Madison Medical Center

All Charges

Charge

Type

Setting

Price

BUPIVACAINE (MARCAINE) 0.25%PF INJ 10ML

Facility

$65.00

Service Code	NDC 6.3323E+10
Hospital Charge Code	2657150
Hospital Revenue Code	250
Rate for Payer: Cash Price	$58.50

BUPIVACAINE MPF 0.25% INJ 10ML

Facility

$56.00

Service Code	NDC 409904217
Hospital Charge Code	2621732
Hospital Revenue Code	250
Rate for Payer: Cash Price	$50.40

BUPIVACAINE MPF 0.25% INJ 10ML

Facility

$56.00

Service Code	NDC 409904217
Hospital Charge Code	2621732
Hospital Revenue Code	250
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$39.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$33.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.98
Rate for Payer: Cash Price	$50.40
Rate for Payer: UnitedHealthcare Commercial	$37.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.16

BUPIVACAINE SPINAL 0.75% 2ML AMP (15MG)

Facility

$216.00

Service Code	NDC 409176110
Hospital Charge Code	2626138
Hospital Revenue Code	250
Min. Negotiated Rate	$77.76
Max. Negotiated Rate	$154.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$127.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$154.22
Rate for Payer: Cash Price	$194.40
Rate for Payer: UnitedHealthcare Commercial	$144.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$77.76

BUPIVACAINE SPINAL 0.75% 2ML AMP (15MG)

Facility

$216.00

Service Code	NDC 409176110
Hospital Charge Code	2626138
Hospital Revenue Code	250
Rate for Payer: Cash Price	$194.40

BUPIVAC/EPI 0.25% INJ 10ML

Facility

$55.00

Service Code	NDC 409904217
Hospital Charge Code	2626356
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

BUPIVAC/EPI 0.25% INJ 10ML

Facility

$55.00

Service Code	NDC 409904217
Hospital Charge Code	2626356
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

BUPIVAC/EPI (MARCAINE/EPI)PF 0.5% 30ML

Facility

$91.00

Service Code	NDC 6.3323E+10
Hospital Charge Code	2697059
Hospital Revenue Code	250
Rate for Payer: Cash Price	$81.90

BUPIVAC/EPI (MARCAINE/EPI)PF 0.5% 30ML

Facility

$91.00

Service Code	NDC 6.3323E+10
Hospital Charge Code	2697059
Hospital Revenue Code	250
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$64.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: UnitedHealthcare Commercial	$60.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

BUPIVAC/EPI (MARC/EPI) PF 0.5% INJ 10ML

Facility

$91.00

Service Code	NDC 6.3323E+10
Hospital Charge Code	2626314
Hospital Revenue Code	250
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$64.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: UnitedHealthcare Commercial	$60.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

BUPIVAC/EPI (MARC/EPI) PF 0.5% INJ 10ML

Facility

$91.00

Service Code	NDC 6.3323E+10
Hospital Charge Code	2626314
Hospital Revenue Code	250
Rate for Payer: Cash Price	$81.90

BUPIVICAINE INJ PF

Facility

$110.00

Service Code	HCPCS S0020
Hospital Charge Code	2058080
Hospital Revenue Code	370
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

BUPIVICAINE INJ PF

Facility

$110.00

Service Code	HCPCS S0020
Hospital Charge Code	2058080
Hospital Revenue Code	370
Rate for Payer: Cash Price	$99.00

BUPRENORPHINE INJ 0.1MG

Facility

$65.00

Service Code	HCPCS J0592
Hospital Charge Code	2059110
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

BUPRENORPHINE INJ 0.1MG

Facility

$65.00

Service Code	HCPCS J0592
Hospital Charge Code	2059110
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

.BUPRENORPHINE REFLEX CONFIRMATION

Facility

$215.00

Service Code	CPT 80348
Hospital Charge Code	22280348
Hospital Revenue Code	301
Rate for Payer: Cash Price	$193.50

.BUPRENORPHINE REFLEX CONFIRMATION

Facility

$215.00

Service Code	CPT 80348
Hospital Charge Code	22280348
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$153.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$127.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$153.51
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$77.40

BUPRENORPHINE SCREEN AND CONFIRM, URINE

Facility

$141.00

Service Code	CPT 80307
Hospital Charge Code	227634
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$124.28
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	$83.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$100.67
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cash Price	$126.90
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	$50.76

BUPRENORPHINE SCREEN AND CONFIRM, URINE

Facility

$141.00

Service Code	CPT 80307
Hospital Charge Code	227634
Hospital Revenue Code	301
Rate for Payer: Cash Price	$126.90

BUPRENORPHINE SCREEN, URINE

Facility

$244.00

Service Code	CPT 80348
Hospital Charge Code	2280348
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$174.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$144.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.22
Rate for Payer: Cash Price	$219.60
Rate for Payer: Cash Price	$219.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$87.84

BUPRENORPHINE SCREEN, URINE

Facility

$244.00

Service Code	CPT 80348
Hospital Charge Code	2280348
Hospital Revenue Code	301
Rate for Payer: Cash Price	$219.60

BUPRENORPHINE, SERUM (NO GEL)

Facility

$328.00

Service Code	CPT 80299
Hospital Charge Code	2270103
Hospital Revenue Code	301
Min. Negotiated Rate	$16.78
Max. Negotiated Rate	$234.19
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	$194.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$234.19
Rate for Payer: Cash Price	$295.20
Rate for Payer: Cash Price	$295.20
Rate for Payer: Cash Price	$295.20
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	$118.08

BUPRENORPHINE, SERUM (NO GEL)

Facility

$328.00

Service Code	CPT 80299
Hospital Charge Code	2270103
Hospital Revenue Code	301
Rate for Payer: Cash Price	$295.20

BUPROPION 100MG SR TAB EMP

Facility

$32.00

Service Code	NDC 173094755
Hospital Charge Code	2621509
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

BUPROPION 100MG SR TAB EMP

Facility

$32.00

Service Code	NDC 173094755
Hospital Charge Code	2621509
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

Know your out-of-pocket cost for care.

All Charges