Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

PROTEIN, TOTAL 24 HOUR

Facility

$110.00

Service Code	CPT 84156
Hospital Charge Code	2221215
Hospital Revenue Code	307
Rate for Payer: Cash Price	$99.00

PROTEIN, TOTAL 24 HOUR

Facility

$110.00

Service Code	CPT 84156
Hospital Charge Code	2221215
Hospital Revenue Code	307
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$78.54
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	$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	$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	$39.60

PROTEIN TOTAL CSF

Facility

$159.00

Service Code	CPT 84157
Hospital Charge Code	2284155
Hospital Revenue Code	301
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$113.53
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	$94.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$113.53
Rate for Payer: Cash Price	$143.10
Rate for Payer: Cash Price	$143.10
Rate for Payer: Cash Price	$143.10
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	$57.24

PROTEIN TOTAL CSF

Facility

$159.00

Service Code	CPT 84157
Hospital Charge Code	2284155
Hospital Revenue Code	301
Rate for Payer: Cash Price	$143.10

PROTHROMBIN FRAGMENT 1+2

Facility

$391.00

Service Code	CPT 85240
Hospital Charge Code	2281241
Hospital Revenue Code	301
Rate for Payer: Cash Price	$351.90

PROTHROMBIN FRAGMENT 1+2

Facility

$391.00

Service Code	CPT 85240
Hospital Charge Code	2281241
Hospital Revenue Code	301
Min. Negotiated Rate	$16.11
Max. Negotiated Rate	$279.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.11
Rate for Payer: Aetna Medicare Advantage	$17.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$231.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$279.17
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cigna Commercial HMO & PPO	$17.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.24
Rate for Payer: Home State Health Plan Medicare Advantage	$17.90
Rate for Payer: Humana Commercial	$35.80
Rate for Payer: Humana Medicare Advantage	$17.90
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$140.76

PROTIME / INR

Facility

$127.00

Service Code	CPT 85610
Hospital Charge Code	2216126
Hospital Revenue Code	305
Rate for Payer: Cash Price	$114.30

PROTIME / INR

Facility

$127.00

Service Code	CPT 85610
Hospital Charge Code	2216126
Hospital Revenue Code	305
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$90.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.86
Rate for Payer: Aetna Medicare Advantage	$4.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$90.68
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cigna Commercial HMO & PPO	$4.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.13
Rate for Payer: Home State Health Plan Medicare Advantage	$4.29
Rate for Payer: Humana Commercial	$8.58
Rate for Payer: Humana Medicare Advantage	$4.29
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

PROTIME/INR (LABCORP)

Facility

$127.00

Service Code	CPT 85610
Hospital Charge Code	2216129
Hospital Revenue Code	301
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$90.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.86
Rate for Payer: Aetna Medicare Advantage	$4.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$90.68
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cigna Commercial HMO & PPO	$4.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.13
Rate for Payer: Home State Health Plan Medicare Advantage	$4.29
Rate for Payer: Humana Commercial	$8.58
Rate for Payer: Humana Medicare Advantage	$4.29
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

PROTIME/INR (LABCORP)

Facility

$127.00

Service Code	CPT 85610
Hospital Charge Code	2216129
Hospital Revenue Code	301
Rate for Payer: Cash Price	$114.30

PROTOPIC 0.03% OINT 30GM EMP

Facility

$166.00

Service Code	NDC 5.0222E+10
Hospital Charge Code	2625075
Hospital Revenue Code	250
Min. Negotiated Rate	$59.76
Max. Negotiated Rate	$118.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$118.52
Rate for Payer: Cash Price	$149.40
Rate for Payer: UnitedHealthcare Commercial	$110.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

PROTOPIC 0.03% OINT 30GM EMP

Facility

$166.00

Service Code	NDC 5.0222E+10
Hospital Charge Code	2625075
Hospital Revenue Code	250
Rate for Payer: Cash Price	$149.40

PR PRIVATE ROOM P

Facility

$850.00

Hospital Charge Code	30000004
Hospital Revenue Code	110
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$1,754.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$185.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.00
Rate for Payer: Cash Price	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,519.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,754.00

PR PRIVATE ROOM P

Facility

$850.00

Hospital Charge Code	30000004
Hospital Revenue Code	120
Min. Negotiated Rate	$742.00
Max. Negotiated Rate	$1,754.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$742.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$742.00
Rate for Payer: Cash Price	$765.00
Rate for Payer: UnitedHealthcare Commercial	$1,519.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,754.00

PRUCALOPRIDE (MOTEGRITY) 2MG TAB EMP

Facility

$60.00

Service Code	NDC 781815931
Hospital Charge Code	2627264
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

PRUCALOPRIDE (MOTEGRITY) 2MG TAB EMP

Facility

$60.00

Service Code	NDC 781815931
Hospital Charge Code	2627264
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

PSA DIAGNOSTIC

Facility

$299.00

Service Code	CPT 84153
Hospital Charge Code	2216802
Hospital Revenue Code	302
Rate for Payer: Cash Price	$269.10

PSA DIAGNOSTIC

Facility

$299.00

Service Code	CPT 84153
Hospital Charge Code	2216802
Hospital Revenue Code	302
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$213.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.55
Rate for Payer: Aetna Medicare Advantage	$18.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$213.49
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cigna Commercial HMO & PPO	$18.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.71
Rate for Payer: Home State Health Plan Medicare Advantage	$18.39
Rate for Payer: Humana Commercial	$36.78
Rate for Payer: Humana Medicare Advantage	$18.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$107.64

PSA DIAGNOSTIC (LABCORP)

Facility

$299.00

Service Code	CPT 84153
Hospital Charge Code	2200107
Hospital Revenue Code	301
Rate for Payer: Cash Price	$269.10

PSA DIAGNOSTIC (LABCORP)

Facility

$299.00

Service Code	CPT 84153
Hospital Charge Code	2200107
Hospital Revenue Code	301
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$213.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.55
Rate for Payer: Aetna Medicare Advantage	$18.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$213.49
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cigna Commercial HMO & PPO	$18.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.71
Rate for Payer: Home State Health Plan Medicare Advantage	$18.39
Rate for Payer: Humana Commercial	$36.78
Rate for Payer: Humana Medicare Advantage	$18.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$107.64

.PSA FREE

Facility

$165.00

Service Code	CPT 84154
Hospital Charge Code	2284154
Hospital Revenue Code	302
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$117.81
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.55
Rate for Payer: Aetna Medicare Advantage	$18.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cigna Commercial HMO & PPO	$18.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.71
Rate for Payer: Home State Health Plan Medicare Advantage	$18.39
Rate for Payer: Humana Commercial	$36.78
Rate for Payer: Humana Medicare Advantage	$18.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

.PSA FREE

Facility

$165.00

Service Code	CPT 84154
Hospital Charge Code	2284154
Hospital Revenue Code	302
Rate for Payer: Cash Price	$148.50

PSA SCREEN

Facility

$299.00

Service Code	CPT 84153
Hospital Charge Code	2200103
Hospital Revenue Code	301
Rate for Payer: Cash Price	$269.10

PSA SCREEN

Facility

$299.00

Service Code	CPT 84153
Hospital Charge Code	2200103
Hospital Revenue Code	301
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$213.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.55
Rate for Payer: Aetna Medicare Advantage	$18.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$213.49
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cigna Commercial HMO & PPO	$18.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.71
Rate for Payer: Home State Health Plan Medicare Advantage	$18.39
Rate for Payer: Humana Commercial	$36.78
Rate for Payer: Humana Medicare Advantage	$18.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$107.64

Know your out-of-pocket cost for care.

All Charges