Madison Medical Center

All Charges

Charge

Type

Setting

Price

VALPROATE (VALPROIC ACID) 500MG INJ 5ML

Facility

$81.00

Service Code	HCPCS Q2009
Hospital Charge Code	2697613
Hospital Revenue Code	250
Min. Negotiated Rate	$0.67
Max. Negotiated Rate	$57.83
Rate for Payer: Aetna Medicare Advantage	$0.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna Commercial HMO & PPO	$0.67
Rate for Payer: Home State Health Plan Medicare Advantage	$0.67
Rate for Payer: Humana Commercial	$1.34
Rate for Payer: Humana Medicare Advantage	$0.67
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

VALPROATE (VALPROIC ACID) 500MG INJ 5ML

Facility

$81.00

Service Code	HCPCS Q2009
Hospital Charge Code	2697613
Hospital Revenue Code	250
Rate for Payer: Cash Price	$72.90

VALPROIC ACID

Facility

$168.00

Service Code	CPT 80164
Hospital Charge Code	224178
Hospital Revenue Code	301
Rate for Payer: Cash Price	$151.20

VALPROIC ACID

Facility

$168.00

Service Code	CPT 80164
Hospital Charge Code	224178
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$119.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.19
Rate for Payer: Aetna Medicare Advantage	$13.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$99.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$119.95
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cash Price	$151.20
Rate for Payer: Cigna Commercial HMO & PPO	$13.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.19
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.04
Rate for Payer: Home State Health Plan Medicare Advantage	$13.54
Rate for Payer: Humana Commercial	$27.08
Rate for Payer: Humana Medicare Advantage	$13.54
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.48

VALPROIC ACID (DEPAKENE) 250MG/5ML SYRUP

Facility

$21.00

Service Code	NDC 6.8094E+10
Hospital Charge Code	2622294
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

VALPROIC ACID (DEPAKENE) 250MG/5ML SYRUP

Facility

$21.00

Service Code	NDC 6.8094E+10
Hospital Charge Code	2622294
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

VALPROIC ACID, FREE

Facility

$126.00

Service Code	CPT 80165
Hospital Charge Code	22280165
Hospital Revenue Code	301
Rate for Payer: Cash Price	$113.40

VALPROIC ACID, FREE

Facility

$126.00

Service Code	CPT 80165
Hospital Charge Code	22280165
Hospital Revenue Code	301
Min. Negotiated Rate	$12.19
Max. Negotiated Rate	$89.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.19
Rate for Payer: Aetna Medicare Advantage	$13.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cigna Commercial HMO & PPO	$13.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.19
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.04
Rate for Payer: Home State Health Plan Medicare Advantage	$13.54
Rate for Payer: Humana Commercial	$27.08
Rate for Payer: Humana Medicare Advantage	$13.54
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

VALPROIC ACID FREE AND TOTAL

Facility

$182.00

Hospital Charge Code	2280169
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$129.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$107.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$129.95
Rate for Payer: Cash Price	$163.80
Rate for Payer: Cash Price	$163.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.52

VALPROIC ACID FREE AND TOTAL

Facility

$182.00

Hospital Charge Code	2280169
Hospital Revenue Code	301
Rate for Payer: Cash Price	$163.80

VALPROIC ACID (LABCORP)

Facility

$28.00

Service Code	CPT 80164
Hospital Charge Code	2280164
Hospital Revenue Code	301
Rate for Payer: Cash Price	$25.20

VALPROIC ACID (LABCORP)

Facility

$28.00

Service Code	CPT 80164
Hospital Charge Code	2280164
Hospital Revenue Code	301
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$27.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.19
Rate for Payer: Aetna Medicare Advantage	$13.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cigna Commercial HMO & PPO	$13.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.19
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.04
Rate for Payer: Home State Health Plan Medicare Advantage	$13.54
Rate for Payer: Humana Commercial	$27.08
Rate for Payer: Humana Medicare Advantage	$13.54
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

VALSARTAN (DIOVAN) 160MG TAB

Facility

$35.00

Service Code	NDC 378581477
Hospital Charge Code	2626341
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

VALSARTAN (DIOVAN) 160MG TAB

Facility

$35.00

Service Code	NDC 378581477
Hospital Charge Code	2626341
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

VALSARTAN (DIOVAN) 160MG TAB EMP

Facility

$35.00

Service Code	NDC 378581477
Hospital Charge Code	2622811
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

VALSARTAN (DIOVAN) 160MG TAB EMP

Facility

$35.00

Service Code	NDC 378581477
Hospital Charge Code	2622811
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

VALSARTAN (DIOVAN) 40MG TAB

Facility

$24.00

Hospital Charge Code	2626340
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

VALSARTAN (DIOVAN) 40MG TAB

Facility

$24.00

Hospital Charge Code	2626340
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

VALSARTAN (DIOVAN) 40MG TAB EMP

Facility

$24.00

Service Code	NDC 378580793
Hospital Charge Code	2626078
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

VALSARTAN (DIOVAN) 40MG TAB EMP

Facility

$24.00

Service Code	NDC 378580793
Hospital Charge Code	2626078
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

VALSARTAN (DIOVAN) 80MG TAB EMP

Facility

$24.00

Service Code	NDC 378581377
Hospital Charge Code	2626192
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

VALSARTAN (DIOVAN) 80MG TAB EMP

Facility

$24.00

Service Code	NDC 378581377
Hospital Charge Code	2626192
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

VALSARTAN/HCTZ 160/12.5MG TAB EMP

Facility

$35.00

Service Code	NDC 78031534
Hospital Charge Code	2622372
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

VALSARTAN/HCTZ 160/12.5MG TAB EMP

Facility

$35.00

Service Code	NDC 78031534
Hospital Charge Code	2622372
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

VALSARTAN/HCTZ 160/12.5MG TAB HE

Facility

$35.00

Service Code	NDC 378632277
Hospital Charge Code	2625580
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

Know your out-of-pocket cost for care.

All Charges