Madison Medical Center

All Charges

Charge

Type

Setting

Price

PRAMIPEXOLE (MIRAPEX) 1MG TAB EMP

Facility

$28.00

Service Code	NDC 555061414
Hospital Charge Code	2626500
Hospital Revenue Code	250
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

PRAVASTATIN 10MG TAB EMP

Facility

$22.00

Service Code	NDC 1E+11
Hospital Charge Code	2618968
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

PRAVASTATIN 10MG TAB EMP

Facility

$22.00

Service Code	NDC 1E+11
Hospital Charge Code	2618968
Hospital Revenue Code	250
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

PRAVASTATIN 20MG TAB EMP

Facility

$28.00

Service Code	NDC 904589261
Hospital Charge Code	2698514
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

PRAVASTATIN 20MG TAB EMP

Facility

$28.00

Service Code	NDC 904589261
Hospital Charge Code	2698514
Hospital Revenue Code	250
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

PRAVASTATIN 40MG TAB EMP

Facility

$28.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2619622
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

PRAVASTATIN 40MG TAB EMP

Facility

$28.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2619622
Hospital Revenue Code	250
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

PRAVASTATIN (PRAVACHOL) 20MG TAB UD

Facility

$28.00

Service Code	NDC 904589261
Hospital Charge Code	2626317
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

PRAVASTATIN (PRAVACHOL) 20MG TAB UD

Facility

$28.00

Service Code	NDC 904589261
Hospital Charge Code	2626317
Hospital Revenue Code	250
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

PREALBUMIN

Facility

$124.00

Service Code	CPT 84134
Hospital Charge Code	2284134
Hospital Revenue Code	301
Min. Negotiated Rate	$13.13
Max. Negotiated Rate	$88.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.13
Rate for Payer: Aetna Medicare Advantage	$14.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial HMO & PPO	$14.59
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.05
Rate for Payer: Home State Health Plan Medicare Advantage	$14.59
Rate for Payer: Humana Commercial	$29.18
Rate for Payer: Humana Medicare Advantage	$14.59
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

PREALBUMIN

Facility

$124.00

Service Code	CPT 84134
Hospital Charge Code	2284134
Hospital Revenue Code	301
Rate for Payer: Cash Price	$111.60

PRECCLAMPSIA PANEL

Facility

$19.00

Service Code	CPT 84550
Hospital Charge Code	4284550
Hospital Revenue Code	521
Min. Negotiated Rate	$3.66
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.07
Rate for Payer: Aetna Medicare Advantage	$4.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cigna Commercial HMO & PPO	$4.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.35
Rate for Payer: Home State Health Plan Medicare Advantage	$4.52
Rate for Payer: Humana Commercial	$9.04
Rate for Payer: Humana Medicare Advantage	$4.52
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PRECCLAMPSIA PANEL

Facility

$19.00

Service Code	CPT 84550
Hospital Charge Code	4284550
Hospital Revenue Code	521
Rate for Payer: Cash Price	$17.10

PRECCLAMPSIA PANEL

Facility

$22.00

Service Code	CPT 85025
Hospital Charge Code	4285025
Hospital Revenue Code	521
Rate for Payer: Cash Price	$19.80

PRECCLAMPSIA PANEL

Facility

$22.00

Service Code	CPT 85730
Hospital Charge Code	4285730
Hospital Revenue Code	521
Min. Negotiated Rate	$4.87
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.41
Rate for Payer: Aetna Medicare Advantage	$6.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$6.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.79
Rate for Payer: Home State Health Plan Medicare Advantage	$6.01
Rate for Payer: Humana Commercial	$12.02
Rate for Payer: Humana Medicare Advantage	$6.01
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PRECCLAMPSIA PANEL

Facility

$22.00

Service Code	CPT 85730
Hospital Charge Code	4285730
Hospital Revenue Code	521
Rate for Payer: Cash Price	$19.80

PRECCLAMPSIA PANEL

Facility

$20.00

Service Code	CPT 84450
Hospital Charge Code	4284450
Hospital Revenue Code	521
Rate for Payer: Cash Price	$18.00

PRECCLAMPSIA PANEL

Facility

$22.00

Service Code	CPT 85025
Hospital Charge Code	4285025
Hospital Revenue Code	521
Min. Negotiated Rate	$6.29
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.99
Rate for Payer: Aetna Medicare Advantage	$7.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$7.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.48
Rate for Payer: Home State Health Plan Medicare Advantage	$7.77
Rate for Payer: Humana Commercial	$15.54
Rate for Payer: Humana Medicare Advantage	$7.77
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PRECCLAMPSIA PANEL

Facility

$20.00

Service Code	CPT 84450
Hospital Charge Code	4284450
Hospital Revenue Code	521
Min. Negotiated Rate	$4.19
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.66
Rate for Payer: Aetna Medicare Advantage	$5.18
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: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cigna Commercial HMO & PPO	$5.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.19
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.99
Rate for Payer: Home State Health Plan Medicare Advantage	$5.18
Rate for Payer: Humana Commercial	$10.36
Rate for Payer: Humana Medicare Advantage	$5.18
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC

Facility

$26,633.20

Service Code	MSDRG 067
Min. Negotiated Rate	$13,316.60
Max. Negotiated Rate	$26,633.20
Rate for Payer: Aetna Medicare Advantage	$13,316.60
Rate for Payer: Cigna Commercial HMO & PPO	$13,316.60
Rate for Payer: Home State Health Plan Medicare Advantage	$13,316.60
Rate for Payer: Humana Commercial	$26,633.20
Rate for Payer: Humana Medicare Advantage	$13,316.60

PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC

Facility

$17,171.84

Service Code	MSDRG 068
Min. Negotiated Rate	$8,585.92
Max. Negotiated Rate	$17,171.84
Rate for Payer: Aetna Medicare Advantage	$8,585.92
Rate for Payer: Cigna Commercial HMO & PPO	$8,585.92
Rate for Payer: Home State Health Plan Medicare Advantage	$8,585.92
Rate for Payer: Humana Commercial	$17,171.84
Rate for Payer: Humana Medicare Advantage	$8,585.92

PRECIP BASIN

Facility

$131.00

Hospital Charge Code	2816848
Hospital Revenue Code	271
Rate for Payer: Cash Price	$117.90

PRECIP BASIN

Facility

$131.00

Hospital Charge Code	2816848
Hospital Revenue Code	271
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$93.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$77.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$93.53
Rate for Payer: Cash Price	$117.90
Rate for Payer: UnitedHealthcare Commercial	$87.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.16

PREDLO/MOXI/BROM 1%/0.5%/0.09% OP SOL

Facility

$58.00

Service Code	NDC 1E+11
Hospital Charge Code	2620680
Hospital Revenue Code	250
Rate for Payer: Cash Price	$52.20

PREDLO/MOXI/BROM 1%/0.5%/0.09% OP SOL

Facility

$58.00

Service Code	NDC 1E+11
Hospital Charge Code	2620680
Hospital Revenue Code	250
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

Know your out-of-pocket cost for care.

All Charges