Madison Medical Center

All Charges

Charge

Type

Setting

Price

PIOGLITAZONE (ACTOS) 45MG TAB EMP

Facility

$45.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2624755
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

PIPERACIL/TAZOBACT(ZOSYN) 4.5GM

Facility

$187.00

Service Code	HCPCS J2543
Hospital Charge Code	2626331
Hospital Revenue Code	250
Rate for Payer: Cash Price	$168.30

PIPERACIL/TAZOBACT(ZOSYN) 4.5GM

Facility

$187.00

Service Code	HCPCS J2543
Hospital Charge Code	2626331
Hospital Revenue Code	250
Min. Negotiated Rate	$67.32
Max. Negotiated Rate	$133.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$110.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$133.52
Rate for Payer: Cash Price	$168.30
Rate for Payer: UnitedHealthcare Commercial	$124.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.32

PIPERAC/TAZOBACT (ZOSYN)2.25GM IVPB

Facility

$111.00

Service Code	HCPCS J2543
Hospital Charge Code	2626508
Hospital Revenue Code	250
Min. Negotiated Rate	$39.96
Max. Negotiated Rate	$79.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.25
Rate for Payer: Cash Price	$99.90
Rate for Payer: UnitedHealthcare Commercial	$74.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.96

PIPERAC/TAZOBACT (ZOSYN)2.25GM IVPB

Facility

$111.00

Service Code	HCPCS J2543
Hospital Charge Code	2626508
Hospital Revenue Code	250
Rate for Payer: Cash Price	$99.90

PIPERAC/TAZOBACT(ZOSYN) 3.375GM IVPB

Facility

$153.00

Service Code	HCPCS J2543
Hospital Charge Code	2626330
Hospital Revenue Code	250
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$109.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: UnitedHealthcare Commercial	$102.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

PIPERAC/TAZOBACT(ZOSYN) 3.375GM IVPB

Facility

$153.00

Service Code	HCPCS J2543
Hospital Charge Code	2626330
Hospital Revenue Code	250
Rate for Payer: Cash Price	$137.70

PIROXICAM 10MG CAP EMP

Facility

$20.00

Service Code	NDC 4.2571E+10
Hospital Charge Code	2619566
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

PIROXICAM 10MG CAP EMP

Facility

$20.00

Service Code	NDC 4.2571E+10
Hospital Charge Code	2619566
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

PIROXICAM 20MG CAP EMP

Facility

$20.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2619516
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

PIROXICAM 20MG CAP EMP

Facility

$20.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2619516
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

PISTON FEEDING SYRINGE

Facility

$18.00

Hospital Charge Code	280025
Hospital Revenue Code	271
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

PISTON FEEDING SYRINGE

Facility

$18.00

Hospital Charge Code	280025
Hospital Revenue Code	271
Rate for Payer: Cash Price	$16.20

PLACEMENT OF NEEDLES INTO MUSCLE/SOFT TI

Facility

$280.00

Service Code	CPT 20553
Hospital Charge Code	9320553
Hospital Revenue Code	521
Min. Negotiated Rate	$165.76
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$165.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$199.92
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$186.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PLACEMENT OF NEEDLES INTO MUSCLE/SOFT TI

Facility

$280.00

Service Code	CPT 20553
Hospital Charge Code	9320553
Hospital Revenue Code	521
Rate for Payer: Cash Price	$252.00

PLASMINOGEN ACTIVATOR INHIBITOR

Facility

$373.00

Service Code	CPT 85415
Hospital Charge Code	2254150
Hospital Revenue Code	305
Min. Negotiated Rate	$15.47
Max. Negotiated Rate	$266.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.47
Rate for Payer: Aetna Medicare Advantage	$17.19
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: Cash Price	$335.70
Rate for Payer: Cash Price	$335.70
Rate for Payer: Cigna Commercial HMO & PPO	$17.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.55
Rate for Payer: Home State Health Plan Medicare Advantage	$17.19
Rate for Payer: Humana Commercial	$34.38
Rate for Payer: Humana Medicare Advantage	$17.19
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$134.28

PLASMINOGEN ACTIVATOR INHIBITOR

Facility

$373.00

Service Code	CPT 85415
Hospital Charge Code	2254150
Hospital Revenue Code	305
Rate for Payer: Cash Price	$335.70

PLASTER, 2 IN

Facility

$42.00

Hospital Charge Code	2816322
Hospital Revenue Code	271
Rate for Payer: Cash Price	$37.80

PLASTER, 2 IN

Facility

$42.00

Hospital Charge Code	2816322
Hospital Revenue Code	271
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

PLASTER, 3 IN

Facility

$42.00

Hospital Charge Code	2816323
Hospital Revenue Code	271
Rate for Payer: Cash Price	$37.80

PLASTER, 3 IN

Facility

$42.00

Hospital Charge Code	2816323
Hospital Revenue Code	271
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

PLASTER, 4 IN

Facility

$48.00

Hospital Charge Code	2816324
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

PLASTER, 4 IN

Facility

$48.00

Hospital Charge Code	2816324
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

PLASTER, 5 IN

Facility

$48.00

Hospital Charge Code	2816330
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

PLASTER, 5 IN

Facility

$48.00

Hospital Charge Code	2816330
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

Know your out-of-pocket cost for care.

All Charges