Madison Medical Center

All Charges

Charge

Type

Setting

Price

PENICIL G BEN LA 600 KU INJ PEDIATRIC

Facility

$576.00

Service Code	HCPCS J0561
Hospital Charge Code	2626389
Hospital Revenue Code	250
Rate for Payer: Cash Price	$518.40

PENICIL G BENZ LA 1.2MU INJ 2ML

Facility

$875.00

Service Code	HCPCS J0561
Hospital Charge Code	2654285
Hospital Revenue Code	250
Min. Negotiated Rate	$32.59
Max. Negotiated Rate	$624.75
Rate for Payer: Aetna Medicare Advantage	$32.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$518.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$624.75
Rate for Payer: Cash Price	$787.50
Rate for Payer: Cash Price	$787.50
Rate for Payer: Cigna Commercial HMO & PPO	$32.59
Rate for Payer: Home State Health Plan Medicare Advantage	$32.59
Rate for Payer: Humana Commercial	$65.18
Rate for Payer: Humana Medicare Advantage	$32.59
Rate for Payer: UnitedHealthcare Commercial	$583.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$315.00

PENICIL G BENZ LA 1.2MU INJ 2ML

Facility

$875.00

Service Code	HCPCS J0561
Hospital Charge Code	2654285
Hospital Revenue Code	250
Rate for Payer: Cash Price	$787.50

PENICILLIN G, IGE

Facility

$55.00

Service Code	CPT 86003
Hospital Charge Code	2286009
Hospital Revenue Code	301
Rate for Payer: Cash Price	$49.50

PENICILLIN G, IGE

Facility

$55.00

Service Code	CPT 86003
Hospital Charge Code	2286009
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

PENICILLIN V, IGE

Facility

$55.00

Service Code	CPT 86003
Hospital Charge Code	2286008
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

PENICILLIN V, IGE

Facility

$55.00

Service Code	CPT 86003
Hospital Charge Code	2286008
Hospital Revenue Code	301
Rate for Payer: Cash Price	$49.50

PENICILLIN VK 500MG TAB EMP

Facility

$18.00

Service Code	NDC 93117401
Hospital Charge Code	2622743
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

PENICILLIN VK 500MG TAB EMP

Facility

$18.00

Service Code	NDC 93117401
Hospital Charge Code	2622743
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PENICILLIN VK (VEETIDS) 500MG TAB

Facility

$18.00

Service Code	NDC 143983601
Hospital Charge Code	2655830
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

PENICILLIN VK (VEETIDS) 500MG TAB

Facility

$18.00

Service Code	NDC 143983601
Hospital Charge Code	2655830
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PENIS PROCEDURES WITH CC/MCC

Facility

$40,152.46

Service Code	MSDRG 709
Min. Negotiated Rate	$20,076.23
Max. Negotiated Rate	$40,152.46
Rate for Payer: Aetna Medicare Advantage	$20,076.23
Rate for Payer: Cigna Commercial HMO & PPO	$20,076.23
Rate for Payer: Home State Health Plan Medicare Advantage	$20,076.23
Rate for Payer: Humana Commercial	$40,152.46
Rate for Payer: Humana Medicare Advantage	$20,076.23

PENIS PROCEDURES WITHOUT CC/MCC

Facility

$25,574.34

Service Code	MSDRG 710
Min. Negotiated Rate	$12,787.17
Max. Negotiated Rate	$25,574.34
Rate for Payer: Aetna Medicare Advantage	$12,787.17
Rate for Payer: Cigna Commercial HMO & PPO	$12,787.17
Rate for Payer: Home State Health Plan Medicare Advantage	$12,787.17
Rate for Payer: Humana Commercial	$25,574.34
Rate for Payer: Humana Medicare Advantage	$12,787.17

PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$23,170.30

Service Code	APR-DRG 4833
Min. Negotiated Rate	$23,170.30
Max. Negotiated Rate	$23,170.30
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,170.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,170.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,170.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,170.30

PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$6,222.01

Service Code	APR-DRG 4831
Min. Negotiated Rate	$6,222.01
Max. Negotiated Rate	$6,222.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,222.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,222.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,222.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,222.01

PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$15,678.92

Service Code	APR-DRG 4832
Min. Negotiated Rate	$15,678.92
Max. Negotiated Rate	$15,678.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,678.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,678.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,678.92
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,678.92

PENIS, TESTES AND SCROTAL PROCEDURES

Facility

$35,334.19

Service Code	APR-DRG 4834
Min. Negotiated Rate	$35,334.19
Max. Negotiated Rate	$35,334.19
Rate for Payer: Aetna Better Health Medicaid/QHP	$35,334.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$35,334.19
Rate for Payer: Home State Health Plan Medicaid Managed Care	$35,334.19
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$35,334.19

PENTOTHAL INJ

Facility

$126.00

Hospital Charge Code	2016003
Hospital Revenue Code	370
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$89.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: UnitedHealthcare Commercial	$84.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

PENTOTHAL INJ

Facility

$126.00

Hospital Charge Code	2016003
Hospital Revenue Code	370
Rate for Payer: Cash Price	$113.40

PENTOXIFYLLINE(TRENTAL)400MG ER TAB

Facility

$21.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2656432
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

PENTOXIFYLLINE(TRENTAL)400MG ER TAB

Facility

$21.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2656432
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

PEPTIC ULCER AND GASTRITIS

Facility

$35,592.39

Service Code	APR-DRG 2414
Min. Negotiated Rate	$35,592.39
Max. Negotiated Rate	$35,592.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$35,592.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$35,592.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$35,592.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$35,592.39

PEPTIC ULCER AND GASTRITIS

Facility

$8,940.49

Service Code	APR-DRG 2412
Min. Negotiated Rate	$8,940.49
Max. Negotiated Rate	$8,940.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,940.49
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,940.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,940.49
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,940.49

PEPTIC ULCER AND GASTRITIS

Facility

$7,321.22

Service Code	APR-DRG 2411
Min. Negotiated Rate	$7,321.22
Max. Negotiated Rate	$7,321.22
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,321.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,321.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,321.22
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,321.22

PEPTIC ULCER AND GASTRITIS

Facility

$14,392.95

Service Code	APR-DRG 2413
Min. Negotiated Rate	$14,392.95
Max. Negotiated Rate	$14,392.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,392.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,392.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,392.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,392.95

Know your out-of-pocket cost for care.

All Charges