Madison Medical Center

All Charges

Charge

Type

Setting

Price

PLASTER, 6 PER INCH

Facility

$16.00

Hospital Charge Code	2816331
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

PLASTER, 6 PER INCH

Facility

$16.00

Hospital Charge Code	2816331
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

PLASTIC HEEL CAPS

Facility

$16.00

Hospital Charge Code	4070005
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

PLASTIC HEEL CAPS

Facility

$16.00

Hospital Charge Code	4070005
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

PLATELET ANTIBODY

Facility

$325.00

Service Code	CPT 86022
Hospital Charge Code	22860221
Hospital Revenue Code	302
Rate for Payer: Cash Price	$292.50

PLATELET ANTIBODY

Facility

$325.00

Service Code	CPT 86022
Hospital Charge Code	22860221
Hospital Revenue Code	302
Min. Negotiated Rate	$16.53
Max. Negotiated Rate	$232.05
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.53
Rate for Payer: Aetna Medicare Advantage	$18.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.05
Rate for Payer: Cash Price	$292.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: Cigna Commercial HMO & PPO	$18.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.69
Rate for Payer: Home State Health Plan Medicare Advantage	$18.37
Rate for Payer: Humana Commercial	$36.74
Rate for Payer: Humana Medicare Advantage	$18.37
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$117.00

PLATELET ANTIBODY DIRECT

Facility

$254.00

Service Code	CPT 86023
Hospital Charge Code	22860222
Hospital Revenue Code	302
Min. Negotiated Rate	$11.21
Max. Negotiated Rate	$181.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.21
Rate for Payer: Aetna Medicare Advantage	$12.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$181.36
Rate for Payer: Cash Price	$228.60
Rate for Payer: Cash Price	$228.60
Rate for Payer: Cash Price	$228.60
Rate for Payer: Cigna Commercial HMO & PPO	$12.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.99
Rate for Payer: Home State Health Plan Medicare Advantage	$12.46
Rate for Payer: Humana Commercial	$24.92
Rate for Payer: Humana Medicare Advantage	$12.46
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$91.44

PLATELET ANTIBODY DIRECT

Facility

$254.00

Service Code	CPT 86023
Hospital Charge Code	22860222
Hospital Revenue Code	302
Rate for Payer: Cash Price	$228.60

PLATELET CITRATE TUBE

Facility

$70.00

Service Code	CPT 85049
Hospital Charge Code	2216190
Hospital Revenue Code	305
Rate for Payer: Cash Price	$63.00

PLATELET CITRATE TUBE

Facility

$70.00

Service Code	CPT 85049
Hospital Charge Code	2216190
Hospital Revenue Code	305
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$49.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.03
Rate for Payer: Aetna Medicare Advantage	$4.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$4.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.31
Rate for Payer: Home State Health Plan Medicare Advantage	$4.48
Rate for Payer: Humana Commercial	$8.96
Rate for Payer: Humana Medicare Advantage	$4.48
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

PLATELET COUNT

Facility

$70.00

Service Code	CPT 85049
Hospital Charge Code	2216191
Hospital Revenue Code	305
Min. Negotiated Rate	$4.03
Max. Negotiated Rate	$49.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.03
Rate for Payer: Aetna Medicare Advantage	$4.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$4.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.31
Rate for Payer: Home State Health Plan Medicare Advantage	$4.48
Rate for Payer: Humana Commercial	$8.96
Rate for Payer: Humana Medicare Advantage	$4.48
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

PLATELET COUNT

Facility

$70.00

Service Code	CPT 85049
Hospital Charge Code	2216191
Hospital Revenue Code	305
Rate for Payer: Cash Price	$63.00

PLATELET FUNCTION ASSAY

Facility

$335.00

Service Code	CPT 85576
Hospital Charge Code	2280422
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$239.19
Rate for Payer: Aetna Better Health Medicaid/QHP	$22.42
Rate for Payer: Aetna Medicare Advantage	$24.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$198.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$239.19
Rate for Payer: Cash Price	$301.50
Rate for Payer: Cash Price	$301.50
Rate for Payer: Cash Price	$301.50
Rate for Payer: Cigna Commercial HMO & PPO	$24.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.99
Rate for Payer: Home State Health Plan Medicare Advantage	$24.91
Rate for Payer: Humana Commercial	$49.82
Rate for Payer: Humana Medicare Advantage	$24.91
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.60

PLATELET FUNCTION ASSAY

Facility

$335.00

Service Code	CPT 85576
Hospital Charge Code	2280422
Hospital Revenue Code	305
Rate for Payer: Cash Price	$301.50

PLATELETS, PHERESIS EA UNIT

Facility

$1,513.00

Service Code	CPT P9034
Hospital Charge Code	222150
Hospital Revenue Code	305
Rate for Payer: Cash Price	$1,361.70

PLATELETS, PHERESIS EA UNIT

Facility

$1,513.00

Service Code	CPT P9034
Hospital Charge Code	222150
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$1,080.28
Rate for Payer: Aetna Medicare Advantage	$308.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$895.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,080.28
Rate for Payer: Cash Price	$1,361.70
Rate for Payer: Cash Price	$1,361.70
Rate for Payer: Cigna Commercial HMO & PPO	$308.96
Rate for Payer: Home State Health Plan Medicare Advantage	$308.96
Rate for Payer: Humana Commercial	$617.92
Rate for Payer: Humana Medicare Advantage	$308.96
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$544.68

PLEURAL EFFUSION WITH CC

Facility

$19,123.32

Service Code	MSDRG 187
Min. Negotiated Rate	$9,561.66
Max. Negotiated Rate	$19,123.32
Rate for Payer: Aetna Medicare Advantage	$9,561.66
Rate for Payer: Cigna Commercial HMO & PPO	$9,561.66
Rate for Payer: Home State Health Plan Medicare Advantage	$9,561.66
Rate for Payer: Humana Commercial	$19,123.32
Rate for Payer: Humana Medicare Advantage	$9,561.66

PLEURAL EFFUSION WITH MCC

Facility

$28,044.12

Service Code	MSDRG 186
Min. Negotiated Rate	$14,022.06
Max. Negotiated Rate	$28,044.12
Rate for Payer: Aetna Medicare Advantage	$14,022.06
Rate for Payer: Cigna Commercial HMO & PPO	$14,022.06
Rate for Payer: Home State Health Plan Medicare Advantage	$14,022.06
Rate for Payer: Humana Commercial	$28,044.12
Rate for Payer: Humana Medicare Advantage	$14,022.06

PLEURAL EFFUSION WITHOUT CC/MCC

Facility

$14,869.62

Service Code	MSDRG 188
Min. Negotiated Rate	$7,434.81
Max. Negotiated Rate	$14,869.62
Rate for Payer: Aetna Medicare Advantage	$7,434.81
Rate for Payer: Cigna Commercial HMO & PPO	$7,434.81
Rate for Payer: Home State Health Plan Medicare Advantage	$7,434.81
Rate for Payer: Humana Commercial	$14,869.62
Rate for Payer: Humana Medicare Advantage	$7,434.81

PLEUR-EVAC (CAVITY DRAIN SYS)

Facility

$568.00

Hospital Charge Code	2816743
Hospital Revenue Code	271
Min. Negotiated Rate	$204.48
Max. Negotiated Rate	$405.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$336.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$405.55
Rate for Payer: Cash Price	$511.20
Rate for Payer: UnitedHealthcare Commercial	$378.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$204.48

PLEUR-EVAC (CAVITY DRAIN SYS)

Facility

$568.00

Hospital Charge Code	2816743
Hospital Revenue Code	271
Rate for Payer: Cash Price	$511.20

PLEURX DRAINAGE KIT

Facility

$250.00

Hospital Charge Code	2816333
Hospital Revenue Code	271
Rate for Payer: Cash Price	$225.00

PLEURX DRAINAGE KIT

Facility

$250.00

Hospital Charge Code	2816333
Hospital Revenue Code	271
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$178.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.00

PLEURX DRAINAGE KIT 1000ML

Facility

$317.00

Hospital Charge Code	2816745
Hospital Revenue Code	271
Min. Negotiated Rate	$114.12
Max. Negotiated Rate	$226.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$187.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$226.34
Rate for Payer: Cash Price	$285.30
Rate for Payer: UnitedHealthcare Commercial	$211.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$114.12

PLEURX DRAINAGE KIT 1000ML

Facility

$317.00

Hospital Charge Code	2816745
Hospital Revenue Code	271
Rate for Payer: Cash Price	$285.30

Know your out-of-pocket cost for care.

All Charges