Madison Medical Center

All Charges

Charge

Type

Setting

Price

NAFCILLIN 2GM VIAL

Facility

$250.00

Service Code	NDC 6.3323E+10
Hospital Charge Code	2655775
Hospital Revenue Code	250
Rate for Payer: Cash Price	$225.00

NAFCILLIN 2GM VIAL

Facility

$250.00

Service Code	NDC 6.3323E+10
Hospital Charge Code	2655775
Hospital Revenue Code	250
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$178.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.00

NAIL-BLOOD DRAINAGE

Professional

Both

$208.00

Service Code	CPT 11740
Hospital Charge Code	1811740
Hospital Revenue Code	981
Min. Negotiated Rate	$28.84
Max. Negotiated Rate	$72.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$28.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$43.21
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cigna Commercial HMO & PPO	$28.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$43.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$47.53
Rate for Payer: Home State Health Plan Medicare Advantage	$28.84
Rate for Payer: Optum Medicare Advantage	$72.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$43.21

NALBUPHINE INJ

Facility

$65.00

Service Code	HCPCS J2300
Hospital Charge Code	2058040
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

NALBUPHINE INJ

Facility

$65.00

Service Code	HCPCS J2300
Hospital Charge Code	2058040
Hospital Revenue Code	370
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

NALOXONE (NARCAN) 0.4MG/ML INJ

Facility

$110.00

Service Code	HCPCS J2312
Hospital Charge Code	2655620
Hospital Revenue Code	250
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$78.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: UnitedHealthcare Commercial	$73.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

NALOXONE (NARCAN) 0.4MG/ML INJ

Facility

$110.00

Service Code	HCPCS J2312
Hospital Charge Code	2655620
Hospital Revenue Code	250
Rate for Payer: Cash Price	$99.00

NALOXONE (NARCAN)2MG INJ 2ML PFS

Facility

$178.00

Service Code	HCPCS J2312
Hospital Charge Code	2626432
Hospital Revenue Code	250
Rate for Payer: Cash Price	$160.20

NALOXONE (NARCAN)2MG INJ 2ML PFS

Facility

$178.00

Service Code	HCPCS J2312
Hospital Charge Code	2626432
Hospital Revenue Code	250
Min. Negotiated Rate	$64.08
Max. Negotiated Rate	$127.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: UnitedHealthcare Commercial	$118.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

NALTREXONE 50MG TAB EMP

Facility

$21.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2622231
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

NALTREXONE 50MG TAB EMP

Facility

$21.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2622231
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

NALTREXONE+METABOLITE

Facility

$586.00

Service Code	CPT 80299
Hospital Charge Code	2280292
Hospital Revenue Code	301
Rate for Payer: Cash Price	$527.40

NALTREXONE+METABOLITE

Facility

$586.00

Service Code	CPT 80299
Hospital Charge Code	2280292
Hospital Revenue Code	301
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$418.40
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	$346.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$418.40
Rate for Payer: Cash Price	$527.40
Rate for Payer: Cash Price	$527.40
Rate for Payer: Cash Price	$527.40
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	$210.96

NAPROXEN 500MG TAB EMP

Facility

$15.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2626729
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

NAPROXEN 500MG TAB EMP

Facility

$15.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2626729
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

NAPROXEN DR 500MG TAB EMP

Facility

$14.00

Service Code	NDC 1.8393E+10
Hospital Charge Code	2697554
Hospital Revenue Code	250
Rate for Payer: Cash Price	$12.60

NAPROXEN DR 500MG TAB EMP

Facility

$14.00

Service Code	NDC 1.8393E+10
Hospital Charge Code	2697554
Hospital Revenue Code	250
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$10.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.00
Rate for Payer: Cash Price	$12.60
Rate for Payer: UnitedHealthcare Commercial	$9.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04

NAPROXEN (NAPROSYN) 500MG TAB

Facility

$15.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2655632
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

NAPROXEN (NAPROSYN) 500MG TAB

Facility

$15.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2655632
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

Narcan 0.4mg/ml inj, naloxone

Facility

$112.00

Service Code	HCPCS J2310
Hospital Charge Code	2058034
Hospital Revenue Code	370
Rate for Payer: Cash Price	$100.80

Narcan 0.4mg/ml inj, naloxone

Facility

$112.00

Service Code	HCPCS J2310
Hospital Charge Code	2058034
Hospital Revenue Code	370
Min. Negotiated Rate	$40.32
Max. Negotiated Rate	$79.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: UnitedHealthcare Commercial	$74.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

NASAL BONES X-RAY

Facility

$502.00

Service Code	CPT 70160
Hospital Charge Code	3214105
Hospital Revenue Code	320
Rate for Payer: Cash Price	$451.80

NASAL BONES X-RAY

Facility

$502.00

Service Code	CPT 70160
Hospital Charge Code	3214105
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$358.43
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	$297.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$358.43
Rate for Payer: Cash Price	$451.80
Rate for Payer: Cash Price	$451.80
Rate for Payer: Cash Price	$451.80
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	$180.72

NASAL ENDOSCOPY DIAGNOSTIC UNI AND BI

Facility

$490.00

Service Code	CPT 31231
Hospital Charge Code	9331231
Hospital Revenue Code	521
Min. Negotiated Rate	$161.94
Max. Negotiated Rate	$407.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$179.93
Rate for Payer: Aetna Medicare Advantage	$203.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$290.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$349.86
Rate for Payer: Cash Price	$441.00
Rate for Payer: Cash Price	$441.00
Rate for Payer: Cash Price	$441.00
Rate for Payer: Cash Price	$441.00
Rate for Payer: Cigna Commercial HMO & PPO	$203.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$161.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$192.53
Rate for Payer: Home State Health Plan Medicare Advantage	$203.93
Rate for Payer: Humana Commercial	$407.86
Rate for Payer: Humana Medicare Advantage	$203.93
Rate for Payer: UnitedHealthcare Commercial	$326.83
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$179.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NASAL ENDOSCOPY DIAGNOSTIC UNI AND BI

Facility

$490.00

Service Code	CPT 31231
Hospital Charge Code	9331231
Hospital Revenue Code	521
Rate for Payer: Cash Price	$441.00

Know your out-of-pocket cost for care.

All Charges