate for Payer: Cash Price	$624.60

SORBITOL 70% 30ML SOL

Facility

$20.00

Service Code	NDC 4.6287E+10
Hospital Charge Code	2619247
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

SORBITOL 70% 30ML SOL

Facility

$20.00

Service Code	NDC 4.6287E+10
Hospital Charge Code	2619247
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

SOTALOL 120MG TAB EMP

Facility

$55.00

Service Code	NDC 93106001
Hospital Charge Code	2622126
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

SOTALOL 120MG TAB EMP

Facility

$55.00

Service Code	NDC 93106001
Hospital Charge Code	2622126
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

SOTALOL (BETAPACE) 80MG TAB

Facility

$21.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2697302
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

SOTALOL (BETAPACE) 80MG TAB

Facility

$21.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2697302
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

SOTALOL (BETAPACE) 80MG TAB EMP

Facility

$55.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2697298
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

SOTALOL (BETAPACE) 80MG TAB EMP

Facility

$55.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2697298
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

SPEC. HANDLING/LAB

Facility

$11.00

Service Code	CPT 99000
Hospital Charge Code	4299000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$9.90

SPEC. HANDLING/LAB

Facility

$11.00

Service Code	CPT 99000
Hospital Charge Code	4299000
Hospital Revenue Code	521
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.85
Rate for Payer: Cash Price	$9.90
Rate for Payer: Cash Price	$9.90
Rate for Payer: UnitedHealthcare Commercial	$7.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SPEC. HANDLING/LAB

Facility

$11.00

Service Code	CPT 99000
Hospital Charge Code	5299000
Hospital Revenue Code	521
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.85
Rate for Payer: Cash Price	$9.90
Rate for Payer: Cash Price	$9.90
Rate for Payer: UnitedHealthcare Commercial	$7.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SPEC. HANDLING/LAB

Facility

$11.00

Service Code	CPT 99000
Hospital Charge Code	5299000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$9.90

SPECIAL HANDLING-PHY.

Facility

$29.00

Service Code	CPT 88302
Hospital Charge Code	4188302
Hospital Revenue Code	521
Min. Negotiated Rate	$17.17
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.67
Rate for Payer: Aetna Medicare Advantage	$38.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$20.71
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cash Price	$26.10
Rate for Payer: Cigna Commercial HMO & PPO	$38.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36.03
Rate for Payer: Home State Health Plan Medicare Advantage	$38.16
Rate for Payer: Humana Commercial	$76.32
Rate for Payer: Humana Medicare Advantage	$38.16
Rate for Payer: UnitedHealthcare Commercial	$19.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges