Madison Medical Center

All Charges

Charge

Type

Setting

Price

PM SCL ANTIBODY

Facility

$221.00

Service Code	CPT 86235
Hospital Charge Code	2219921
Hospital Revenue Code	301
Rate for Payer: Cash Price	$198.90

PM SCL ANTIBODY

Facility

$221.00

Service Code	CPT 86235
Hospital Charge Code	2219921
Hospital Revenue Code	301
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$157.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.14
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$130.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.79
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cigna Commercial HMO & PPO	$17.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.27
Rate for Payer: Home State Health Plan Medicare Advantage	$17.93
Rate for Payer: Humana Commercial	$35.86
Rate for Payer: Humana Medicare Advantage	$17.93
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$79.56

PNEUMATIC TURNIQST

Facility

$62.00

Hospital Charge Code	2824484
Hospital Revenue Code	370
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$44.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: UnitedHealthcare Commercial	$41.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

PNEUMATIC TURNIQST

Facility

$62.00

Hospital Charge Code	2824484
Hospital Revenue Code	370
Rate for Payer: Cash Price	$55.80

PNEUMO AB PANEL, 23 SEROTYPES

Facility

$194.50

Service Code	CPT 86581
Hospital Charge Code	2286620
Hospital Revenue Code	301
Rate for Payer: Cash Price	$175.05

PNEUMO AB PANEL, 23 SEROTYPES

Facility

$194.50

Service Code	CPT 86581
Hospital Charge Code	2286620
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$184.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$82.83
Rate for Payer: Aetna Medicare Advantage	$92.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$115.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$138.87
Rate for Payer: Cash Price	$175.05
Rate for Payer: Cash Price	$175.05
Rate for Payer: Cash Price	$175.05
Rate for Payer: Cigna Commercial HMO & PPO	$92.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$82.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$88.63
Rate for Payer: Home State Health Plan Medicare Advantage	$92.03
Rate for Payer: Humana Commercial	$184.06
Rate for Payer: Humana Medicare Advantage	$92.03
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$82.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.02

PNEUMONIA VACCINE 23 POLYVALENT

Facility

$495.00

Service Code	HCPCS 90732
Hospital Charge Code	2655925
Hospital Revenue Code	250
Min. Negotiated Rate	$178.20
Max. Negotiated Rate	$353.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$293.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$353.43
Rate for Payer: Cash Price	$445.50
Rate for Payer: UnitedHealthcare Commercial	$330.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$178.20

PNEUMONIA VACCINE 23 POLYVALENT

Facility

$495.00

Service Code	HCPCS 90732
Hospital Charge Code	2655925
Hospital Revenue Code	250
Rate for Payer: Cash Price	$445.50

PNEUMOTHORAX SET

Facility

$320.00

Hospital Charge Code	3600030
Hospital Revenue Code	350
Rate for Payer: Cash Price	$288.00

PNEUMOTHORAX SET

Facility

$320.00

Hospital Charge Code	3600030
Hospital Revenue Code	350
Min. Negotiated Rate	$115.20
Max. Negotiated Rate	$853.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$853.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$228.48
Rate for Payer: Cash Price	$288.00
Rate for Payer: Cash Price	$288.00
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$115.20

PNEUMOTHORAX WITH CC

Facility

$20,847.88

Service Code	MSDRG 200
Min. Negotiated Rate	$10,423.94
Max. Negotiated Rate	$20,847.88
Rate for Payer: Aetna Medicare Advantage	$10,423.94
Rate for Payer: Cigna Commercial HMO & PPO	$10,423.94
Rate for Payer: Home State Health Plan Medicare Advantage	$10,423.94
Rate for Payer: Humana Commercial	$20,847.88
Rate for Payer: Humana Medicare Advantage	$10,423.94

PNEUMOTHORAX WITH MCC

Facility

$31,283.10

Service Code	MSDRG 199
Min. Negotiated Rate	$15,641.55
Max. Negotiated Rate	$31,283.10
Rate for Payer: Aetna Medicare Advantage	$15,641.55
Rate for Payer: Cigna Commercial HMO & PPO	$15,641.55
Rate for Payer: Home State Health Plan Medicare Advantage	$15,641.55
Rate for Payer: Humana Commercial	$31,283.10
Rate for Payer: Humana Medicare Advantage	$15,641.55

PNEUMOTHORAX WITHOUT CC/MCC

Facility

$14,836.90

Service Code	MSDRG 201
Min. Negotiated Rate	$7,418.45
Max. Negotiated Rate	$14,836.90
Rate for Payer: Aetna Medicare Advantage	$7,418.45
Rate for Payer: Cigna Commercial HMO & PPO	$7,418.45
Rate for Payer: Home State Health Plan Medicare Advantage	$7,418.45
Rate for Payer: Humana Commercial	$14,836.90
Rate for Payer: Humana Medicare Advantage	$7,418.45

PNEUMO VACC 20 CONJUGATE PFS INJ 0.5ML

Facility

$1,052.00

Service Code	HCPCS 90732
Hospital Charge Code	2624810
Hospital Revenue Code	250
Min. Negotiated Rate	$378.72
Max. Negotiated Rate	$751.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$622.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$751.13
Rate for Payer: Cash Price	$946.80
Rate for Payer: UnitedHealthcare Commercial	$701.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$378.72

PNEUMO VACC 20 CONJUGATE PFS INJ 0.5ML

Facility

$1,052.00

Service Code	HCPCS 90732
Hospital Charge Code	2624810
Hospital Revenue Code	250
Rate for Payer: Cash Price	$946.80

PNEUOMOCOCCAL VAC

Facility

$250.00

Service Code	CPT 90732
Hospital Charge Code	4190732
Hospital Revenue Code	636
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

PNEUOMOCOCCAL VAC

Facility

$250.00

Service Code	CPT 90732
Hospital Charge Code	4190732
Hospital Revenue Code	636
Min. Negotiated Rate	$166.75
Max. Negotiated Rate	$166.75
Rate for Payer: Cash Price	$225.00
Rate for Payer: UnitedHealthcare Commercial	$166.75

PNS

Facility

$28.00

Hospital Charge Code	2024485
Hospital Revenue Code	370
Rate for Payer: Cash Price	$25.20

PNS

Facility

$28.00

Hospital Charge Code	2024485
Hospital Revenue Code	370
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

PNUEMATIC TOURNIQUET

Facility

$183.00

Hospital Charge Code	1224484
Hospital Revenue Code	360
Rate for Payer: Cash Price	$164.70

PNUEMATIC TOURNIQUET

Facility

$183.00

Hospital Charge Code	1224484
Hospital Revenue Code	360
Min. Negotiated Rate	$65.88
Max. Negotiated Rate	$122.06
Rate for Payer: Cash Price	$164.70
Rate for Payer: UnitedHealthcare Commercial	$122.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.88

POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC

Facility

$28,200.10

Service Code	MSDRG 917
Min. Negotiated Rate	$14,100.05
Max. Negotiated Rate	$28,200.10
Rate for Payer: Aetna Medicare Advantage	$14,100.05
Rate for Payer: Cigna Commercial HMO & PPO	$14,100.05
Rate for Payer: Home State Health Plan Medicare Advantage	$14,100.05
Rate for Payer: Humana Commercial	$28,200.10
Rate for Payer: Humana Medicare Advantage	$14,100.05

POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC

Facility

$17,057.58

Service Code	MSDRG 918
Min. Negotiated Rate	$8,528.79
Max. Negotiated Rate	$17,057.58
Rate for Payer: Aetna Medicare Advantage	$8,528.79
Rate for Payer: Cigna Commercial HMO & PPO	$8,528.79
Rate for Payer: Home State Health Plan Medicare Advantage	$8,528.79
Rate for Payer: Humana Commercial	$17,057.58
Rate for Payer: Humana Medicare Advantage	$8,528.79

POISONING OF MEDICINAL AGENTS

Facility

$5,932.07

Service Code	APR-DRG 8122
Min. Negotiated Rate	$5,932.07
Max. Negotiated Rate	$5,932.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,932.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,932.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,932.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,932.07

POISONING OF MEDICINAL AGENTS

Facility

$22,841.72

Service Code	APR-DRG 8124
Min. Negotiated Rate	$22,841.72
Max. Negotiated Rate	$22,841.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,841.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,841.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,841.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,841.72

Know your out-of-pocket cost for care.

All Charges