Madison Medical Center

All Charges

Charge

Type

Setting

Price

PERMETHRIN (ELIMITE) 5% 60GM CRM

Facility

$373.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2626561
Hospital Revenue Code	250
Min. Negotiated Rate	$134.28
Max. Negotiated Rate	$266.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$220.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$266.32
Rate for Payer: Cash Price	$335.70
Rate for Payer: UnitedHealthcare Commercial	$248.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$134.28

PERMETHRIN (ELIMITE) 5% 60GM CRM

Facility

$373.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2626561
Hospital Revenue Code	250
Rate for Payer: Cash Price	$335.70

PERSONAL CARE KIT

Facility

$16.00

Hospital Charge Code	2816140
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

PERSONAL CARE KIT

Facility

$16.00

Hospital Charge Code	2816140
Hospital Revenue Code	271
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

PERSONALITY DISORDERS

Facility

$11,238.01

Service Code	APR-DRG 7522
Min. Negotiated Rate	$11,238.01
Max. Negotiated Rate	$11,238.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,238.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,238.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,238.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,238.01

PERSONALITY DISORDERS

Facility

$20,241.20

Service Code	APR-DRG 7523
Min. Negotiated Rate	$20,241.20
Max. Negotiated Rate	$20,241.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,241.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,241.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,241.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,241.20

PERSONALITY DISORDERS

Facility

$88,496.44

Service Code	APR-DRG 7524
Min. Negotiated Rate	$88,496.44
Max. Negotiated Rate	$88,496.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$88,496.44
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$88,496.44
Rate for Payer: Home State Health Plan Medicaid Managed Care	$88,496.44
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$88,496.44

PERSONALITY DISORDERS

Facility

$8,069.50

Service Code	APR-DRG 7521
Min. Negotiated Rate	$8,069.50
Max. Negotiated Rate	$8,069.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,069.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,069.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,069.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,069.50

PERVENOUS LEAD TEMP

Facility

$463.00

Hospital Charge Code	2816750
Hospital Revenue Code	271
Rate for Payer: Cash Price	$416.70

PERVENOUS LEAD TEMP

Facility

$463.00

Hospital Charge Code	2816750
Hospital Revenue Code	271
Min. Negotiated Rate	$166.68
Max. Negotiated Rate	$330.58
Rate for Payer: Cash Price	$416.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$274.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$330.58
Rate for Payer: UnitedHealthcare Commercial	$308.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$166.68

PESSARY FITTING

Facility

$34.00

Service Code	CPT 57160
Hospital Charge Code	4257160
Hospital Revenue Code	521
Min. Negotiated Rate	$20.13
Max. Negotiated Rate	$413.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$182.25
Rate for Payer: Aetna Medicare Advantage	$206.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.28
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cigna Commercial HMO & PPO	$206.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$164.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$195.01
Rate for Payer: Home State Health Plan Medicare Advantage	$206.55
Rate for Payer: Humana Commercial	$413.10
Rate for Payer: Humana Medicare Advantage	$206.55
Rate for Payer: UnitedHealthcare Commercial	$22.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$182.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PESSARY FITTING

Facility

$34.00

Service Code	CPT 57160
Hospital Charge Code	4257160
Hospital Revenue Code	521
Rate for Payer: Cash Price	$30.60

PFT MULITI

Facility

$999.00

Service Code	CPT 94010
Hospital Charge Code	4500340
Hospital Revenue Code	460
Min. Negotiated Rate	$194.65
Max. Negotiated Rate	$713.29
Rate for Payer: Aetna Better Health Medicaid/QHP	$194.65
Rate for Payer: Aetna Medicare Advantage	$220.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$591.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$713.29
Rate for Payer: Cash Price	$899.10
Rate for Payer: Cash Price	$899.10
Rate for Payer: Cash Price	$899.10
Rate for Payer: Cigna Commercial HMO & PPO	$220.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$194.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$208.28
Rate for Payer: Home State Health Plan Medicare Advantage	$220.60
Rate for Payer: Humana Commercial	$441.20
Rate for Payer: Humana Medicare Advantage	$220.60
Rate for Payer: UnitedHealthcare Commercial	$666.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$194.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$359.64

PFT MULITI

Facility

$999.00

Service Code	CPT 94010
Hospital Charge Code	4500340
Hospital Revenue Code	460
Rate for Payer: Cash Price	$899.10

PFT, PHY INTERPRETATION&REPORT

Professional

Both

$355.00

Service Code	CPT 94016
Hospital Charge Code	4593020
Hospital Revenue Code	976
Min. Negotiated Rate	$23.73
Max. Negotiated Rate	$124.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$23.73
Rate for Payer: Cash Price	$319.50
Rate for Payer: Cash Price	$319.50
Rate for Payer: Cigna Commercial HMO & PPO	$23.73
Rate for Payer: Home State Health Plan Medicare Advantage	$23.73
Rate for Payer: Optum Medicare Advantage	$124.25

PHASEAL CONNECTOR FOR CHEMO (N35)

Facility

$81.00

Service Code	NDC 3.8291E+10
Hospital Charge Code	2626569
Hospital Revenue Code	335
Rate for Payer: Cash Price	$72.90

PHASEAL CONNECTOR FOR CHEMO (N35)

Facility

$81.00

Service Code	NDC 3.8291E+10
Hospital Charge Code	2626569
Hospital Revenue Code	335
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$57.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

PHASEAL INJECTOR FOR CHEMO (N35)

Facility

$125.00

Service Code	NDC 3.8291E+10
Hospital Charge Code	2626568
Hospital Revenue Code	335
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$89.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: UnitedHealthcare Commercial	$83.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

PHASEAL INJECTOR FOR CHEMO (N35)

Facility

$125.00

Service Code	NDC 3.8291E+10
Hospital Charge Code	2626568
Hospital Revenue Code	335
Rate for Payer: Cash Price	$112.50

PH BODY FLUID

Facility

$27.00

Service Code	CPT 83986
Hospital Charge Code	9283986
Hospital Revenue Code	301
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.22
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$15.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.28
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cigna Commercial HMO & PPO	$3.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.45
Rate for Payer: Home State Health Plan Medicare Advantage	$3.58
Rate for Payer: Humana Commercial	$7.16
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72

PH BODY FLUID

Facility

$27.00

Service Code	CPT 83986
Hospital Charge Code	9283986
Hospital Revenue Code	301
Rate for Payer: Cash Price	$24.30

PH BODY FLUID NOT OTHERWISE SPECFIED

Facility

$25.00

Service Code	CPT 83986
Hospital Charge Code	9883986
Hospital Revenue Code	301
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.22
Rate for Payer: Aetna Medicare Advantage	$3.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cash Price	$22.50
Rate for Payer: Cigna Commercial HMO & PPO	$3.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.45
Rate for Payer: Home State Health Plan Medicare Advantage	$3.58
Rate for Payer: Humana Commercial	$7.16
Rate for Payer: Humana Medicare Advantage	$3.58
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.00

PH BODY FLUID NOT OTHERWISE SPECFIED

Facility

$25.00

Service Code	CPT 83986
Hospital Charge Code	9883986
Hospital Revenue Code	301
Rate for Payer: Cash Price	$22.50

PHENAZOPYRID 100MG TAB EMP

Facility

$28.00

Service Code	NDC 364028601
Hospital Charge Code	2622293
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

PHENAZOPYRID 100MG TAB EMP

Facility

$28.00

Service Code	NDC 364028601
Hospital Charge Code	2622293
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

Know your out-of-pocket cost for care.

All Charges