Madison Medical Center

All Charges

Charge

Type

Setting

Price

PROCTOZONE-HC 2.5% CRM 30GM EMP

Facility

$75.00

Service Code	NDC 6.498E+10
Hospital Charge Code	2625635
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

PROCTOZONE-HC 2.5% CRM 30GM EMP

Facility

$75.00

Service Code	NDC 6.498E+10
Hospital Charge Code	2625635
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

PROGESTERONE

Facility

$156.00

Service Code	CPT 84144
Hospital Charge Code	2216301
Hospital Revenue Code	301
Rate for Payer: Cash Price	$140.40

PROGESTERONE

Facility

$84.00

Service Code	CPT 84144
Hospital Charge Code	4284144
Hospital Revenue Code	521
Rate for Payer: Cash Price	$75.60

PROGESTERONE

Facility

$156.00

Service Code	CPT 84144
Hospital Charge Code	2216301
Hospital Revenue Code	301
Min. Negotiated Rate	$18.77
Max. Negotiated Rate	$111.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.77
Rate for Payer: Aetna Medicare Advantage	$20.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial HMO & PPO	$20.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.08
Rate for Payer: Home State Health Plan Medicare Advantage	$20.86
Rate for Payer: Humana Commercial	$41.72
Rate for Payer: Humana Medicare Advantage	$20.86
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

PROGESTERONE

Facility

$84.00

Service Code	CPT 84144
Hospital Charge Code	4284144
Hospital Revenue Code	521
Min. Negotiated Rate	$16.89
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.77
Rate for Payer: Aetna Medicare Advantage	$20.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$49.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$59.98
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cigna Commercial HMO & PPO	$20.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.08
Rate for Payer: Home State Health Plan Medicare Advantage	$20.86
Rate for Payer: Humana Commercial	$41.72
Rate for Payer: Humana Medicare Advantage	$20.86
Rate for Payer: UnitedHealthcare Commercial	$56.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PROGESTERONE (PROMETRIUM) 100MG CAP EMP

Facility

$55.00

Service Code	NDC 5.9651E+10
Hospital Charge Code	2622602
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

PROGESTERONE (PROMETRIUM) 100MG CAP EMP

Facility

$55.00

Service Code	NDC 5.9651E+10
Hospital Charge Code	2622602
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

PROGESTERONE (PROMETRIUM) 200MG CAP EMP

Facility

$55.00

Service Code	NDC 6.9543E+10
Hospital Charge Code	2624793
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

PROGESTERONE (PROMETRIUM) 200MG CAP EMP

Facility

$55.00

Service Code	NDC 6.9543E+10
Hospital Charge Code	2624793
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

PROGESTRONE____MG IM

Facility

$137.00

Service Code	CPT J2675
Hospital Charge Code	42907820
Hospital Revenue Code	521
Rate for Payer: Cash Price	$123.30

PROGESTRONE____MG IM

Facility

$137.00

Service Code	CPT J2675
Hospital Charge Code	42907820
Hospital Revenue Code	521
Min. Negotiated Rate	$81.10
Max. Negotiated Rate	$173.53
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: UnitedHealthcare Commercial	$91.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PROINSULIN

Facility

$333.00

Service Code	CPT 84206
Hospital Charge Code	2284206
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$237.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$24.02
Rate for Payer: Aetna Medicare Advantage	$26.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$197.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$237.76
Rate for Payer: Cash Price	$299.70
Rate for Payer: Cash Price	$299.70
Rate for Payer: Cash Price	$299.70
Rate for Payer: Cigna Commercial HMO & PPO	$26.69
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25.70
Rate for Payer: Home State Health Plan Medicare Advantage	$26.69
Rate for Payer: Humana Commercial	$53.38
Rate for Payer: Humana Medicare Advantage	$26.69
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$119.88

PROINSULIN

Facility

$333.00

Service Code	CPT 84206
Hospital Charge Code	2284206
Hospital Revenue Code	301
Rate for Payer: Cash Price	$299.70

PROLACTIN

Facility

$84.00

Service Code	CPT 84146
Hospital Charge Code	4284146
Hospital Revenue Code	521
Min. Negotiated Rate	$15.70
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$17.44
Rate for Payer: Aetna Medicare Advantage	$19.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$49.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$59.98
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cash Price	$75.60
Rate for Payer: Cigna Commercial HMO & PPO	$19.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18.66
Rate for Payer: Home State Health Plan Medicare Advantage	$19.38
Rate for Payer: Humana Commercial	$38.76
Rate for Payer: Humana Medicare Advantage	$19.38
Rate for Payer: UnitedHealthcare Commercial	$56.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PROLACTIN

Facility

$185.00

Service Code	CPT 84146
Hospital Charge Code	2216600
Hospital Revenue Code	301
Rate for Payer: Cash Price	$166.50

PROLACTIN

Facility

$185.00

Service Code	CPT 84146
Hospital Charge Code	2216600
Hospital Revenue Code	301
Min. Negotiated Rate	$17.44
Max. Negotiated Rate	$132.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$17.44
Rate for Payer: Aetna Medicare Advantage	$19.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$109.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.09
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cigna Commercial HMO & PPO	$19.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.44
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18.66
Rate for Payer: Home State Health Plan Medicare Advantage	$19.38
Rate for Payer: Humana Commercial	$38.76
Rate for Payer: Humana Medicare Advantage	$19.38
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.60

PROLACTIN

Facility

$84.00

Service Code	CPT 84146
Hospital Charge Code	4284146
Hospital Revenue Code	521
Rate for Payer: Cash Price	$75.60

PROLENE

Facility

$76.00

Hospital Charge Code	1269120
Hospital Revenue Code	271
Min. Negotiated Rate	$27.36
Max. Negotiated Rate	$54.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.26
Rate for Payer: Cash Price	$68.40
Rate for Payer: UnitedHealthcare Commercial	$50.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.36

PROLENE

Facility

$76.00

Hospital Charge Code	1269120
Hospital Revenue Code	271
Rate for Payer: Cash Price	$68.40

PROLENSA 0.7% OP SOL 3ML EMP

Facility

$499.00

Service Code	NDC 2.4208E+10
Hospital Charge Code	2624479
Hospital Revenue Code	250
Min. Negotiated Rate	$179.64
Max. Negotiated Rate	$356.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$295.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$356.29
Rate for Payer: Cash Price	$449.10
Rate for Payer: UnitedHealthcare Commercial	$332.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$179.64

PROLENSA 0.7% OP SOL 3ML EMP

Facility

$499.00

Service Code	NDC 2.4208E+10
Hospital Charge Code	2624479
Hospital Revenue Code	250
Rate for Payer: Cash Price	$449.10

PROLONGED EVAL AFTER FACE TO FACE 1HOUR

Facility

$250.00

Service Code	CPT 99358
Hospital Charge Code	9899358
Hospital Revenue Code	521
Min. Negotiated Rate	$148.00
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: Cash Price	$225.00
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PROLONGED EVAL AFTER FACE TO FACE 1HOUR

Facility

$250.00

Service Code	CPT 99358
Hospital Charge Code	9899358
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

PROLONGED EVAL AFTER FACE TO FACE 30 MIN

Facility

$150.00

Service Code	CPT 99359
Hospital Charge Code	9899359
Hospital Revenue Code	521
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges