Madison Medical Center

All Charges

Charge

Type

Setting

Price

VALSARTAN/HCTZ 160/12.5MG TAB HE

Facility

$35.00

Service Code	NDC 378632277
Hospital Charge Code	2625580
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

VANCOMYCIN + NS : 1.5GM + 500ML

Facility

$1,331.00

Service Code	NDC 1E+11
Hospital Charge Code	2623826
Hospital Revenue Code	250
Rate for Payer: Cash Price	$1,197.90

VANCOMYCIN + NS : 1.5GM + 500ML

Facility

$1,331.00

Service Code	NDC 1E+11
Hospital Charge Code	2623826
Hospital Revenue Code	250
Min. Negotiated Rate	$479.16
Max. Negotiated Rate	$950.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$787.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$950.33
Rate for Payer: Cash Price	$1,197.90
Rate for Payer: UnitedHealthcare Commercial	$887.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$479.16

VANCOMYCIN ORAL SOL 25MG/ML 150ML BOTTLE

Facility

$552.00

Service Code	NDC 6.5628E+10
Hospital Charge Code	2622677
Hospital Revenue Code	250
Rate for Payer: Cash Price	$496.80

VANCOMYCIN ORAL SOL 25MG/ML 150ML BOTTLE

Facility

$552.00

Service Code	NDC 6.5628E+10
Hospital Charge Code	2622677
Hospital Revenue Code	250
Min. Negotiated Rate	$198.72
Max. Negotiated Rate	$394.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$326.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$394.13
Rate for Payer: Cash Price	$496.80
Rate for Payer: UnitedHealthcare Commercial	$368.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$198.72

VANCOMYCIN ORAL SOL 25MG/ML 300ML BOTTLE

Facility

$553.00

Service Code	NDC 6.5628E+10
Hospital Charge Code	2625502
Hospital Revenue Code	250
Rate for Payer: Cash Price	$497.70

VANCOMYCIN ORAL SOL 25MG/ML 300ML BOTTLE

Facility

$553.00

Service Code	NDC 6.5628E+10
Hospital Charge Code	2625502
Hospital Revenue Code	250
Min. Negotiated Rate	$199.08
Max. Negotiated Rate	$394.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$327.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$394.84
Rate for Payer: Cash Price	$497.70
Rate for Payer: UnitedHealthcare Commercial	$368.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$199.08

VANCOMYCIN PEAK

Facility

$124.00

Service Code	CPT 80202
Hospital Charge Code	2222292
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$88.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.19
Rate for Payer: Aetna Medicare Advantage	$13.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial HMO & PPO	$13.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.19
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.04
Rate for Payer: Home State Health Plan Medicare Advantage	$13.54
Rate for Payer: Humana Commercial	$27.08
Rate for Payer: Humana Medicare Advantage	$13.54
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

VANCOMYCIN PEAK

Facility

$124.00

Service Code	CPT 80202
Hospital Charge Code	2222292
Hospital Revenue Code	301
Rate for Payer: Cash Price	$111.60

VANCOMYCIN RANDOM

Facility

$124.00

Service Code	CPT 80202
Hospital Charge Code	2222290
Hospital Revenue Code	301
Rate for Payer: Cash Price	$111.60

VANCOMYCIN RANDOM

Facility

$124.00

Service Code	CPT 80202
Hospital Charge Code	2222290
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$88.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.19
Rate for Payer: Aetna Medicare Advantage	$13.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial HMO & PPO	$13.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.19
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.04
Rate for Payer: Home State Health Plan Medicare Advantage	$13.54
Rate for Payer: Humana Commercial	$27.08
Rate for Payer: Humana Medicare Advantage	$13.54
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

VANCOMYCIN / SWFI 125MG/2.5ML ORAL SOL

Facility

$107.00

Service Code	NDC 6.7457E+10
Hospital Charge Code	2626513
Hospital Revenue Code	250
Min. Negotiated Rate	$38.52
Max. Negotiated Rate	$76.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: UnitedHealthcare Commercial	$71.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

VANCOMYCIN / SWFI 125MG/2.5ML ORAL SOL

Facility

$107.00

Service Code	NDC 6.7457E+10
Hospital Charge Code	2626513
Hospital Revenue Code	250
Rate for Payer: Cash Price	$96.30

VANCOMYCIN / SWFI 250MG/5ML ORAL SOL

Facility

$107.00

Service Code	NDC 409488724
Hospital Charge Code	2697174
Hospital Revenue Code	250
Min. Negotiated Rate	$38.52
Max. Negotiated Rate	$76.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: UnitedHealthcare Commercial	$71.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

VANCOMYCIN / SWFI 250MG/5ML ORAL SOL

Facility

$107.00

Service Code	NDC 409488724
Hospital Charge Code	2697174
Hospital Revenue Code	250
Rate for Payer: Cash Price	$96.30

VANCOMYCIN / SWFI 500MG/10ML ORAL SOL

Facility

$107.00

Service Code	NDC 6.7457E+10
Hospital Charge Code	2697175
Hospital Revenue Code	250
Min. Negotiated Rate	$38.52
Max. Negotiated Rate	$76.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: UnitedHealthcare Commercial	$71.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

VANCOMYCIN / SWFI 500MG/10ML ORAL SOL

Facility

$107.00

Service Code	NDC 6.7457E+10
Hospital Charge Code	2697175
Hospital Revenue Code	250
Rate for Payer: Cash Price	$96.30

VANCOMYCIN TROUGH

Facility

$124.00

Service Code	CPT 80202
Hospital Charge Code	2222291
Hospital Revenue Code	301
Rate for Payer: Cash Price	$111.60

VANCOMYCIN TROUGH

Facility

$124.00

Service Code	CPT 80202
Hospital Charge Code	2222291
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$88.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.19
Rate for Payer: Aetna Medicare Advantage	$13.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial HMO & PPO	$13.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.19
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.04
Rate for Payer: Home State Health Plan Medicare Advantage	$13.54
Rate for Payer: Humana Commercial	$27.08
Rate for Payer: Humana Medicare Advantage	$13.54
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

VANCOMYCIN (VANCOCIN) 1GM INJ

Facility

$706.00

Service Code	NDC 6.7457E+10
Hospital Charge Code	2656519
Hospital Revenue Code	250
Min. Negotiated Rate	$254.16
Max. Negotiated Rate	$504.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$417.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$504.08
Rate for Payer: Cash Price	$635.40
Rate for Payer: UnitedHealthcare Commercial	$470.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$254.16

VANCOMYCIN (VANCOCIN) 1GM INJ

Facility

$706.00

Service Code	NDC 6.7457E+10
Hospital Charge Code	2656519
Hospital Revenue Code	250
Rate for Payer: Cash Price	$635.40

VANCOMYCIN (VANCOCIN) 500MG IVPB

Facility

$271.00

Service Code	HCPCS J3370
Hospital Charge Code	2622292
Hospital Revenue Code	250
Rate for Payer: Cash Price	$243.90

VANCOMYCIN (VANCOCIN) 500MG IVPB

Facility

$271.00

Service Code	HCPCS J3370
Hospital Charge Code	2622292
Hospital Revenue Code	250
Min. Negotiated Rate	$97.56
Max. Negotiated Rate	$193.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$160.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$193.49
Rate for Payer: Cash Price	$243.90
Rate for Payer: UnitedHealthcare Commercial	$180.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.56

VARICELLA ZOSTER IGG

Facility

$111.00

Service Code	CPT 86787
Hospital Charge Code	2286787
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.90

VARICELLA ZOSTER IGG

Facility

$111.00

Service Code	CPT 86787
Hospital Charge Code	2286787
Hospital Revenue Code	301
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$79.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.59
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.25
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cigna Commercial HMO & PPO	$12.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.40
Rate for Payer: Home State Health Plan Medicare Advantage	$12.88
Rate for Payer: Humana Commercial	$25.76
Rate for Payer: Humana Medicare Advantage	$12.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.96

Know your out-of-pocket cost for care.

All Charges