Madison Medical Center

All Charges

Charge

Type

Setting

Price

OPIATES CONF URINE

Facility

$179.00

Service Code	CPT 80307
Hospital Charge Code	2280308
Hospital Revenue Code	301
Rate for Payer: Cash Price	$161.10

OPIATES CONF URINE

Facility

$179.00

Service Code	CPT 80307
Hospital Charge Code	2280308
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$127.81
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	$105.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.81
Rate for Payer: Cash Price	$161.10
Rate for Payer: Cash Price	$161.10
Rate for Payer: Cash Price	$161.10
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	$64.44

OPIATES (LABCORP MEDWATCH)

Facility

$161.00

Service Code	CPT 80361
Hospital Charge Code	2280361
Hospital Revenue Code	301
Rate for Payer: Cash Price	$144.90

OPIATES (LABCORP MEDWATCH)

Facility

$161.00

Service Code	CPT 80361
Hospital Charge Code	2280361
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$114.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$95.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.95
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cash Price	$144.90
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$57.96

.OPIATES REFLEX CONFIRMATION

Facility

$110.00

Service Code	CPT 80361
Hospital Charge Code	221290
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

.OPIATES REFLEX CONFIRMATION

Facility

$110.00

Service Code	CPT 80361
Hospital Charge Code	221290
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
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: Cash Price	$99.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

OPIATES SERUM

Facility

$302.00

Service Code	CPT 80361
Hospital Charge Code	2283926
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$215.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$178.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$215.63
Rate for Payer: Cash Price	$271.80
Rate for Payer: Cash Price	$271.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.72

OPIATES SERUM

Facility

$302.00

Service Code	CPT 80361
Hospital Charge Code	2283926
Hospital Revenue Code	301
Rate for Payer: Cash Price	$271.80

OP INTERMEDIATE

Facility

$307.00

Service Code	CPT 99211
Hospital Charge Code	1819008
Hospital Revenue Code	761
Rate for Payer: Cash Price	$276.30

OP INTERMEDIATE

Facility

$307.00

Service Code	CPT 99211
Hospital Charge Code	1819008
Hospital Revenue Code	761
Min. Negotiated Rate	$110.52
Max. Negotiated Rate	$219.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$181.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.20
Rate for Payer: Cash Price	$276.30
Rate for Payer: UnitedHealthcare Commercial	$204.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$110.52

OPIOID ABUSE AND DEPENDENCE

Facility

$35,496.20

Service Code	APR-DRG 7734
Min. Negotiated Rate	$35,496.20
Max. Negotiated Rate	$35,496.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$35,496.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$35,496.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$35,496.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$35,496.20

OPIOID ABUSE AND DEPENDENCE

Facility

$10,913.17

Service Code	APR-DRG 7732
Min. Negotiated Rate	$10,913.17
Max. Negotiated Rate	$10,913.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,913.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,913.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,913.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,913.17

OPIOID ABUSE AND DEPENDENCE

Facility

$9,178.92

Service Code	APR-DRG 7731
Min. Negotiated Rate	$9,178.92
Max. Negotiated Rate	$9,178.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,178.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,178.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,178.92
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,178.92

OPIOID ABUSE AND DEPENDENCE

Facility

$18,725.28

Service Code	APR-DRG 7733
Min. Negotiated Rate	$18,725.28
Max. Negotiated Rate	$18,725.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,725.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,725.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,725.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,725.28

OPO ADMIT BRIEF

Facility

$250.00

Service Code	CPT 99221
Hospital Charge Code	9899218
Rate for Payer: Cash Price	$225.00

OPO ADMIT EXTENDED

Facility

$480.00

Service Code	CPT 99223
Hospital Charge Code	9899220
Rate for Payer: Cash Price	$432.00

OPO ADMIT INTERMEDIATE

Facility

$370.00

Service Code	CPT 99222
Hospital Charge Code	9899219
Rate for Payer: Cash Price	$333.00

OPO DISCHARGE

Facility

$150.00

Service Code	CPT 99238
Hospital Charge Code	9699217
Hospital Revenue Code	521
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OPO DISCHARGE

Facility

$150.00

Service Code	CPT 99238
Hospital Charge Code	9699217
Hospital Revenue Code	521
Rate for Payer: Cash Price	$135.00

OPO DISCHARGE

Facility

$205.00

Service Code	CPT 99238
Hospital Charge Code	9899217
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

OPO DISCHARGE

Facility

$205.00

Service Code	CPT 99238
Hospital Charge Code	9899217
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OPO INITIAL CARE BRIEF

Facility

$235.00

Service Code	CPT 99221
Hospital Charge Code	4299218
Rate for Payer: Cash Price	$211.50

OPO INITIAL CARE EXTENDED

Facility

$450.00

Service Code	CPT 99223
Hospital Charge Code	4299220
Rate for Payer: Cash Price	$405.00

OPO INITIAL CARE INTERMEDIATED

Facility

$333.00

Service Code	CPT 99222
Hospital Charge Code	4299219
Rate for Payer: Cash Price	$299.70

OPO INITIAL, HIGH SEVERITY

Facility

$410.00

Service Code	CPT 99223
Hospital Charge Code	9699220
Hospital Revenue Code	521
Rate for Payer: Cash Price	$369.00

Know your out-of-pocket cost for care.

All Charges