Madison Medical Center

All Charges

Charge

Type

Setting

Price

OXCARBAZEPINE 150MG TAB EMP

Facility

$20.00

Service Code	NDC 78045605
Hospital Charge Code	2623541
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

OXCARBAZEPINE 150MG TAB EMP

Facility

$20.00

Service Code	NDC 78045605
Hospital Charge Code	2623541
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

OXCARBAZEPINE 300MG TAB EMP

Facility

$20.00

Service Code	NDC 78033705
Hospital Charge Code	2623286
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

OXCARBAZEPINE 300MG TAB EMP

Facility

$20.00

Service Code	NDC 78033705
Hospital Charge Code	2623286
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

OXYBUTYNIN 5MG ER TAB EMP

Facility

$21.00

Service Code	NDC 7.2888E+10
Hospital Charge Code	2626650
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

OXYBUTYNIN 5MG ER TAB EMP

Facility

$21.00

Service Code	NDC 7.2888E+10
Hospital Charge Code	2626650
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

OXYBUTYNIN (DITROPAN) 5MG TAB

Facility

$21.00

Service Code	NDC 832003889
Hospital Charge Code	2657124
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

OXYBUTYNIN (DITROPAN) 5MG TAB

Facility

$21.00

Service Code	NDC 832003889
Hospital Charge Code	2657124
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

OXYBUTYNIN (DITROPAN) 5MG TAB EMP

Facility

$21.00

Service Code	NDC 7.0954E+10
Hospital Charge Code	2624461
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

OXYBUTYNIN (DITROPAN) 5MG TAB EMP

Facility

$21.00

Service Code	NDC 7.0954E+10
Hospital Charge Code	2624461
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

OXYBUTYNIN (DITROPAN) XL 10MG TAB EMP

Facility

$21.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2622590
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

OXYBUTYNIN (DITROPAN) XL 10MG TAB EMP

Facility

$21.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2622590
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

OXYCARBAZEPINE (TRILEPTOL)

Facility

$255.00

Service Code	CPT 83789
Hospital Charge Code	2280296
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$182.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.70
Rate for Payer: Aetna Medicare Advantage	$24.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.07
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cigna Commercial HMO & PPO	$24.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.22
Rate for Payer: Home State Health Plan Medicare Advantage	$24.11
Rate for Payer: Humana Commercial	$48.22
Rate for Payer: Humana Medicare Advantage	$24.11
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$91.80

OXYCARBAZEPINE (TRILEPTOL)

Facility

$255.00

Service Code	CPT 83789
Hospital Charge Code	2280296
Hospital Revenue Code	301
Rate for Payer: Cash Price	$229.50

OXYCOD/ACET 5/325MG TAB EMP C2

Facility

$35.00

Service Code	NDC 406051223
Hospital Charge Code	2697093
Hospital Revenue Code	250
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: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

OXYCOD/ACET 5/325MG TAB EMP C2

Facility

$35.00

Service Code	NDC 406051223
Hospital Charge Code	2697093
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

OXYCOD/ACET (PERCOCET) 5/325MG TAB C2

Facility

$35.00

Service Code	NDC 904709361
Hospital Charge Code	2655790
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Cash Price	$31.50
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: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

OXYCOD/ACET (PERCOCET) 5/325MG TAB C2

Facility

$35.00

Service Code	NDC 904709361
Hospital Charge Code	2655790
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

OXYCODONE 15MG IR TAB C2

Facility

$39.00

Service Code	NDC 5.7664E+10
Hospital Charge Code	2622392
Hospital Revenue Code	250
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
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: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

OXYCODONE 15MG IR TAB C2

Facility

$39.00

Service Code	NDC 5.7664E+10
Hospital Charge Code	2622392
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

OXYCODONE/APAP 10/325MG TAB EMP C2

Facility

$20.00

Service Code	NDC 1E+11
Hospital Charge Code	2620097
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

OXYCODONE/APAP 10/325MG TAB EMP C2

Facility

$20.00

Service Code	NDC 1E+11
Hospital Charge Code	2620097
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

OXYCODONE (LABCORP MEDWATCH)

Facility

$308.00

Service Code	CPT 80365
Hospital Charge Code	2280365
Hospital Revenue Code	301
Rate for Payer: Cash Price	$277.20

OXYCODONE (LABCORP MEDWATCH)

Facility

$308.00

Service Code	CPT 80365
Hospital Charge Code	2280365
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$219.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$182.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$219.91
Rate for Payer: Cash Price	$277.20
Rate for Payer: Cash Price	$277.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$110.88

OXYCODONE ORAL SOL 5MG 5ML C2

Facility

$21.00

Service Code	NDC 1E+11
Hospital Charge Code	2619354
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

Know your out-of-pocket cost for care.

All Charges