Madison Medical Center

All Charges

Charge

Type

Setting

Price

.PROCALCITONIN

Facility

$402.00

Service Code	CPT 84145
Hospital Charge Code	223302
Hospital Revenue Code	301
Rate for Payer: Cash Price	$361.80

.PROCALCITONIN

Facility

$402.00

Service Code	CPT 84145
Hospital Charge Code	223302
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$287.03
Rate for Payer: Aetna Better Health Medicaid/QHP	$24.50
Rate for Payer: Aetna Medicare Advantage	$27.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$237.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$287.03
Rate for Payer: Cash Price	$361.80
Rate for Payer: Cash Price	$361.80
Rate for Payer: Cash Price	$361.80
Rate for Payer: Cigna Commercial HMO & PPO	$27.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.21
Rate for Payer: Home State Health Plan Medicare Advantage	$27.22
Rate for Payer: Humana Commercial	$54.44
Rate for Payer: Humana Medicare Advantage	$27.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$144.72

.PROCALCITONIN (LABCORP)

Facility

$402.00

Service Code	CPT 84145
Hospital Charge Code	223303
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$287.03
Rate for Payer: Aetna Better Health Medicaid/QHP	$24.50
Rate for Payer: Aetna Medicare Advantage	$27.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$237.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$287.03
Rate for Payer: Cash Price	$361.80
Rate for Payer: Cash Price	$361.80
Rate for Payer: Cash Price	$361.80
Rate for Payer: Cigna Commercial HMO & PPO	$27.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.21
Rate for Payer: Home State Health Plan Medicare Advantage	$27.22
Rate for Payer: Humana Commercial	$54.44
Rate for Payer: Humana Medicare Advantage	$27.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$144.72

.PROCALCITONIN (LABCORP)

Facility

$402.00

Service Code	CPT 84145
Hospital Charge Code	223303
Hospital Revenue Code	301
Rate for Payer: Cash Price	$361.80

PROCALCITONIN (ORTHO)

Facility

$264.00

Service Code	CPT 84145
Hospital Charge Code	223304
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$188.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$24.50
Rate for Payer: Aetna Medicare Advantage	$27.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$156.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$188.50
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cigna Commercial HMO & PPO	$27.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.21
Rate for Payer: Home State Health Plan Medicare Advantage	$27.22
Rate for Payer: Humana Commercial	$54.44
Rate for Payer: Humana Medicare Advantage	$27.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.04

PROCALCITONIN (ORTHO)

Facility

$264.00

Service Code	CPT 84145
Hospital Charge Code	223304
Hospital Revenue Code	301
Rate for Payer: Cash Price	$237.60

PROCEDURES FOR OBESITY

Facility

$23,737.95

Service Code	APR-DRG 4033
Min. Negotiated Rate	$23,737.95
Max. Negotiated Rate	$23,737.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$23,737.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23,737.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23,737.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23,737.95

PROCEDURES FOR OBESITY

Facility

$7,336.98

Service Code	APR-DRG 4032
Min. Negotiated Rate	$7,336.98
Max. Negotiated Rate	$7,336.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,336.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,336.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,336.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,336.98

PROCEDURES FOR OBESITY

Facility

$50,429.74

Service Code	APR-DRG 4034
Min. Negotiated Rate	$50,429.74
Max. Negotiated Rate	$50,429.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$50,429.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$50,429.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$50,429.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$50,429.74

PROCEDURES FOR OBESITY

Facility

$5,995.51

Service Code	APR-DRG 4031
Min. Negotiated Rate	$5,995.51
Max. Negotiated Rate	$5,995.51
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,995.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,995.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,995.51
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,995.51

PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES

Facility

$26,158.34

Service Code	APR-DRG 8502
Min. Negotiated Rate	$26,158.34
Max. Negotiated Rate	$26,158.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$26,158.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26,158.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26,158.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26,158.34

PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES

Facility

$65,250.70

Service Code	APR-DRG 8504
Min. Negotiated Rate	$65,250.70
Max. Negotiated Rate	$65,250.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$65,250.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$65,250.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$65,250.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$65,250.70

PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES

Facility

$15,687.24

Service Code	APR-DRG 8501
Min. Negotiated Rate	$15,687.24
Max. Negotiated Rate	$15,687.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,687.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,687.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,687.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,687.24

PROCEDURE WITH DIAGNOSIS OF REHABILITATION, AFTERCARE OR OTHER CONTACT WITH HEALTH SERVICES

Facility

$37,613.13

Service Code	APR-DRG 8503
Min. Negotiated Rate	$37,613.13
Max. Negotiated Rate	$37,613.13
Rate for Payer: Aetna Better Health Medicaid/QHP	$37,613.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37,613.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37,613.13
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37,613.13

PROCHLORPERAZINE 5MG TAB

Facility

$32.00

Service Code	NDC 378510501
Hospital Charge Code	2620697
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

PROCHLORPERAZINE 5MG TAB

Facility

$32.00

Service Code	NDC 378510501
Hospital Charge Code	2620697
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

PROCHLORPER (COMPAZINE) 10MG 2ML INJ

Facility

$93.00

Service Code	HCPCS J0780
Hospital Charge Code	2696421
Hospital Revenue Code	250
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$66.40
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: UnitedHealthcare Commercial	$62.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

PROCHLORPER (COMPAZINE) 10MG 2ML INJ

Facility

$93.00

Service Code	HCPCS J0780
Hospital Charge Code	2696421
Hospital Revenue Code	250
Rate for Payer: Cash Price	$83.70

PROCTOSIGMOIDOSCOPY

Professional

Both

$448.00

Service Code	CPT 45300
Hospital Charge Code	1845300
Hospital Revenue Code	981
Min. Negotiated Rate	$42.95
Max. Negotiated Rate	$156.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$42.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$98.79
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cigna Commercial HMO & PPO	$42.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$98.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$108.67
Rate for Payer: Home State Health Plan Medicare Advantage	$42.95
Rate for Payer: Optum Medicare Advantage	$156.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$98.79

PROCTOSIGMOIDOSCOPY,RIGID DIAG. COLL-SPE

Professional

Both

$123.00

Service Code	CPT 45300
Hospital Charge Code	4145300
Hospital Revenue Code	975
Min. Negotiated Rate	$42.95
Max. Negotiated Rate	$108.67
Rate for Payer: Aetna Commercial/Medicare Advantage	$42.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$98.79
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$42.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$98.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$108.67
Rate for Payer: Home State Health Plan Medicare Advantage	$42.95
Rate for Payer: Optum Medicare Advantage	$43.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$98.79

PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHER LESION BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY

Facility

$5,671.56

Service Code	CPT 45308
Hospital Revenue Code	360
Min. Negotiated Rate	$1,462.00
Max. Negotiated Rate	$5,671.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,502.11
Rate for Payer: Aetna Medicare Advantage	$2,835.78
Rate for Payer: Cigna Commercial HMO & PPO	$2,835.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,502.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2,677.26
Rate for Payer: Home State Health Plan Medicare Advantage	$2,835.78
Rate for Payer: Humana Commercial	$5,671.56
Rate for Payer: Humana Medicare Advantage	$2,835.78
Rate for Payer: UnitedHealthcare Commercial	$1,462.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,502.11

PROCTOSIGMOIDOSCOPY,W/BIO SING OR MULTIE

Professional

Both

$246.00

Service Code	CPT 45305
Hospital Charge Code	4145305
Hospital Revenue Code	975
Min. Negotiated Rate	$65.51
Max. Negotiated Rate	$154.38
Rate for Payer: Aetna Commercial/Medicare Advantage	$65.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$140.35
Rate for Payer: Cash Price	$221.40
Rate for Payer: Cash Price	$221.40
Rate for Payer: Cigna Commercial HMO & PPO	$65.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$140.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$154.38
Rate for Payer: Home State Health Plan Medicare Advantage	$65.51
Rate for Payer: Optum Medicare Advantage	$86.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$140.35

PROCTOSIGMOIDSCOPY, RIGID W/OR W/O COLLE

Facility

$137.00

Service Code	CPT 45300
Hospital Charge Code	4445300
Hospital Revenue Code	521
Rate for Payer: Cash Price	$123.30

PROCTOSIGMOIDSCOPY, RIGID W/OR W/O COLLE

Facility

$137.00

Service Code	CPT 45300
Hospital Charge Code	4445300
Hospital Revenue Code	521
Min. Negotiated Rate	$81.10
Max. Negotiated Rate	$1,900.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$838.31
Rate for Payer: Aetna Medicare Advantage	$950.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$81.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$97.82
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cigna Commercial HMO & PPO	$950.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$754.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$896.99
Rate for Payer: Home State Health Plan Medicare Advantage	$950.10
Rate for Payer: Humana Commercial	$1,900.20
Rate for Payer: Humana Medicare Advantage	$950.10
Rate for Payer: UnitedHealthcare Commercial	$91.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$838.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PROCTOSIG W/REM OF TUMORS/POLYPS SNARE..

Professional

Both

$408.00

Service Code	CPT 45315
Hospital Charge Code	4145315
Hospital Revenue Code	975
Min. Negotiated Rate	$95.63
Max. Negotiated Rate	$195.18
Rate for Payer: Aetna Commercial/Medicare Advantage	$95.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$177.44
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cigna Commercial HMO & PPO	$95.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$177.44
Rate for Payer: Home State Health Plan Medicaid Managed Care	$195.18
Rate for Payer: Home State Health Plan Medicare Advantage	$95.63
Rate for Payer: Optum Medicare Advantage	$142.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$177.44

Know your out-of-pocket cost for care.

All Charges