Madison Medical Center

All Charges

Charge

Type

Setting

Price

.PHOSPHATIDYLETHANOLAMINE IGM

Facility

$174.00

Service Code	CPT 86148
Hospital Charge Code	2286144
Hospital Revenue Code	301
Rate for Payer: Cash Price	$156.60

.PHOSPHATIDYLETHANOLAMIN IGA

Facility

$174.00

Service Code	CPT 86148
Hospital Charge Code	2286143
Hospital Revenue Code	301
Rate for Payer: Cash Price	$156.60

.PHOSPHATIDYLETHANOLAMIN IGA

Facility

$174.00

Service Code	CPT 86148
Hospital Charge Code	2286143
Hospital Revenue Code	301
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$124.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.46
Rate for Payer: Aetna Medicare Advantage	$16.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$103.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$124.24
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cash Price	$156.60
Rate for Payer: Cigna Commercial HMO & PPO	$16.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.47
Rate for Payer: Home State Health Plan Medicare Advantage	$16.07
Rate for Payer: Humana Commercial	$32.14
Rate for Payer: Humana Medicare Advantage	$16.07
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$62.64

PHOSPHATIDYLETHANOL (PEth)

Facility

$279.00

Service Code	CPT 80321
Hospital Charge Code	22863141
Hospital Revenue Code	301
Rate for Payer: Cash Price	$251.10

PHOSPHATIDYLETHANOL (PEth)

Facility

$279.00

Service Code	CPT 80321
Hospital Charge Code	22863141
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$199.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$165.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$199.21
Rate for Payer: Cash Price	$251.10
Rate for Payer: Cash Price	$251.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$100.44

PHOSPHOLIPASE A2 RECEPT AB

Facility

$498.00

Service Code	CPT 83516
Hospital Charge Code	2283518
Hospital Revenue Code	302
Rate for Payer: Cash Price	$448.20

PHOSPHOLIPASE A2 RECEPT AB

Facility

$498.00

Service Code	CPT 83516
Hospital Charge Code	2283518
Hospital Revenue Code	302
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$355.57
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	$294.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$355.57
Rate for Payer: Cash Price	$448.20
Rate for Payer: Cash Price	$448.20
Rate for Payer: Cash Price	$448.20
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	$179.28

PHOSPHORUS

Facility

$112.00

Service Code	CPT 84100
Hospital Charge Code	2216110
Hospital Revenue Code	301
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.27
Rate for Payer: Aetna Medicare Advantage	$4.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$4.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.57
Rate for Payer: Home State Health Plan Medicare Advantage	$4.74
Rate for Payer: Humana Commercial	$9.48
Rate for Payer: Humana Medicare Advantage	$4.74
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

PHOSPHORUS

Facility

$112.00

Service Code	CPT 84100
Hospital Charge Code	2216110
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

PHOSPHORUS 24 HR URINE

Facility

$81.00

Service Code	CPT 84105
Hospital Charge Code	2284105
Hospital Revenue Code	301
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$57.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.20
Rate for Payer: Aetna Medicare Advantage	$5.78
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: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna Commercial HMO & PPO	$5.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.56
Rate for Payer: Home State Health Plan Medicare Advantage	$5.78
Rate for Payer: Humana Commercial	$11.56
Rate for Payer: Humana Medicare Advantage	$5.78
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

PHOSPHORUS 24 HR URINE

Facility

$81.00

Service Code	CPT 84105
Hospital Charge Code	2284105
Hospital Revenue Code	301
Rate for Payer: Cash Price	$72.90

PHOSPHORUS RANDOM URINE

Facility

$81.00

Service Code	CPT 84105
Hospital Charge Code	2284106
Hospital Revenue Code	301
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$57.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.20
Rate for Payer: Aetna Medicare Advantage	$5.78
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: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna Commercial HMO & PPO	$5.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.56
Rate for Payer: Home State Health Plan Medicare Advantage	$5.78
Rate for Payer: Humana Commercial	$11.56
Rate for Payer: Humana Medicare Advantage	$5.78
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

PHOSPHORUS RANDOM URINE

Facility

$81.00

Service Code	CPT 84105
Hospital Charge Code	2284106
Hospital Revenue Code	301
Rate for Payer: Cash Price	$72.90

PH PAPER (UNIVERSAL) 2.0-10 STRIP

Facility

$14.00

Hospital Charge Code	2625779
Hospital Revenue Code	250
Rate for Payer: Cash Price	$12.60

PH PAPER (UNIVERSAL) 2.0-10 STRIP

Facility

$14.00

Hospital Charge Code	2625779
Hospital Revenue Code	250
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$10.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.00
Rate for Payer: Cash Price	$12.60
Rate for Payer: UnitedHealthcare Commercial	$9.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04

PH URINE

Facility

$40.00

Service Code	CPT 83986
Hospital Charge Code	2283987
Hospital Revenue Code	301
Rate for Payer: Cash Price	$36.00

PH URINE

Facility

$40.00

Service Code	CPT 83986
Hospital Charge Code	2283987
Hospital Revenue Code	301
Min. Negotiated Rate	$3.22
Max. Negotiated Rate	$28.56
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	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
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	$14.40

PHYSICAL

Facility

$35.00

Service Code	CPT 99499
Hospital Charge Code	4499499
Hospital Revenue Code	521
Rate for Payer: Cash Price	$31.50

PHYSICAL

Facility

$35.00

Service Code	CPT 99499
Hospital Charge Code	4499499
Hospital Revenue Code	521
Min. Negotiated Rate	$20.72
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PHYSICAL AGE 40 - 64

Facility

$285.00

Service Code	CPT 99396
Hospital Charge Code	9799396
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

PHYSICAL AGE 40 - 64

Facility

$285.00

Service Code	CPT 99396
Hospital Charge Code	9799396
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
Max. Negotiated Rate	$203.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: UnitedHealthcare Commercial	$190.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PHYSICAL AGE 65 AND OLDER

Facility

$330.00

Service Code	CPT 99397
Hospital Charge Code	9799397
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$235.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$195.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$235.62
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: UnitedHealthcare Commercial	$220.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PHYSICAL AGE 65 AND OLDER

Facility

$330.00

Service Code	CPT 99397
Hospital Charge Code	9799397
Hospital Revenue Code	521
Rate for Payer: Cash Price	$297.00

PHYSICIAN DIRECTION

Facility

$172.00

Service Code	CPT 99288
Hospital Charge Code	4499288
Hospital Revenue Code	525
Min. Negotiated Rate	$101.82
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$101.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$122.81
Rate for Payer: Cash Price	$154.80
Rate for Payer: Cash Price	$154.80
Rate for Payer: UnitedHealthcare Commercial	$114.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PHYSICIAN DIRECTION

Facility

$172.00

Service Code	CPT 99288
Hospital Charge Code	4499288
Hospital Revenue Code	525
Rate for Payer: Cash Price	$154.80

Know your out-of-pocket cost for care.

All Charges