Madison Medical Center

All Charges

Charge

Type

Setting

Price

PAROXETINE 30MG TAB HE

Facility

$20.00

Service Code	NDC 1.3107E+10
Hospital Charge Code	2627101
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

PAROXETINE 30MG TAB HE

Facility

$20.00

Service Code	NDC 1.3107E+10
Hospital Charge Code	2627101
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

PAROXETINE 40MG TAB EMP

Facility

$21.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2619276
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

PAROXETINE 40MG TAB EMP

Facility

$21.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2619276
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

PAROXETINE (PAXIL) 20MG TAB

Facility

$43.00

Service Code	NDC 4.3547E+10
Hospital Charge Code	2655806
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

PAROXETINE (PAXIL) 20MG TAB

Facility

$43.00

Service Code	NDC 4.3547E+10
Hospital Charge Code	2655806
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

PARTIAL HEMORRHOIDECTOMY

Professional

Both

$266.00

Service Code	CPT 46230
Hospital Charge Code	4146230
Hospital Revenue Code	975
Min. Negotiated Rate	$93.10
Max. Negotiated Rate	$263.24
Rate for Payer: Aetna Commercial/Medicare Advantage	$156.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$239.31
Rate for Payer: Cash Price	$239.40
Rate for Payer: Cash Price	$239.40
Rate for Payer: Cigna Commercial HMO & PPO	$156.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$239.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$263.24
Rate for Payer: Home State Health Plan Medicare Advantage	$156.93
Rate for Payer: Optum Medicare Advantage	$93.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$239.31

PARTIALLY THREADED GUIDE WIRE 0.35 X 4

Facility

$168.00

Hospital Charge Code	127778
Hospital Revenue Code	271
Min. Negotiated Rate	$60.48
Max. Negotiated Rate	$119.95
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: UnitedHealthcare Commercial	$112.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.48

PARTIALLY THREADED GUIDE WIRE 0.35 X 4

Facility

$168.00

Hospital Charge Code	127778
Hospital Revenue Code	271
Rate for Payer: Cash Price	$151.20

PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT

Facility

$26,787.01

Service Code	APR-DRG 8444
Min. Negotiated Rate	$26,787.01
Max. Negotiated Rate	$26,787.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$26,787.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26,787.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26,787.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26,787.01

PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT

Facility

$6,462.39

Service Code	APR-DRG 8441
Min. Negotiated Rate	$6,462.39
Max. Negotiated Rate	$6,462.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,462.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,462.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,462.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,462.39

PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT

Facility

$12,995.96

Service Code	APR-DRG 8443
Min. Negotiated Rate	$12,995.96
Max. Negotiated Rate	$12,995.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,995.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,995.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,995.96
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,995.96

PARTIAL THICKNESS BURNS WITHOUT SKIN GRAFT

Facility

$9,093.57

Service Code	APR-DRG 8442
Min. Negotiated Rate	$9,093.57
Max. Negotiated Rate	$9,093.57
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,093.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,093.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,093.57
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,093.57

PARTIAL THYROIS LOBECTOMY

Facility

$811.00

Service Code	CPT 60210
Hospital Charge Code	5260210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$729.90

PARTIAL THYROIS LOBECTOMY

Facility

$811.00

Service Code	CPT 60210
Hospital Charge Code	5260210
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$12,352.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,449.73
Rate for Payer: Aetna Medicare Advantage	$6,176.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$480.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$579.05
Rate for Payer: Cash Price	$729.90
Rate for Payer: Cash Price	$729.90
Rate for Payer: Cash Price	$729.90
Rate for Payer: Cash Price	$729.90
Rate for Payer: Cigna Commercial HMO & PPO	$6,176.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,904.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,831.21
Rate for Payer: Home State Health Plan Medicare Advantage	$6,176.47
Rate for Payer: Humana Commercial	$12,352.94
Rate for Payer: Humana Medicare Advantage	$6,176.47
Rate for Payer: UnitedHealthcare Commercial	$540.94
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,449.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PARTIAL TOENAIL DESTRUCTION

Facility

$65.00

Service Code	CPT 11730
Hospital Charge Code	9811730
Hospital Revenue Code	521
Min. Negotiated Rate	$38.48
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	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
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	$43.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PARTIAL TOENAIL DESTRUCTION

Facility

$65.00

Service Code	CPT 11730
Hospital Charge Code	9811730
Hospital Revenue Code	521
Rate for Payer: Cash Price	$58.50

PARTIEL REMOVAL OF RECTUM

Professional

Both

$3,250.00

Service Code	CPT 45111
Hospital Charge Code	4145111
Hospital Revenue Code	975
Min. Negotiated Rate	$820.10
Max. Negotiated Rate	$1,137.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$965.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$820.10
Rate for Payer: Cash Price	$2,925.00
Rate for Payer: Cash Price	$2,925.00
Rate for Payer: Cigna Commercial HMO & PPO	$965.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$820.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$902.11
Rate for Payer: Home State Health Plan Medicare Advantage	$965.75
Rate for Payer: Optum Medicare Advantage	$1,137.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$820.10

PARVOVIRUS 19, PCR

Facility

$529.00

Service Code	CPT 87798
Hospital Charge Code	2286749
Hospital Revenue Code	307
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$377.71
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.58
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$313.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$377.71
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cigna Commercial HMO & PPO	$35.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.79
Rate for Payer: Home State Health Plan Medicare Advantage	$35.09
Rate for Payer: Humana Commercial	$70.18
Rate for Payer: Humana Medicare Advantage	$35.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$190.44

PARVOVIRUS 19, PCR

Facility

$529.00

Service Code	CPT 87798
Hospital Charge Code	2286749
Hospital Revenue Code	307
Rate for Payer: Cash Price	$476.10

PARVOVIRUS IGG

Facility

$210.00

Service Code	CPT 86747
Hospital Charge Code	2286747
Hospital Revenue Code	302
Min. Negotiated Rate	$13.53
Max. Negotiated Rate	$149.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.53
Rate for Payer: Aetna Medicare Advantage	$15.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$124.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cigna Commercial HMO & PPO	$15.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.48
Rate for Payer: Home State Health Plan Medicare Advantage	$15.03
Rate for Payer: Humana Commercial	$30.06
Rate for Payer: Humana Medicare Advantage	$15.03
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$75.60

PARVOVIRUS IGG

Facility

$210.00

Service Code	CPT 86747
Hospital Charge Code	2286747
Hospital Revenue Code	302
Rate for Payer: Cash Price	$189.00

PARVOVIRUS IGM

Facility

$210.00

Service Code	CPT 86747
Hospital Charge Code	2286746
Hospital Revenue Code	302
Min. Negotiated Rate	$13.53
Max. Negotiated Rate	$149.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.53
Rate for Payer: Aetna Medicare Advantage	$15.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$124.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cigna Commercial HMO & PPO	$15.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.48
Rate for Payer: Home State Health Plan Medicare Advantage	$15.03
Rate for Payer: Humana Commercial	$30.06
Rate for Payer: Humana Medicare Advantage	$15.03
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$75.60

PARVOVIRUS IGM

Facility

$210.00

Service Code	CPT 86747
Hospital Charge Code	2286746
Hospital Revenue Code	302
Rate for Payer: Cash Price	$189.00

PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC

Facility

$19,732.08

Service Code	MSDRG 543
Min. Negotiated Rate	$9,866.04
Max. Negotiated Rate	$19,732.08
Rate for Payer: Aetna Medicare Advantage	$9,866.04
Rate for Payer: Cigna Commercial HMO & PPO	$9,866.04
Rate for Payer: Home State Health Plan Medicare Advantage	$9,866.04
Rate for Payer: Humana Commercial	$19,732.08
Rate for Payer: Humana Medicare Advantage	$9,866.04

Know your out-of-pocket cost for care.

All Charges