Madison Medical Center

All Charges

Charge

Type

Setting

Price

PAIRING 2 TO 4 LESIONS

Facility

$135.00

Service Code	CPT 11056
Hospital Charge Code	9311056
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

PAIRING 2 TO 4 LESIONS

Facility

$135.00

Service Code	CPT 11056
Hospital Charge Code	9311056
Hospital Revenue Code	521
Min. Negotiated Rate	$79.92
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PALONOSETRON (ALOXI) 0.25MG/5ML IV

Facility

$4,494.00

Service Code	HCPCS J2469
Hospital Charge Code	2626558
Hospital Revenue Code	335
Min. Negotiated Rate	$1,617.84
Max. Negotiated Rate	$3,208.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,660.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3,208.72
Rate for Payer: Cash Price	$4,044.60
Rate for Payer: UnitedHealthcare Commercial	$2,997.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,617.84

PALONOSETRON (ALOXI) 0.25MG/5ML IV

Facility

$4,494.00

Service Code	HCPCS J2469
Hospital Charge Code	2626558
Hospital Revenue Code	335
Rate for Payer: Cash Price	$4,044.60

PAMIDRONATE DISODIUM 60MG INJ 10ML VIAL

Facility

$323.00

Service Code	HCPCS J0897
Hospital Charge Code	2622395
Hospital Revenue Code	250
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$230.62
Rate for Payer: Aetna Medicare Advantage	$30.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$191.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$230.62
Rate for Payer: Cash Price	$290.70
Rate for Payer: Cash Price	$290.70
Rate for Payer: Cigna Commercial HMO & PPO	$30.10
Rate for Payer: Home State Health Plan Medicare Advantage	$30.10
Rate for Payer: Humana Commercial	$60.20
Rate for Payer: Humana Medicare Advantage	$30.10
Rate for Payer: UnitedHealthcare Commercial	$215.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$116.28

PAMIDRONATE DISODIUM 60MG INJ 10ML VIAL

Facility

$323.00

Service Code	HCPCS J0897
Hospital Charge Code	2622395
Hospital Revenue Code	250
Rate for Payer: Cash Price	$290.70

PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC

Facility

$49,208.44

Service Code	MSDRG 406
Min. Negotiated Rate	$24,604.22
Max. Negotiated Rate	$49,208.44
Rate for Payer: Aetna Medicare Advantage	$24,604.22
Rate for Payer: Cigna Commercial HMO & PPO	$24,604.22
Rate for Payer: Home State Health Plan Medicare Advantage	$24,604.22
Rate for Payer: Humana Commercial	$49,208.44
Rate for Payer: Humana Medicare Advantage	$24,604.22

PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC

Facility

$89,976.78

Service Code	MSDRG 405
Min. Negotiated Rate	$44,988.39
Max. Negotiated Rate	$89,976.78
Rate for Payer: Aetna Medicare Advantage	$44,988.39
Rate for Payer: Cigna Commercial HMO & PPO	$44,988.39
Rate for Payer: Home State Health Plan Medicare Advantage	$44,988.39
Rate for Payer: Humana Commercial	$89,976.78
Rate for Payer: Humana Medicare Advantage	$44,988.39

PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC

Facility

$38,458.92

Service Code	MSDRG 407
Min. Negotiated Rate	$19,229.46
Max. Negotiated Rate	$38,458.92
Rate for Payer: Aetna Medicare Advantage	$19,229.46
Rate for Payer: Cigna Commercial HMO & PPO	$19,229.46
Rate for Payer: Home State Health Plan Medicare Advantage	$19,229.46
Rate for Payer: Humana Commercial	$38,458.92
Rate for Payer: Humana Medicare Advantage	$19,229.46

PANCREAS TRANSPLANT

Facility

$117,046.24

Service Code	MSDRG 010
Min. Negotiated Rate	$58,523.12
Max. Negotiated Rate	$117,046.24
Rate for Payer: Aetna Medicare Advantage	$58,523.12
Rate for Payer: Cigna Commercial HMO & PPO	$58,523.12
Rate for Payer: Home State Health Plan Medicare Advantage	$58,523.12
Rate for Payer: Humana Commercial	$117,046.24
Rate for Payer: Humana Medicare Advantage	$58,523.12

PANCREATIC ELASTASE

Facility

$1,008.00

Service Code	CPT 82656
Hospital Charge Code	2282656
Hospital Revenue Code	301
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$719.71
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$596.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$719.71
Rate for Payer: Cash Price	$907.20
Rate for Payer: Cash Price	$907.20
Rate for Payer: Cash Price	$907.20
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$362.88

PANCREATIC ELASTASE

Facility

$1,008.00

Service Code	CPT 82656
Hospital Charge Code	2282656
Hospital Revenue Code	301
Rate for Payer: Cash Price	$907.20

PANCRELIPASE DR L=5K,P=17K,A=27K CP

Facility

$18.00

Service Code	NDC 3.9822E+10
Hospital Charge Code	2686436
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PANCRELIPASE DR L=5K,P=17K,A=27K CP

Facility

$18.00

Service Code	NDC 3.9822E+10
Hospital Charge Code	2686436
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

PANCURINIOM INJ

Facility

$142.00

Hospital Charge Code	2012725
Hospital Revenue Code	370
Min. Negotiated Rate	$51.12
Max. Negotiated Rate	$101.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$84.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$101.39
Rate for Payer: Cash Price	$127.80
Rate for Payer: UnitedHealthcare Commercial	$94.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.12

PANCURINIOM INJ

Facility

$142.00

Hospital Charge Code	2012725
Hospital Revenue Code	370
Rate for Payer: Cash Price	$127.80

PANTOPRAZOLE 20MG TAB EMP

Facility

$39.00

Service Code	NDC 378668877
Hospital Charge Code	2619442
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

PANTOPRAZOLE 20MG TAB EMP

Facility

$39.00

Service Code	NDC 378668877
Hospital Charge Code	2619442
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

PANTOPRAZOLE 40MG TAB EMP

Facility

$39.00

Service Code	NDC 8084181
Hospital Charge Code	2698223
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

PANTOPRAZOLE 40MG TAB EMP

Facility

$39.00

Service Code	NDC 8084181
Hospital Charge Code	2698223
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

PANTOPRAZOLE (PROTONIX) 40MG IVPB

Facility

$209.00

Service Code	HCPCS J3490
Hospital Charge Code	2626391
Hospital Revenue Code	250
Rate for Payer: Cash Price	$188.10

PANTOPRAZOLE (PROTONIX) 40MG IVPB

Facility

$209.00

Service Code	HCPCS J3490
Hospital Charge Code	2626391
Hospital Revenue Code	250
Min. Negotiated Rate	$75.24
Max. Negotiated Rate	$149.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$123.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.23
Rate for Payer: Cash Price	$188.10
Rate for Payer: UnitedHealthcare Commercial	$139.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$75.24

PANTOPRAZOLE (PROTONIX) 40MG SUSP

Facility

$63.00

Service Code	NDC 8084401
Hospital Charge Code	2626514
Hospital Revenue Code	250
Rate for Payer: Cash Price	$56.70

PANTOPRAZOLE (PROTONIX) 40MG SUSP

Facility

$63.00

Service Code	NDC 8084401
Hospital Charge Code	2626514
Hospital Revenue Code	250
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

PANTOPRAZOLE (PROTONIX) 40MG TAB U/D

Facility

$39.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2626312
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

Know your out-of-pocket cost for care.

All Charges