Madison Medical Center

All Charges

Charge

Type

Setting

Price

PROPRANOLOL 20MG TAB EMP

Facility

$18.00

Service Code	NDC 591555501
Hospital Charge Code	2623506
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PROPRANOLOL 20MG TAB EMP

Facility

$18.00

Service Code	NDC 591555501
Hospital Charge Code	2623506
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

PROPRANOLOL 40MG TAB EMP

Facility

$18.00

Service Code	NDC 591555601
Hospital Charge Code	2698323
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PROPRANOLOL 40MG TAB EMP

Facility

$18.00

Service Code	NDC 591555601
Hospital Charge Code	2698323
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

PROPRANOLOL 60MG TAB EMP

Facility

$18.00

Service Code	NDC 603548521
Hospital Charge Code	2623318
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

PROPRANOLOL 60MG TAB EMP

Facility

$18.00

Service Code	NDC 603548521
Hospital Charge Code	2623318
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PROPRANOLOL ER 60MG CAP EMP

Facility

$18.00

Service Code	NDC 6.2559E+10
Hospital Charge Code	2623203
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

PROPRANOLOL ER 60MG CAP EMP

Facility

$18.00

Service Code	NDC 6.2559E+10
Hospital Charge Code	2623203
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PROPRANOLOL (INDERAL) 20MG TABLET

Facility

$18.00

Service Code	NDC 6.9238E+10
Hospital Charge Code	2656101
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PROPRANOLOL (INDERAL) 20MG TABLET

Facility

$18.00

Service Code	NDC 6.9238E+10
Hospital Charge Code	2656101
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

PROPRANOLOL INJ

Facility

$58.00

Service Code	HCPCS J1800
Hospital Charge Code	2058024
Hospital Revenue Code	370
Rate for Payer: Cash Price	$52.20

PROPRANOLOL INJ

Facility

$58.00

Service Code	HCPCS J1800
Hospital Charge Code	2058024
Hospital Revenue Code	370
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

PROPRANOLOL LA 120MG CAP EMP

Facility

$18.00

Service Code	NDC 5.1991E+10
Hospital Charge Code	2624950
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

PROPRANOLOL LA 120MG CAP EMP

Facility

$18.00

Service Code	NDC 5.1991E+10
Hospital Charge Code	2624950
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PROSTAGLANDIN D2, URINE (AEL)

Facility

$500.00

Service Code	CPT 84150
Hospital Charge Code	22841500
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$357.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$37.59
Rate for Payer: Aetna Medicare Advantage	$41.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$296.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$357.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cigna Commercial HMO & PPO	$41.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$40.22
Rate for Payer: Home State Health Plan Medicare Advantage	$41.77
Rate for Payer: Humana Commercial	$83.54
Rate for Payer: Humana Medicare Advantage	$41.77
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$180.00

PROSTAGLANDIN D2, URINE (AEL)

Facility

$500.00

Service Code	CPT 84150
Hospital Charge Code	22841500
Hospital Revenue Code	301
Rate for Payer: Cash Price	$450.00

PROSTATECTOMY PROCEDURES

Facility

$33,755.11

Service Code	APR-DRG 4853
Min. Negotiated Rate	$33,755.11
Max. Negotiated Rate	$33,755.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$33,755.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33,755.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33,755.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33,755.11

PROSTATECTOMY PROCEDURES

Facility

$57,174.10

Service Code	APR-DRG 4854
Min. Negotiated Rate	$57,174.10
Max. Negotiated Rate	$57,174.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$57,174.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$57,174.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$57,174.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$57,174.10

PROSTATECTOMY PROCEDURES

Facility

$18,205.63

Service Code	APR-DRG 4852
Min. Negotiated Rate	$18,205.63
Max. Negotiated Rate	$18,205.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$18,205.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18,205.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18,205.63
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18,205.63

PROSTATECTOMY PROCEDURES

Facility

$6,057.45

Service Code	APR-DRG 4851
Min. Negotiated Rate	$6,057.45
Max. Negotiated Rate	$6,057.45
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,057.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,057.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,057.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,057.45

PROSTATECTOMY WITH CC

Facility

$31,049.96

Service Code	MSDRG 666
Min. Negotiated Rate	$15,524.98
Max. Negotiated Rate	$31,049.96
Rate for Payer: Aetna Medicare Advantage	$15,524.98
Rate for Payer: Cigna Commercial HMO & PPO	$15,524.98
Rate for Payer: Home State Health Plan Medicare Advantage	$15,524.98
Rate for Payer: Humana Commercial	$31,049.96
Rate for Payer: Humana Medicare Advantage	$15,524.98

PROSTATECTOMY WITH MCC

Facility

$52,704.70

Service Code	MSDRG 665
Min. Negotiated Rate	$26,352.35
Max. Negotiated Rate	$52,704.70
Rate for Payer: Aetna Medicare Advantage	$26,352.35
Rate for Payer: Cigna Commercial HMO & PPO	$26,352.35
Rate for Payer: Home State Health Plan Medicare Advantage	$26,352.35
Rate for Payer: Humana Commercial	$52,704.70
Rate for Payer: Humana Medicare Advantage	$26,352.35

PROSTATECTOMY WITHOUT CC/MCC

Facility

$20,955.84

Service Code	MSDRG 667
Min. Negotiated Rate	$10,477.92
Max. Negotiated Rate	$20,955.84
Rate for Payer: Aetna Medicare Advantage	$10,477.92
Rate for Payer: Cigna Commercial HMO & PPO	$10,477.92
Rate for Payer: Home State Health Plan Medicare Advantage	$10,477.92
Rate for Payer: Humana Commercial	$20,955.84
Rate for Payer: Humana Medicare Advantage	$10,477.92

PROTECTIVE BARRIER FILM

Facility

$70.00

Hospital Charge Code	2816906
Hospital Revenue Code	271
Rate for Payer: Cash Price	$63.00

PROTECTIVE BARRIER FILM

Facility

$70.00

Hospital Charge Code	2816906
Hospital Revenue Code	271
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$49.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

Know your out-of-pocket cost for care.

All Charges