Madison Medical Center

All Charges

Charge

Type

Setting

Price

DRUG SCREEN 7 W/ALC

Facility

$35.00

Service Code	CPT 80301
Hospital Charge Code	2280111
Hospital Revenue Code	301
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

DRUG SCREEN 7 W/ALC

Facility

$35.00

Service Code	CPT 80301
Hospital Charge Code	2280111
Hospital Revenue Code	301
Rate for Payer: Cash Price	$31.50

DRUG SCREEN 7 W/ALC BLOOD

Facility

$344.00

Service Code	CPT 80377
Hospital Charge Code	2280303
Hospital Revenue Code	301
Rate for Payer: Cash Price	$309.60

DRUG SCREEN 7 W/ALC BLOOD

Facility

$344.00

Service Code	CPT 80377
Hospital Charge Code	2280303
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$245.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$203.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$245.62
Rate for Payer: Cash Price	$309.60
Rate for Payer: Cash Price	$309.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$123.84

DRUG SCREEN CAP AMERICA

Facility

$33.00

Service Code	CPT 80377
Hospital Charge Code	224258
Hospital Revenue Code	301
Min. Negotiated Rate	$11.88
Max. Negotiated Rate	$23.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$19.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$23.56
Rate for Payer: Cash Price	$29.70
Rate for Payer: Cash Price	$29.70
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.88

DRUG SCREEN CAP AMERICA

Facility

$33.00

Service Code	CPT 80377
Hospital Charge Code	224258
Hospital Revenue Code	301
Rate for Payer: Cash Price	$29.70

DRUG SCREEN, CHAIN OF CUSTODY, DOT

Facility

$73.00

Hospital Charge Code	2214150
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$52.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$43.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$52.12
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cash Price	$65.70
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.28

DRUG SCREEN, CHAIN OF CUSTODY, DOT

Facility

$73.00

Hospital Charge Code	2214150
Hospital Revenue Code	301
Rate for Payer: Cash Price	$65.70

DRUG SCREEN CHAIN OF CUSTODY N-DOT

Facility

$68.00

Service Code	CPT 80377
Hospital Charge Code	224256
Hospital Revenue Code	301
Rate for Payer: Cash Price	$61.20

DRUG SCREEN CHAIN OF CUSTODY N-DOT

Facility

$68.00

Service Code	CPT 80377
Hospital Charge Code	224256
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$48.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$40.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$48.55
Rate for Payer: Cash Price	$61.20
Rate for Payer: Cash Price	$61.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.48

DRUG SCREEN, COLLECTION ONLY

Facility

$34.00

Hospital Charge Code	2219000
Hospital Revenue Code	300
Rate for Payer: Cash Price	$30.60

DRUG SCREEN, COLLECTION ONLY

Facility

$34.00

Hospital Charge Code	2219000
Hospital Revenue Code	300
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$24.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.28
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$30.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.24

DRUG SCREEN, RAPID

Facility

$352.00

Service Code	CPT 80307
Hospital Charge Code	2280100
Hospital Revenue Code	301
Rate for Payer: Cash Price	$316.80

DRUG SCREEN, RAPID

Facility

$352.00

Service Code	CPT 80307
Hospital Charge Code	2280100
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$251.33
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	$208.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$251.33
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
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	$126.72

DRUG SCREEN SERUM (LABCORP 700841)

Facility

$289.00

Service Code	CPT 80307
Hospital Charge Code	2280307
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$206.35
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	$171.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$206.35
Rate for Payer: Cash Price	$260.10
Rate for Payer: Cash Price	$260.10
Rate for Payer: Cash Price	$260.10
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	$104.04

DRUG SCREEN SERUM (LABCORP 700841)

Facility

$289.00

Service Code	CPT 80307
Hospital Charge Code	2280307
Hospital Revenue Code	301
Rate for Payer: Cash Price	$260.10

DRUG SCREEN WB (LABCORP 700886)

Facility

$289.00

Service Code	CPT 80307
Hospital Charge Code	2280309
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$206.35
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	$171.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$206.35
Rate for Payer: Cash Price	$260.10
Rate for Payer: Cash Price	$260.10
Rate for Payer: Cash Price	$260.10
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	$104.04

DRUG SCREEN WB (LABCORP 700886)

Facility

$289.00

Service Code	CPT 80307
Hospital Charge Code	2280309
Hospital Revenue Code	301
Rate for Payer: Cash Price	$260.10

.DRVVT

Facility

$92.00

Service Code	CPT 85613
Hospital Charge Code	22285613
Hospital Revenue Code	305
Rate for Payer: Cash Price	$82.80

.DRVVT

Facility

$92.00

Service Code	CPT 85613
Hospital Charge Code	22285613
Hospital Revenue Code	305
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$65.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.62
Rate for Payer: Aetna Medicare Advantage	$9.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$54.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$65.69
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cigna Commercial HMO & PPO	$9.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.22
Rate for Payer: Home State Health Plan Medicare Advantage	$9.58
Rate for Payer: Humana Commercial	$19.16
Rate for Payer: Humana Medicare Advantage	$9.58
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.12

DTAP <7 YEARS OF AGE

Facility

$25.00

Service Code	HCPCS 90700
Hospital Charge Code	9790700
Hospital Revenue Code	521
Rate for Payer: Cash Price	$22.50

DTAP <7 YEARS OF AGE

Facility

$25.00

Service Code	HCPCS 90700
Hospital Charge Code	9790700
Hospital Revenue Code	521
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: UnitedHealthcare Commercial	$16.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DUAL CUT BLADES (STRICKER)

Facility

$320.00

Hospital Charge Code	127799
Hospital Revenue Code	271
Rate for Payer: Cash Price	$288.00

DUAL CUT BLADES (STRICKER)

Facility

$320.00

Hospital Charge Code	127799
Hospital Revenue Code	271
Min. Negotiated Rate	$115.20
Max. Negotiated Rate	$228.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$189.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$228.48
Rate for Payer: Cash Price	$288.00
Rate for Payer: UnitedHealthcare Commercial	$213.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$115.20

DULOXETINE 30MG CAP EMP

Facility

$55.00

Service Code	NDC 4.3547E+10
Hospital Charge Code	2619086
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

Know your out-of-pocket cost for care.

All Charges