Madison Medical Center

All Charges

Charge

Type

Setting

Price

ZOLPIDEM (AMBIEN) 5MG TAB UD C4

Facility

$43.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2656559
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

ZONISAMIDE

Facility

$272.00

Service Code	CPT 80299
Hospital Charge Code	2280297
Hospital Revenue Code	301
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$194.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.78
Rate for Payer: Aetna Medicare Advantage	$18.64
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	$18.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.95
Rate for Payer: Home State Health Plan Medicare Advantage	$18.64
Rate for Payer: Humana Commercial	$37.28
Rate for Payer: Humana Medicare Advantage	$18.64
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.92

ZONISAMIDE

Facility

$272.00

Service Code	CPT 80299
Hospital Charge Code	2280297
Hospital Revenue Code	301
Rate for Payer: Cash Price	$244.80

ZONISAMIDE 100MG CAP EMP

Facility

$13.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2625546
Hospital Revenue Code	250
Rate for Payer: Cash Price	$11.70

ZONISAMIDE 100MG CAP EMP

Facility

$13.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2625546
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

ZORVOLEX 35MG CAP EMP

Facility

$13.00

Service Code	NDC 1.3913E+10
Hospital Charge Code	2624495
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

ZORVOLEX 35MG CAP EMP

Facility

$13.00

Service Code	NDC 1.3913E+10
Hospital Charge Code	2624495
Hospital Revenue Code	250
Rate for Payer: Cash Price	$11.70

ZOSTAVAX

Facility

$200.00

Service Code	CPT 90736
Hospital Charge Code	4490736
Hospital Revenue Code	636
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$142.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$118.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.80
Rate for Payer: Cash Price	$180.00
Rate for Payer: UnitedHealthcare Commercial	$133.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$72.00

ZOSTAVAX

Facility

$200.00

Service Code	CPT 90736
Hospital Charge Code	4490736
Hospital Revenue Code	636
Min. Negotiated Rate	$133.40
Max. Negotiated Rate	$133.40
Rate for Payer: Cash Price	$180.00
Rate for Payer: UnitedHealthcare Commercial	$133.40

ZOSTER VACCINE LIVE 0.65ML INJ W/DILUENT

Facility

$449.00

Service Code	HCPCS 90732
Hospital Charge Code	2618971
Hospital Revenue Code	250
Min. Negotiated Rate	$161.64
Max. Negotiated Rate	$320.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$265.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$320.59
Rate for Payer: Cash Price	$404.10
Rate for Payer: UnitedHealthcare Commercial	$299.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$161.64

ZOSTER VACCINE LIVE 0.65ML INJ W/DILUENT

Facility

$449.00

Service Code	HCPCS 90732
Hospital Charge Code	2618971
Hospital Revenue Code	250
Rate for Payer: Cash Price	$404.10

ZOSTER VACC RECOM, ADJ (SHINGRIX) IM

Facility

$857.00

Service Code	NDC 5.816E+10
Hospital Charge Code	2621334
Hospital Revenue Code	250
Min. Negotiated Rate	$308.52
Max. Negotiated Rate	$611.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$507.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$611.90
Rate for Payer: Cash Price	$771.30
Rate for Payer: UnitedHealthcare Commercial	$571.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$308.52

ZOSTER VACC RECOM, ADJ (SHINGRIX) IM

Facility

$857.00

Service Code	NDC 5.816E+10
Hospital Charge Code	2621334
Hospital Revenue Code	250
Rate for Payer: Cash Price	$771.30

ZOSTERVAX

Facility

$200.00

Service Code	CPT 90736
Hospital Charge Code	9290736
Hospital Revenue Code	636
Min. Negotiated Rate	$133.40
Max. Negotiated Rate	$133.40
Rate for Payer: Cash Price	$180.00
Rate for Payer: UnitedHealthcare Commercial	$133.40

ZOSTERVAX

Facility

$200.00

Service Code	CPT 90736
Hospital Charge Code	9290736
Hospital Revenue Code	636
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$142.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$118.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.80
Rate for Payer: Cash Price	$180.00
Rate for Payer: UnitedHealthcare Commercial	$133.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$72.00

ZOSYN + NS : 3.375GM + 100ML MINIBAG

Facility

$392.00

Service Code	NDC 1E+11
Hospital Charge Code	2623822
Hospital Revenue Code	250
Rate for Payer: Cash Price	$352.80

ZOSYN + NS : 3.375GM + 100ML MINIBAG

Facility

$392.00

Service Code	NDC 1E+11
Hospital Charge Code	2623822
Hospital Revenue Code	250
Min. Negotiated Rate	$141.12
Max. Negotiated Rate	$279.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$232.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$279.89
Rate for Payer: Cash Price	$352.80
Rate for Payer: UnitedHealthcare Commercial	$261.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$141.12

ZOSYN + NS : 3.375GM + 50ML MINIBAG

Facility

$392.00

Service Code	NDC 1E+11
Hospital Charge Code	2626624
Hospital Revenue Code	250
Rate for Payer: Cash Price	$352.80

ZOSYN + NS : 3.375GM + 50ML MINIBAG

Facility

$392.00

Service Code	NDC 1E+11
Hospital Charge Code	2626624
Hospital Revenue Code	250
Min. Negotiated Rate	$141.12
Max. Negotiated Rate	$279.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$232.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$279.89
Rate for Payer: Cash Price	$352.80
Rate for Payer: UnitedHealthcare Commercial	$261.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$141.12

ZYGOMAS

Facility

$238.00

Service Code	CPT 70150
Hospital Charge Code	3226108
Hospital Revenue Code	320
Min. Negotiated Rate	$85.68
Max. Negotiated Rate	$213.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$140.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$169.93
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.68

ZYGOMAS

Facility

$238.00

Service Code	CPT 70150
Hospital Charge Code	3226108
Hospital Revenue Code	320
Rate for Payer: Cash Price	$214.20

ZYRTEC D ER 5MG/120 MG TAB EMP #24

Facility

$43.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2623595
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

ZYRTEC D ER 5MG/120 MG TAB EMP #24

Facility

$43.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2623595
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

Know your out-of-pocket cost for care.

All Charges