Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

PAPER TAPE

Facility

$18.00

Hospital Charge Code	1269075
Hospital Revenue Code	360
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.01
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

PAPER TAPE

Facility

$18.00

Hospital Charge Code	1269075
Hospital Revenue Code	360
Rate for Payer: Cash Price	$16.20

PAPILLECTOMY/EXC OF SINGLE TAG, ANUS

Professional

Both

$420.00

Service Code	CPT 46220
Hospital Charge Code	5446220
Hospital Revenue Code	975
Min. Negotiated Rate	$111.40
Max. Negotiated Rate	$212.71
Rate for Payer: Aetna Commercial/Medicare Advantage	$111.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$193.37
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cigna Commercial HMO & PPO	$111.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$193.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$212.71
Rate for Payer: Home State Health Plan Medicare Advantage	$111.40
Rate for Payer: Optum Medicare Advantage	$147.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$193.37

PAPSMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	4288150
Hospital Revenue Code	521
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.69
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$18.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.86
Rate for Payer: Home State Health Plan Medicare Advantage	$18.54
Rate for Payer: Humana Commercial	$37.08
Rate for Payer: Humana Medicare Advantage	$18.54
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PAPSMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	5288150
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.00

PAPSMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	5288150
Hospital Revenue Code	521
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.69
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$18.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.86
Rate for Payer: Home State Health Plan Medicare Advantage	$18.54
Rate for Payer: Humana Commercial	$37.08
Rate for Payer: Humana Medicare Advantage	$18.54
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PAPSMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	4288150
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.00

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	9788150
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.00

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	9488150
Hospital Revenue Code	521
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.69
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$18.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.86
Rate for Payer: Home State Health Plan Medicare Advantage	$18.54
Rate for Payer: Humana Commercial	$37.08
Rate for Payer: Humana Medicare Advantage	$18.54
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PAP SMEAR

Facility

$32.00

Service Code	CPT Q0091
Hospital Charge Code	3900091
Hospital Revenue Code	521
Rate for Payer: Cash Price	$28.80

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	3988150
Hospital Revenue Code	521
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.69
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$18.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.86
Rate for Payer: Home State Health Plan Medicare Advantage	$18.54
Rate for Payer: Humana Commercial	$37.08
Rate for Payer: Humana Medicare Advantage	$18.54
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	4488150
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.00

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	4488150
Hospital Revenue Code	521
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.69
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$18.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.86
Rate for Payer: Home State Health Plan Medicare Advantage	$18.54
Rate for Payer: Humana Commercial	$37.08
Rate for Payer: Humana Medicare Advantage	$18.54
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	4188150
Hospital Revenue Code	521
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.69
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$18.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.86
Rate for Payer: Home State Health Plan Medicare Advantage	$18.54
Rate for Payer: Humana Commercial	$37.08
Rate for Payer: Humana Medicare Advantage	$18.54
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	9788150
Hospital Revenue Code	521
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.69
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$18.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.86
Rate for Payer: Home State Health Plan Medicare Advantage	$18.54
Rate for Payer: Humana Commercial	$37.08
Rate for Payer: Humana Medicare Advantage	$18.54
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	9288150
Hospital Revenue Code	521
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.69
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$18.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.86
Rate for Payer: Home State Health Plan Medicare Advantage	$18.54
Rate for Payer: Humana Commercial	$37.08
Rate for Payer: Humana Medicare Advantage	$18.54
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	9288150
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.00

PAP SMEAR

Facility

$32.00

Service Code	CPT Q0091
Hospital Charge Code	3900091
Hospital Revenue Code	521
Min. Negotiated Rate	$18.94
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Medicare Advantage	$29.55
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: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna Commercial HMO & PPO	$29.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23.46
Rate for Payer: Home State Health Plan Medicare Advantage	$29.55
Rate for Payer: Humana Commercial	$59.10
Rate for Payer: Humana Medicare Advantage	$29.55
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	3988150
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.00

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	4188150
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.00

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	9488150
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.00

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	9688150
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.00

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	9888150
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.00

PAP SMEAR

Facility

$60.00

Service Code	CPT 88150
Hospital Charge Code	9888150
Hospital Revenue Code	521
Min. Negotiated Rate	$15.02
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.69
Rate for Payer: Aetna Medicare Advantage	$18.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$18.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.86
Rate for Payer: Home State Health Plan Medicare Advantage	$18.54
Rate for Payer: Humana Commercial	$37.08
Rate for Payer: Humana Medicare Advantage	$18.54
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges