Madison Medical Center

All Charges

Charge

Type

Setting

Price

BUPROPION 100MG TAB EMP

Facility

$32.00

Service Code	NDC 173094755
Hospital Charge Code	2625658
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

BUPROPION 100MG TAB EMP

Facility

$32.00

Service Code	NDC 173094755
Hospital Charge Code	2625658
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

BUPROPION 150MG SR TAB EMP

Facility

$16.00

Service Code	NDC 591354160
Hospital Charge Code	2619688
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

BUPROPION 150MG SR TAB EMP

Facility

$16.00

Service Code	NDC 591354160
Hospital Charge Code	2619688
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

BUPROPION 150MG XL TAB EMP

Facility

$16.00

Service Code	NDC 591333119
Hospital Charge Code	2622098
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

BUPROPION 150MG XL TAB EMP

Facility

$16.00

Service Code	NDC 591333119
Hospital Charge Code	2622098
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

BUPROPION 200MG SR TAB EMP

Facility

$16.00

Service Code	NDC 591354160
Hospital Charge Code	2626027
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

BUPROPION 200MG SR TAB EMP

Facility

$16.00

Service Code	NDC 591354160
Hospital Charge Code	2626027
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

BUPROPION 300MG XL TAB EMP

Facility

$16.00

Service Code	NDC 187073130
Hospital Charge Code	2623443
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

BUPROPION 300MG XL TAB EMP

Facility

$16.00

Service Code	NDC 187073130
Hospital Charge Code	2623443
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

BUPROPION 75MG TAB EMP

Facility

$16.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2625503
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

BUPROPION 75MG TAB EMP

Facility

$16.00

Service Code	NDC 2.3155E+10
Hospital Charge Code	2625503
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

BUPROPION (WELLBUTRIN)150MG SR TAB

Facility

$21.00

Service Code	NDC 185041560
Hospital Charge Code	2626492
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

BUPROPION (WELLBUTRIN)150MG SR TAB

Facility

$21.00

Service Code	NDC 185041560
Hospital Charge Code	2626492
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

BURN PACK

Facility

$39.00

Hospital Charge Code	282856
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

BURN PACK

Facility

$39.00

Hospital Charge Code	282856
Hospital Revenue Code	271
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

BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS

Facility

$23,161.97

Service Code	APR-DRG 8422
Min. Negotiated Rate	$23,161.97
Max. Negotiated Rate	$23,161.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,161.97
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,161.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,161.97
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,161.97

BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS

Facility

$58,780.92

Service Code	APR-DRG 8423
Min. Negotiated Rate	$58,780.92
Max. Negotiated Rate	$58,780.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$58,780.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58,780.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$58,780.92
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$58,780.92

BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS

Facility

$128,017.22

Service Code	APR-DRG 8424
Min. Negotiated Rate	$128,017.22
Max. Negotiated Rate	$128,017.22
Rate for Payer: Aetna Better Health Medicaid/QHP	$128,017.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$128,017.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128,017.22
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$128,017.22

BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE THIRD DEGREE BURNS

Facility

$12,578.08

Service Code	APR-DRG 8421
Min. Negotiated Rate	$12,578.08
Max. Negotiated Rate	$12,578.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,578.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,578.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,578.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,578.08

BUSPIRONE 15MG TAB EMP

Facility

$15.00

Service Code	NDC 93100301
Hospital Charge Code	2622913
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

BUSPIRONE 15MG TAB EMP

Facility

$15.00

Service Code	NDC 93100301
Hospital Charge Code	2622913
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

BUSPIRONE 30MG TAB EMP

Facility

$15.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2624393
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

BUSPIRONE 30MG TAB EMP

Facility

$15.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2624393
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

BUSPIRONE 5MG TAB EMP

Facility

$24.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2619575
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

Know your out-of-pocket cost for care.

All Charges