Madison Medical Center

All Charges

Charge

Type

Setting

Price

HALOPERIDOL 1MG TAB (HALDOL)

Facility

$15.00

Service Code	NDC 781139213
Hospital Charge Code	2697334
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

HALOPERIDOL (HALDOL)

Facility

$147.00

Service Code	CPT 80173
Hospital Charge Code	2280173
Hospital Revenue Code	301
Min. Negotiated Rate	$14.20
Max. Negotiated Rate	$104.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.20
Rate for Payer: Aetna Medicare Advantage	$15.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$87.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$104.96
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cigna Commercial HMO & PPO	$15.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.19
Rate for Payer: Home State Health Plan Medicare Advantage	$15.78
Rate for Payer: Humana Commercial	$31.56
Rate for Payer: Humana Medicare Advantage	$15.78
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$52.92

HALOPERIDOL (HALDOL)

Facility

$147.00

Service Code	CPT 80173
Hospital Charge Code	2280173
Hospital Revenue Code	301
Rate for Payer: Cash Price	$132.30

HALOPERIDOL (HALDOL) 0.5MG TAB

Facility

$9.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2655125
Hospital Revenue Code	250
Rate for Payer: Cash Price	$8.10

HALOPERIDOL (HALDOL) 0.5MG TAB

Facility

$9.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2655125
Hospital Revenue Code	250
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$6.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$6.43
Rate for Payer: Cash Price	$8.10
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.24

HALOPERIDOL (HALDOL) 5MG IR INJ 1ML

Facility

$79.00

Service Code	HCPCS J1630
Hospital Charge Code	2655140
Hospital Revenue Code	250
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$56.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$46.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$56.41
Rate for Payer: Cash Price	$71.10
Rate for Payer: UnitedHealthcare Commercial	$52.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.44

HALOPERIDOL (HALDOL) 5MG IR INJ 1ML

Facility

$79.00

Service Code	HCPCS J1630
Hospital Charge Code	2655140
Hospital Revenue Code	250
Rate for Payer: Cash Price	$71.10

HALOPERIDOL (HALDOL) 5MG TAB

Facility

$18.00

Service Code	NDC 904678261
Hospital Charge Code	2622267
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

HALOPERIDOL (HALDOL) 5MG TAB

Facility

$18.00

Service Code	NDC 904678261
Hospital Charge Code	2622267
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

HALOPERIDOL (HALDOL) 5MG TAB EMP

Facility

$18.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2622745
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

HALOPERIDOL (HALDOL) 5MG TAB EMP

Facility

$18.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2622745
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

HAND AND WRIST PROCEDURES

Facility

$34,479.94

Service Code	APR-DRG 3164
Min. Negotiated Rate	$34,479.94
Max. Negotiated Rate	$34,479.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$34,479.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$34,479.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$34,479.94
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$34,479.94

HAND AND WRIST PROCEDURES

Facility

$22,059.95

Service Code	APR-DRG 3163
Min. Negotiated Rate	$22,059.95
Max. Negotiated Rate	$22,059.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,059.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,059.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,059.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,059.95

HAND AND WRIST PROCEDURES

Facility

$9,301.59

Service Code	APR-DRG 3162
Min. Negotiated Rate	$9,301.59
Max. Negotiated Rate	$9,301.59
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,301.59
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,301.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,301.59
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,301.59

HAND AND WRIST PROCEDURES

Facility

$7,300.93

Service Code	APR-DRG 3161
Min. Negotiated Rate	$7,300.93
Max. Negotiated Rate	$7,300.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,300.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,300.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,300.93
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,300.93

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC

Facility

$28,293.04

Service Code	MSDRG 513
Min. Negotiated Rate	$14,146.52
Max. Negotiated Rate	$28,293.04
Rate for Payer: Aetna Medicare Advantage	$14,146.52
Rate for Payer: Cigna Commercial HMO & PPO	$14,146.52
Rate for Payer: Home State Health Plan Medicare Advantage	$14,146.52
Rate for Payer: Humana Commercial	$28,293.04
Rate for Payer: Humana Medicare Advantage	$14,146.52

HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$19,642.88

Service Code	MSDRG 514
Min. Negotiated Rate	$9,821.44
Max. Negotiated Rate	$19,642.88
Rate for Payer: Aetna Medicare Advantage	$9,821.44
Rate for Payer: Cigna Commercial HMO & PPO	$9,821.44
Rate for Payer: Home State Health Plan Medicare Advantage	$9,821.44
Rate for Payer: Humana Commercial	$19,642.88
Rate for Payer: Humana Medicare Advantage	$9,821.44

HAND PROCEDURES FOR INJURIES

Facility

$34,437.00

Service Code	MSDRG 906
Min. Negotiated Rate	$17,218.50
Max. Negotiated Rate	$34,437.00
Rate for Payer: Aetna Medicare Advantage	$17,218.50
Rate for Payer: Cigna Commercial HMO & PPO	$17,218.50
Rate for Payer: Home State Health Plan Medicare Advantage	$17,218.50
Rate for Payer: Humana Commercial	$34,437.00
Rate for Payer: Humana Medicare Advantage	$17,218.50

HAND XRAY LT

Facility

$465.00

Service Code	CPT 73130
Hospital Charge Code	328131
Hospital Revenue Code	320
Rate for Payer: Cash Price	$418.50

HAND XRAY LT

Facility

$465.00

Service Code	CPT 73130
Hospital Charge Code	328131
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$332.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$275.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.01
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$167.40

HAND XRAY RT

Facility

$465.00

Service Code	CPT 73130
Hospital Charge Code	328130
Hospital Revenue Code	320
Rate for Payer: Cash Price	$418.50

HAND XRAY RT

Facility

$465.00

Service Code	CPT 73130
Hospital Charge Code	328130
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$332.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$275.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.01
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cash Price	$418.50
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$167.40

.HANTAVIRUS IGG

Facility

$166.00

Service Code	CPT 86790
Hospital Charge Code	2286791
Hospital Revenue Code	302
Rate for Payer: Cash Price	$149.40

.HANTAVIRUS IGG

Facility

$166.00

Service Code	CPT 86790
Hospital Charge Code	2286791
Hospital Revenue Code	302
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$118.52
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	$98.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$118.52
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cash Price	$149.40
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	$59.76

.HANTAVIRUS IGM

Facility

$317.00

Service Code	CPT 86790
Hospital Charge Code	2286790
Hospital Revenue Code	302
Rate for Payer: Cash Price	$285.30

Know your out-of-pocket cost for care.

All Charges