Madison Medical Center

All Charges

Charge

Type

Setting

Price

PHYSOSTIGMINE INJ

Facility

$76.00

Hospital Charge Code	2058044
Hospital Revenue Code	370
Rate for Payer: Cash Price	$68.40

PHYSOSTIGMINE INJ

Facility

$76.00

Hospital Charge Code	2058044
Hospital Revenue Code	370
Min. Negotiated Rate	$27.36
Max. Negotiated Rate	$54.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.26
Rate for Payer: Cash Price	$68.40
Rate for Payer: UnitedHealthcare Commercial	$50.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.36

PHYTONADIONE INJ

Facility

$65.00

Service Code	HCPCS J3430
Hospital Charge Code	2058004
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

PHYTONADIONE INJ

Facility

$65.00

Service Code	HCPCS J3430
Hospital Charge Code	2058004
Hospital Revenue Code	370
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
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: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

PICC NEEDLES

Facility

$414.00

Hospital Charge Code	2816671
Hospital Revenue Code	271
Min. Negotiated Rate	$149.04
Max. Negotiated Rate	$295.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$245.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$295.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: UnitedHealthcare Commercial	$276.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$149.04

PICC NEEDLES

Facility

$414.00

Hospital Charge Code	2816671
Hospital Revenue Code	271
Rate for Payer: Cash Price	$372.60

PIGEON SERUM AB

Facility

$110.00

Service Code	CPT 86331
Hospital Charge Code	2286599
Hospital Revenue Code	305
Min. Negotiated Rate	$10.78
Max. Negotiated Rate	$78.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.78
Rate for Payer: Aetna Medicare Advantage	$11.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$11.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.53
Rate for Payer: Home State Health Plan Medicare Advantage	$11.98
Rate for Payer: Humana Commercial	$23.96
Rate for Payer: Humana Medicare Advantage	$11.98
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

PIGEON SERUM AB

Facility

$110.00

Service Code	CPT 86331
Hospital Charge Code	2286599
Hospital Revenue Code	305
Rate for Payer: Cash Price	$99.00

PILLOW

Facility

$35.00

Hospital Charge Code	2816027
Hospital Revenue Code	271
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
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: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

PILLOW

Facility

$35.00

Hospital Charge Code	2816027
Hospital Revenue Code	271
Rate for Payer: Cash Price	$31.50

PILOCARPINE (SALAGEN) 5 MG TAB EMP

Facility

$10.00

Service Code	NDC 115592201
Hospital Charge Code	2624645
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$7.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.14
Rate for Payer: Cash Price	$9.00
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

PILOCARPINE (SALAGEN) 5 MG TAB EMP

Facility

$10.00

Service Code	NDC 115592201
Hospital Charge Code	2624645
Hospital Revenue Code	250
Rate for Payer: Cash Price	$9.00

PIMECROLIMUS 1% CRM 100GM EMP

Facility

$373.00

Service Code	NDC 6.8682E+10
Hospital Charge Code	2626725
Hospital Revenue Code	250
Rate for Payer: Cash Price	$335.70

PIMECROLIMUS 1% CRM 100GM EMP

Facility

$373.00

Service Code	NDC 6.8682E+10
Hospital Charge Code	2626725
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

PIN GUARD

Facility

$15.00

Hospital Charge Code	12101001
Hospital Revenue Code	271
Rate for Payer: Cash Price	$13.50

PIN GUARD

Facility

$15.00

Hospital Charge Code	12101001
Hospital Revenue Code	271
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

PINS, STEINMAN

Facility

$75.00

Hospital Charge Code	2816031
Hospital Revenue Code	271
Rate for Payer: Cash Price	$67.50

PINS, STEINMAN

Facility

$75.00

Hospital Charge Code	2816031
Hospital Revenue Code	271
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

PINWORM IDENTIFICATION

Facility

$138.00

Service Code	CPT 87172
Hospital Charge Code	309021
Hospital Revenue Code	306
Rate for Payer: Cash Price	$124.20

PINWORM IDENTIFICATION

Facility

$138.00

Service Code	CPT 87172
Hospital Charge Code	309021
Hospital Revenue Code	306
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$98.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.84
Rate for Payer: Aetna Medicare Advantage	$4.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$81.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$98.53
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cigna Commercial HMO & PPO	$4.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.11
Rate for Payer: Home State Health Plan Medicare Advantage	$4.27
Rate for Payer: Humana Commercial	$8.54
Rate for Payer: Humana Medicare Advantage	$4.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$49.68

PIOGLITAZONE (ACTOS) 15MG TAB

Facility

$45.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2697064
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

PIOGLITAZONE (ACTOS) 15MG TAB

Facility

$45.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2697064
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

PIOGLITAZONE (ACTOS) 15MG TAB EMP

Facility

$45.00

Service Code	NDC 93727198
Hospital Charge Code	2626057
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

PIOGLITAZONE (ACTOS) 15MG TAB EMP

Facility

$45.00

Service Code	NDC 93727198
Hospital Charge Code	2626057
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

PIOGLITAZONE (ACTOS) 45MG TAB EMP

Facility

$45.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2624755
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

Know your out-of-pocket cost for care.

All Charges