Madison Medical Center

All Charges

Charge

Type

Setting

Price

PREGNANCY TEST

Facility

$73.00

Hospital Charge Code	120012
Hospital Revenue Code	510
Rate for Payer: Cash Price	$65.70

PREGNANCY TEST

Facility

$73.00

Hospital Charge Code	120012
Hospital Revenue Code	510
Min. Negotiated Rate	$26.28
Max. Negotiated Rate	$52.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$43.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$52.12
Rate for Payer: Cash Price	$65.70
Rate for Payer: UnitedHealthcare Commercial	$48.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.28

PREGNANCY TEST SERUM

Facility

$93.00

Service Code	CPT 84703
Hospital Charge Code	2284703
Hospital Revenue Code	301
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$66.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.77
Rate for Payer: Aetna Medicare Advantage	$7.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cigna Commercial HMO & PPO	$7.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.24
Rate for Payer: Home State Health Plan Medicare Advantage	$7.52
Rate for Payer: Humana Commercial	$15.04
Rate for Payer: Humana Medicare Advantage	$7.52
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

PREGNANCY TEST SERUM

Facility

$93.00

Service Code	CPT 84703
Hospital Charge Code	2284703
Hospital Revenue Code	301
Rate for Payer: Cash Price	$83.70

PREGNANCY TEST URINE

Facility

$93.00

Service Code	CPT 81025
Hospital Charge Code	2216192
Hospital Revenue Code	301
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$66.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.75
Rate for Payer: Aetna Medicare Advantage	$8.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cash Price	$83.70
Rate for Payer: Cigna Commercial HMO & PPO	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.29
Rate for Payer: Home State Health Plan Medicare Advantage	$8.61
Rate for Payer: Humana Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$8.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

PREGNANCY TEST URINE

Facility

$93.00

Service Code	CPT 81025
Hospital Charge Code	2216192
Hospital Revenue Code	301
Rate for Payer: Cash Price	$83.70

PREGNENOLONE

Facility

$521.00

Service Code	CPT 84140
Hospital Charge Code	2284140
Hospital Revenue Code	301
Rate for Payer: Cash Price	$468.90

PREGNENOLONE

Facility

$521.00

Service Code	CPT 84140
Hospital Charge Code	2284140
Hospital Revenue Code	301
Min. Negotiated Rate	$18.60
Max. Negotiated Rate	$371.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.60
Rate for Payer: Aetna Medicare Advantage	$20.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$308.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$371.99
Rate for Payer: Cash Price	$468.90
Rate for Payer: Cash Price	$468.90
Rate for Payer: Cash Price	$468.90
Rate for Payer: Cigna Commercial HMO & PPO	$20.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19.90
Rate for Payer: Home State Health Plan Medicare Advantage	$20.67
Rate for Payer: Humana Commercial	$41.34
Rate for Payer: Humana Medicare Advantage	$20.67
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$187.56

PREMARIN VAG CREAM 30GM EMP

Facility

$972.00

Service Code	NDC 46087221
Hospital Charge Code	2623025
Hospital Revenue Code	250
Min. Negotiated Rate	$349.92
Max. Negotiated Rate	$694.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$575.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$694.01
Rate for Payer: Cash Price	$874.80
Rate for Payer: UnitedHealthcare Commercial	$648.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$349.92

PREMARIN VAG CREAM 30GM EMP

Facility

$972.00

Service Code	NDC 46087221
Hospital Charge Code	2623025
Hospital Revenue Code	250
Rate for Payer: Cash Price	$874.80

PREMATURITY WITH MAJOR PROBLEMS

Facility

$67,571.28

Service Code	MSDRG 791
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$67,571.28
Rate for Payer: Aetna Medicare Advantage	$33,785.64
Rate for Payer: Cigna Commercial HMO & PPO	$33,785.64
Rate for Payer: Home State Health Plan Medicare Advantage	$33,785.64
Rate for Payer: Humana Commercial	$67,571.28
Rate for Payer: Humana Medicare Advantage	$33,785.64
Rate for Payer: UnitedHealthcare Commercial	$351.00

PREMATURITY WITHOUT MAJOR PROBLEMS

Facility

$42,076.84

Service Code	MSDRG 792
Min. Negotiated Rate	$351.00
Max. Negotiated Rate	$42,076.84
Rate for Payer: Aetna Medicare Advantage	$21,038.42
Rate for Payer: Cigna Commercial HMO & PPO	$21,038.42
Rate for Payer: Home State Health Plan Medicare Advantage	$21,038.42
Rate for Payer: Humana Commercial	$42,076.84
Rate for Payer: Humana Medicare Advantage	$21,038.42
Rate for Payer: UnitedHealthcare Commercial	$351.00

PRENATAL PANEL

Facility

$58.00

Service Code	CPT 80055
Hospital Charge Code	4280055
Hospital Revenue Code	521
Rate for Payer: Cash Price	$52.20

PRENATAL PANEL

Facility

$58.00

Service Code	CPT 80055
Hospital Charge Code	4280055
Hospital Revenue Code	521
Min. Negotiated Rate	$34.34
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$43.03
Rate for Payer: Aetna Medicare Advantage	$47.81
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: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cigna Commercial HMO & PPO	$47.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$38.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$46.04
Rate for Payer: Home State Health Plan Medicare Advantage	$47.81
Rate for Payer: Humana Commercial	$95.62
Rate for Payer: Humana Medicare Advantage	$47.81
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$43.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

.PRENATAL URINE CULTURE (CPT ITEM)

Facility

$16.00

Service Code	CPT 87086
Hospital Charge Code	2287086
Hospital Revenue Code	306
Rate for Payer: Cash Price	$14.40

.PRENATAL URINE CULTURE (CPT ITEM)

Facility

$16.00

Service Code	CPT 87086
Hospital Charge Code	2287086
Hospital Revenue Code	306
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.26
Rate for Payer: Aetna Medicare Advantage	$8.07
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: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna Commercial HMO & PPO	$8.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.77
Rate for Payer: Home State Health Plan Medicare Advantage	$8.07
Rate for Payer: Humana Commercial	$16.14
Rate for Payer: Humana Medicare Advantage	$8.07
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

PRE-PEN TEST

Facility

$44.00

Service Code	NDC 1E+11
Hospital Charge Code	2656000
Hospital Revenue Code	250
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

PRE-PEN TEST

Facility

$44.00

Service Code	NDC 1E+11
Hospital Charge Code	2656000
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

PRE PHLEBOTOMY HEMOGLOBIN

Facility

$67.00

Service Code	CPT 85018
Hospital Charge Code	228106
Hospital Revenue Code	305
Min. Negotiated Rate	$2.13
Max. Negotiated Rate	$47.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.13
Rate for Payer: Aetna Medicare Advantage	$2.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cigna Commercial HMO & PPO	$2.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2.28
Rate for Payer: Home State Health Plan Medicare Advantage	$2.37
Rate for Payer: Humana Commercial	$4.74
Rate for Payer: Humana Medicare Advantage	$2.37
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

PRE PHLEBOTOMY HEMOGLOBIN

Facility

$67.00

Service Code	CPT 85018
Hospital Charge Code	228106
Hospital Revenue Code	305
Rate for Payer: Cash Price	$60.30

PREP SET OR

Facility

$62.00

Hospital Charge Code	2817064
Hospital Revenue Code	271
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

PREP SET OR

Facility

$62.00

Hospital Charge Code	2817064
Hospital Revenue Code	271
Rate for Payer: Cash Price	$55.80

PREP SET (SKIN)

Facility

$67.00

Hospital Charge Code	1217064
Hospital Revenue Code	271
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

PREP SET (SKIN)

Facility

$67.00

Hospital Charge Code	1217064
Hospital Revenue Code	271
Rate for Payer: Cash Price	$60.30

PREP TRAY E.R.

Facility

$39.00

Hospital Charge Code	2816009
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

Know your out-of-pocket cost for care.

All Charges