Madison Medical Center

All Charges

Charge

Type

Setting

Price

PREP TRAY E.R.

Facility

$39.00

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

PREPUTIAL STRETCHING

Professional

Both

$194.00

Service Code	CPT 54450
Hospital Charge Code	4154450
Hospital Revenue Code	975
Min. Negotiated Rate	$49.06
Max. Negotiated Rate	$67.90
Rate for Payer: Aetna Commercial/Medicare Advantage	$49.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$50.84
Rate for Payer: Cash Price	$174.60
Rate for Payer: Cash Price	$174.60
Rate for Payer: Cigna Commercial HMO & PPO	$49.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$50.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$55.92
Rate for Payer: Home State Health Plan Medicare Advantage	$49.06
Rate for Payer: Optum Medicare Advantage	$67.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$50.84

PRESSURE PAD

Facility

$42.00

Service Code	NDC 1E+11
Hospital Charge Code	2696416
Hospital Revenue Code	250
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

PRESSURE PAD

Facility

$42.00

Service Code	NDC 1E+11
Hospital Charge Code	2696416
Hospital Revenue Code	250
Rate for Payer: Cash Price	$37.80

PRESSURE, PAD

Facility

$43.00

Hospital Charge Code	2813103
Hospital Revenue Code	946
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

PRESSURE, PAD

Facility

$43.00

Hospital Charge Code	2813103
Hospital Revenue Code	946
Rate for Payer: Cash Price	$38.70

PREVENTATIVE MEDICINE COUNSELING 15 MIN

Facility

$100.00

Service Code	CPT 99401
Hospital Charge Code	9899401
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

PREVENTATIVE MEDICINE COUNSELING 15 MIN

Facility

$100.00

Service Code	CPT 99401
Hospital Charge Code	9899401
Hospital Revenue Code	521
Min. Negotiated Rate	$59.20
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PRIAPISM (PENILE ENGORGEMENT)

Professional

Both

$1,415.00

Service Code	CPT 54220
Hospital Charge Code	1854220
Hospital Revenue Code	981
Min. Negotiated Rate	$124.20
Max. Negotiated Rate	$495.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$124.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$165.83
Rate for Payer: Cash Price	$1,273.50
Rate for Payer: Cash Price	$1,273.50
Rate for Payer: Cigna Commercial HMO & PPO	$124.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$165.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$182.41
Rate for Payer: Home State Health Plan Medicare Advantage	$124.20
Rate for Payer: Optum Medicare Advantage	$495.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$165.83

PRIMIDONE

Facility

$41.00

Service Code	CPT 80188
Hospital Charge Code	2280188
Hospital Revenue Code	301
Rate for Payer: Cash Price	$36.90

PRIMIDONE

Facility

$41.00

Service Code	CPT 80188
Hospital Charge Code	2280188
Hospital Revenue Code	301
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$33.18
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.93
Rate for Payer: Aetna Medicare Advantage	$16.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.27
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cash Price	$36.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.59
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.98
Rate for Payer: Home State Health Plan Medicare Advantage	$16.59
Rate for Payer: Humana Commercial	$33.18
Rate for Payer: Humana Medicare Advantage	$16.59
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.76

PRIMIDONE (MYSOLINE) 250MG TAB EMP

Facility

$18.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2624733
Hospital Revenue Code	250
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

PRIMIDONE (MYSOLINE) 250MG TAB EMP

Facility

$18.00

Service Code	NDC 5.3746E+10
Hospital Charge Code	2624733
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PRIMIDONE (MYSOLINE) 50MG TAB UD

Facility

$18.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2626524
Hospital Revenue Code	250
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

PRIMIDONE (MYSOLINE) 50MG TAB UD

Facility

$18.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2626524
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PRISMA AG

Facility

$21.00

Hospital Charge Code	28403766
Hospital Revenue Code	271
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

PRISMA AG

Facility

$21.00

Hospital Charge Code	28403766
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

PROBENECID 500MG TAB EMP

Facility

$20.00

Service Code	NDC 591534701
Hospital Charge Code	2622143
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

PROBENECID 500MG TAB EMP

Facility

$20.00

Service Code	NDC 591534701
Hospital Charge Code	2622143
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

PRO BNP (LABCORP TEST)

Facility

$346.00

Service Code	CPT 83880
Hospital Charge Code	2283530
Hospital Revenue Code	301
Rate for Payer: Cash Price	$311.40

PRO BNP (LABCORP TEST)

Facility

$346.00

Service Code	CPT 83880
Hospital Charge Code	2283530
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$247.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$35.33
Rate for Payer: Aetna Medicare Advantage	$39.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$204.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$247.04
Rate for Payer: Cash Price	$311.40
Rate for Payer: Cash Price	$311.40
Rate for Payer: Cash Price	$311.40
Rate for Payer: Cigna Commercial HMO & PPO	$39.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$35.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37.80
Rate for Payer: Home State Health Plan Medicare Advantage	$39.26
Rate for Payer: Humana Commercial	$78.52
Rate for Payer: Humana Medicare Advantage	$39.26
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$35.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.56

PROCAINAMIDE

Facility

$110.00

Service Code	CPT 80192
Hospital Charge Code	2216128
Hospital Revenue Code	301
Min. Negotiated Rate	$15.08
Max. Negotiated Rate	$78.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.08
Rate for Payer: Aetna Medicare Advantage	$16.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$16.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.14
Rate for Payer: Home State Health Plan Medicare Advantage	$16.75
Rate for Payer: Humana Commercial	$33.50
Rate for Payer: Humana Medicare Advantage	$16.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

PROCAINAMIDE

Facility

$110.00

Service Code	CPT 80192
Hospital Charge Code	2216128
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

PROCAINAMIDE (PROCAN) 500MG SR TAB

Facility

$9.00

Service Code	NDC 3.8245E+10
Hospital Charge Code	2656010
Hospital Revenue Code	250
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$6.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$6.43
Rate for Payer: Cash Price	$8.10
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.24

PROCAINAMIDE (PROCAN) 500MG SR TAB

Facility

$9.00

Service Code	NDC 3.8245E+10
Hospital Charge Code	2656010
Hospital Revenue Code	250
Rate for Payer: Cash Price	$8.10

Know your out-of-pocket cost for care.

All Charges