Madison Medical Center

All Charges

Charge

Type

Setting

Price

PROTEINASE-3 ANTIBODY

Facility

$155.00

Service Code	CPT 83516
Hospital Charge Code	2283516
Hospital Revenue Code	302
Rate for Payer: Cash Price	$139.50

PROTEINASE-3 ANTIBODY

Facility

$155.00

Service Code	CPT 83516
Hospital Charge Code	2283516
Hospital Revenue Code	302
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$110.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$91.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$110.67
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.80

PROTEIN C ACTIVITY

Facility

$309.00

Service Code	CPT 85705
Hospital Charge Code	2285303
Hospital Revenue Code	305
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$220.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.67
Rate for Payer: Aetna Medicare Advantage	$9.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$182.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$220.63
Rate for Payer: Cash Price	$278.10
Rate for Payer: Cash Price	$278.10
Rate for Payer: Cash Price	$278.10
Rate for Payer: Cigna Commercial HMO & PPO	$9.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.28
Rate for Payer: Home State Health Plan Medicare Advantage	$9.63
Rate for Payer: Humana Commercial	$19.26
Rate for Payer: Humana Medicare Advantage	$9.63
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$111.24

PROTEIN C ACTIVITY

Facility

$309.00

Service Code	CPT 85705
Hospital Charge Code	2285303
Hospital Revenue Code	305
Rate for Payer: Cash Price	$278.10

PROTEIN C ANTIGEN

Facility

$245.00

Service Code	CPT 85302
Hospital Charge Code	2285302
Hospital Revenue Code	301
Min. Negotiated Rate	$10.81
Max. Negotiated Rate	$174.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.81
Rate for Payer: Aetna Medicare Advantage	$12.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$145.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.93
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cigna Commercial HMO & PPO	$12.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.57
Rate for Payer: Home State Health Plan Medicare Advantage	$12.01
Rate for Payer: Humana Commercial	$24.02
Rate for Payer: Humana Medicare Advantage	$12.01
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$88.20

PROTEIN C ANTIGEN

Facility

$245.00

Service Code	CPT 85302
Hospital Charge Code	2285302
Hospital Revenue Code	301
Rate for Payer: Cash Price	$220.50

PROTEIN&CREAT RAND UR (LABCORP)

Facility

$110.00

Hospital Charge Code	2221220
Hospital Revenue Code	307
Rate for Payer: Cash Price	$99.00

PROTEIN&CREAT RAND UR (LABCORP)

Facility

$110.00

Hospital Charge Code	2221220
Hospital Revenue Code	307
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$78.54
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: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

PROTEIN C RESISTANCE (LABCORP 117762)

Facility

$245.00

Service Code	CPT 85307
Hospital Charge Code	2285304
Hospital Revenue Code	305
Min. Negotiated Rate	$13.79
Max. Negotiated Rate	$174.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.79
Rate for Payer: Aetna Medicare Advantage	$15.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$145.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.93
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cigna Commercial HMO & PPO	$15.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.76
Rate for Payer: Home State Health Plan Medicare Advantage	$15.32
Rate for Payer: Humana Commercial	$30.64
Rate for Payer: Humana Medicare Advantage	$15.32
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$88.20

PROTEIN C RESISTANCE (LABCORP 117762)

Facility

$245.00

Service Code	CPT 85307
Hospital Charge Code	2285304
Hospital Revenue Code	305
Rate for Payer: Cash Price	$220.50

PROTEIN ELE 24 HOUR URINE

Facility

$76.00

Service Code	CPT 84166
Hospital Charge Code	2284166
Hospital Revenue Code	301
Rate for Payer: Cash Price	$68.40

PROTEIN ELE 24 HOUR URINE

Facility

$76.00

Service Code	CPT 84166
Hospital Charge Code	2284166
Hospital Revenue Code	301
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$54.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.05
Rate for Payer: Aetna Medicare Advantage	$17.83
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: Cash Price	$68.40
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cigna Commercial HMO & PPO	$17.83
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.17
Rate for Payer: Home State Health Plan Medicare Advantage	$17.83
Rate for Payer: Humana Commercial	$35.66
Rate for Payer: Humana Medicare Advantage	$17.83
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.36

PROTEIN ELECTROPHORISIS SERUM

Facility

$125.00

Service Code	CPT 84165
Hospital Charge Code	225182
Hospital Revenue Code	301
Rate for Payer: Cash Price	$112.50

PROTEIN ELECTROPHORISIS SERUM

Facility

$125.00

Service Code	CPT 84165
Hospital Charge Code	225182
Hospital Revenue Code	301
Min. Negotiated Rate	$9.67
Max. Negotiated Rate	$89.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.67
Rate for Payer: Aetna Medicare Advantage	$10.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cigna Commercial HMO & PPO	$10.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10.35
Rate for Payer: Home State Health Plan Medicare Advantage	$10.74
Rate for Payer: Humana Commercial	$21.48
Rate for Payer: Humana Medicare Advantage	$10.74
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

PROTEIN ELE RANDOM URINE

Facility

$141.00

Service Code	CPT 84166
Hospital Charge Code	2284165
Hospital Revenue Code	301
Min. Negotiated Rate	$16.05
Max. Negotiated Rate	$100.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.05
Rate for Payer: Aetna Medicare Advantage	$17.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$83.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$100.67
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cigna Commercial HMO & PPO	$17.83
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.17
Rate for Payer: Home State Health Plan Medicare Advantage	$17.83
Rate for Payer: Humana Commercial	$35.66
Rate for Payer: Humana Medicare Advantage	$17.83
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$50.76

PROTEIN ELE RANDOM URINE

Facility

$141.00

Service Code	CPT 84166
Hospital Charge Code	2284165
Hospital Revenue Code	301
Rate for Payer: Cash Price	$126.90

PROTEIN FLUID

Facility

$24.00

Service Code	CPT 84157
Hospital Charge Code	2284157
Hospital Revenue Code	307
Rate for Payer: Cash Price	$21.60

PROTEIN FLUID

Facility

$24.00

Service Code	CPT 84157
Hospital Charge Code	2284157
Hospital Revenue Code	307
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.60
Rate for Payer: Aetna Medicare Advantage	$4.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cigna Commercial HMO & PPO	$4.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.85
Rate for Payer: Home State Health Plan Medicare Advantage	$4.00
Rate for Payer: Humana Commercial	$8.00
Rate for Payer: Humana Medicare Advantage	$4.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

PROTEIN S ACTIVITY

Facility

$245.00

Service Code	CPT 85306
Hospital Charge Code	2285306
Hospital Revenue Code	301
Min. Negotiated Rate	$13.79
Max. Negotiated Rate	$174.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.79
Rate for Payer: Aetna Medicare Advantage	$15.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$145.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.93
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cigna Commercial HMO & PPO	$15.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.76
Rate for Payer: Home State Health Plan Medicare Advantage	$15.32
Rate for Payer: Humana Commercial	$30.64
Rate for Payer: Humana Medicare Advantage	$15.32
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$88.20

PROTEIN S ACTIVITY

Facility

$245.00

Service Code	CPT 85306
Hospital Charge Code	2285306
Hospital Revenue Code	301
Rate for Payer: Cash Price	$220.50

PROTEIN S ANTIGEN

Facility

$245.00

Service Code	CPT 85305
Hospital Charge Code	2216117
Hospital Revenue Code	301
Min. Negotiated Rate	$10.45
Max. Negotiated Rate	$174.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.45
Rate for Payer: Aetna Medicare Advantage	$11.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$145.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.93
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cigna Commercial HMO & PPO	$11.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.18
Rate for Payer: Home State Health Plan Medicare Advantage	$11.61
Rate for Payer: Humana Commercial	$23.22
Rate for Payer: Humana Medicare Advantage	$11.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$88.20

PROTEIN S ANTIGEN

Facility

$245.00

Service Code	CPT 85305
Hospital Charge Code	2216117
Hospital Revenue Code	301
Rate for Payer: Cash Price	$220.50

PROTEIN S FREE

Facility

$111.00

Service Code	CPT 85306
Hospital Charge Code	2285319
Hospital Revenue Code	305
Rate for Payer: Cash Price	$99.90

PROTEIN S FREE

Facility

$111.00

Service Code	CPT 85306
Hospital Charge Code	2285319
Hospital Revenue Code	305
Min. Negotiated Rate	$13.79
Max. Negotiated Rate	$79.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.79
Rate for Payer: Aetna Medicare Advantage	$15.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.25
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cigna Commercial HMO & PPO	$15.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.76
Rate for Payer: Home State Health Plan Medicare Advantage	$15.32
Rate for Payer: Humana Commercial	$30.64
Rate for Payer: Humana Medicare Advantage	$15.32
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.96

PROTEIN TOTAL

Facility

$112.00

Service Code	CPT 84155
Hospital Charge Code	2216115
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.30
Rate for Payer: Aetna Medicare Advantage	$3.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$3.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.53
Rate for Payer: Home State Health Plan Medicare Advantage	$3.67
Rate for Payer: Humana Commercial	$7.34
Rate for Payer: Humana Medicare Advantage	$3.67
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

Know your out-of-pocket cost for care.

All Charges