Madison Medical Center

All Charges

Charge

Type

Setting

Price

DRILL BIT 2.0MMX135MM AO DIA SCALED

Facility

$924.00

Hospital Charge Code	123423
Hospital Revenue Code	271
Rate for Payer: Cash Price	$831.60

DRILL BIT 2.6MMX135MM SCALED(STRYKER)

Facility

$931.00

Hospital Charge Code	123400
Hospital Revenue Code	271
Min. Negotiated Rate	$335.16
Max. Negotiated Rate	$664.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$551.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$664.73
Rate for Payer: Cash Price	$837.90
Rate for Payer: UnitedHealthcare Commercial	$620.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$335.16

DRILL BIT 2.6MMX135MM SCALED(STRYKER)

Facility

$931.00

Hospital Charge Code	123400
Hospital Revenue Code	271
Rate for Payer: Cash Price	$837.90

DRONABINOL (MARINOL) 2.5MG CAP

Facility

$44.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2626364
Hospital Revenue Code	250
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

DRONABINOL (MARINOL) 2.5MG CAP

Facility

$44.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2626364
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

DRONABINOL (MARINOL) 2.5MG CAP EMP

Facility

$44.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2624862
Hospital Revenue Code	250
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

DRONABINOL (MARINOL) 2.5MG CAP EMP

Facility

$44.00

Service Code	NDC 1.7478E+10
Hospital Charge Code	2624862
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

DROPERIDOL INJ

Facility

$87.00

Service Code	CPT J1790
Hospital Charge Code	209220
Hospital Revenue Code	370
Rate for Payer: Cash Price	$78.30

DROPERIDOL INJ

Facility

$87.00

Service Code	CPT J1790
Hospital Charge Code	209220
Hospital Revenue Code	370
Min. Negotiated Rate	$31.32
Max. Negotiated Rate	$62.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$51.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.12
Rate for Payer: Cash Price	$78.30
Rate for Payer: UnitedHealthcare Commercial	$58.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.32

Droperidol inj 5mg/2ml Inapsine 2ml amp

Facility

$87.00

Service Code	HCPCS J1790
Hospital Charge Code	260392
Hospital Revenue Code	370
Rate for Payer: Cash Price	$78.30

Droperidol inj 5mg/2ml Inapsine 2ml amp

Facility

$87.00

Service Code	HCPCS J1790
Hospital Charge Code	260392
Hospital Revenue Code	370
Min. Negotiated Rate	$31.32
Max. Negotiated Rate	$62.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$51.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.12
Rate for Payer: Cash Price	$78.30
Rate for Payer: UnitedHealthcare Commercial	$58.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.32

DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$6,878.42

Service Code	APR-DRG 7702
Min. Negotiated Rate	$6,878.42
Max. Negotiated Rate	$6,878.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,878.42
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,878.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,878.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,878.42

DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$29,219.53

Service Code	APR-DRG 7704
Min. Negotiated Rate	$29,219.53
Max. Negotiated Rate	$29,219.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,219.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,219.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,219.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,219.53

DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$12,038.57

Service Code	APR-DRG 7703
Min. Negotiated Rate	$12,038.57
Max. Negotiated Rate	$12,038.57
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,038.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,038.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,038.57
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,038.57

DRUG AND ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE

Facility

$5,287.95

Service Code	APR-DRG 7701
Min. Negotiated Rate	$5,287.95
Max. Negotiated Rate	$5,287.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,287.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,287.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,287.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,287.95

DRUG SCREEN 10 + ETHANOL W/ CONFIRMATION

Facility

$327.00

Service Code	CPT 80307
Hospital Charge Code	2280312
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$233.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$55.93
Rate for Payer: Aetna Medicare Advantage	$62.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$193.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$233.48
Rate for Payer: Cash Price	$294.30
Rate for Payer: Cash Price	$294.30
Rate for Payer: Cash Price	$294.30
Rate for Payer: Cigna Commercial HMO & PPO	$62.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$59.85
Rate for Payer: Home State Health Plan Medicare Advantage	$62.14
Rate for Payer: Humana Commercial	$124.28
Rate for Payer: Humana Medicare Advantage	$62.14
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$117.72

DRUG SCREEN 10 + ETHANOL W/ CONFIRMATION

Facility

$327.00

Service Code	CPT 80307
Hospital Charge Code	2280312
Hospital Revenue Code	301
Rate for Payer: Cash Price	$294.30

DRUG SCREEN 11 (BLOOD) W/ALC

Facility

$567.00

Service Code	CPT 80301
Hospital Charge Code	2280304
Hospital Revenue Code	301
Rate for Payer: Cash Price	$510.30

DRUG SCREEN 11 (BLOOD) W/ALC

Facility

$567.00

Service Code	CPT 80301
Hospital Charge Code	2280304
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$404.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$335.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$404.84
Rate for Payer: Cash Price	$510.30
Rate for Payer: Cash Price	$510.30
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$204.12

DRUG SCREEN 12+OXY(LABCORP 737921)

Facility

$460.00

Service Code	CPT 80307
Hospital Charge Code	2280311
Hospital Revenue Code	301
Rate for Payer: Cash Price	$414.00

DRUG SCREEN 12+OXY(LABCORP 737921)

Facility

$460.00

Service Code	CPT 80307
Hospital Charge Code	2280311
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$328.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$55.93
Rate for Payer: Aetna Medicare Advantage	$62.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$272.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$328.44
Rate for Payer: Cash Price	$414.00
Rate for Payer: Cash Price	$414.00
Rate for Payer: Cash Price	$414.00
Rate for Payer: Cigna Commercial HMO & PPO	$62.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$59.85
Rate for Payer: Home State Health Plan Medicare Advantage	$62.14
Rate for Payer: Humana Commercial	$124.28
Rate for Payer: Humana Medicare Advantage	$62.14
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$165.60

DRUG SCREEN 13, SERUM (LABCORP 700845)

Facility

$444.00

Service Code	CPT 80307
Hospital Charge Code	222845
Hospital Revenue Code	301
Rate for Payer: Cash Price	$399.60

DRUG SCREEN 13, SERUM (LABCORP 700845)

Facility

$444.00

Service Code	CPT 80307
Hospital Charge Code	222845
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$317.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$55.93
Rate for Payer: Aetna Medicare Advantage	$62.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$262.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$317.02
Rate for Payer: Cash Price	$399.60
Rate for Payer: Cash Price	$399.60
Rate for Payer: Cash Price	$399.60
Rate for Payer: Cigna Commercial HMO & PPO	$62.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$59.85
Rate for Payer: Home State Health Plan Medicare Advantage	$62.14
Rate for Payer: Humana Commercial	$124.28
Rate for Payer: Humana Medicare Advantage	$62.14
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$159.84

DRUG SCREEN 7 LAB CORP 725788

Facility

$39.00

Service Code	CPT 80307
Hospital Charge Code	2280305
Hospital Revenue Code	301
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$124.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$55.93
Rate for Payer: Aetna Medicare Advantage	$62.14
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: Cash Price	$35.10
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cigna Commercial HMO & PPO	$62.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$59.85
Rate for Payer: Home State Health Plan Medicare Advantage	$62.14
Rate for Payer: Humana Commercial	$124.28
Rate for Payer: Humana Medicare Advantage	$62.14
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

DRUG SCREEN 7 LAB CORP 725788

Facility

$39.00

Service Code	CPT 80307
Hospital Charge Code	2280305
Hospital Revenue Code	301
Rate for Payer: Cash Price	$35.10

Know your out-of-pocket cost for care.

All Charges