Madison Medical Center

All Charges

Charge

Type

Setting

Price

CULTURE BACT,THROAT - NOSE

Professional

Both

$221.00

Service Code	CPT 87070
Hospital Charge Code	1887060
Hospital Revenue Code	981
Min. Negotiated Rate	$8.62
Max. Negotiated Rate	$77.35
Rate for Payer: Aetna Commercial/Medicare Advantage	$8.62
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cigna Commercial HMO & PPO	$8.62
Rate for Payer: Home State Health Plan Medicare Advantage	$8.62
Rate for Payer: Optum Medicare Advantage	$77.35

CULTURE BLOOD 1ST SET

Facility

$217.00

Service Code	CPT 87040
Hospital Charge Code	302002
Hospital Revenue Code	306
Rate for Payer: Cash Price	$195.30

CULTURE BLOOD 1ST SET

Facility

$217.00

Service Code	CPT 87040
Hospital Charge Code	302002
Hospital Revenue Code	306
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$154.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.29
Rate for Payer: Aetna Medicare Advantage	$10.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$128.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$154.94
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cigna Commercial HMO & PPO	$10.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.94
Rate for Payer: Home State Health Plan Medicare Advantage	$10.32
Rate for Payer: Humana Commercial	$20.64
Rate for Payer: Humana Medicare Advantage	$10.32
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$78.12

CULTURE BLOOD 1ST SET (AEL)

Facility

$217.00

Service Code	CPT 87040
Hospital Charge Code	302000
Hospital Revenue Code	306
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$154.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.29
Rate for Payer: Aetna Medicare Advantage	$10.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$128.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$154.94
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cigna Commercial HMO & PPO	$10.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.94
Rate for Payer: Home State Health Plan Medicare Advantage	$10.32
Rate for Payer: Humana Commercial	$20.64
Rate for Payer: Humana Medicare Advantage	$10.32
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$78.12

CULTURE BLOOD 1ST SET (AEL)

Facility

$217.00

Service Code	CPT 87040
Hospital Charge Code	302000
Hospital Revenue Code	306
Rate for Payer: Cash Price	$195.30

CULTURE BLOOD 2ND SET

Facility

$217.00

Service Code	CPT 87040
Hospital Charge Code	302003
Hospital Revenue Code	306
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$154.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.29
Rate for Payer: Aetna Medicare Advantage	$10.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$128.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$154.94
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cigna Commercial HMO & PPO	$10.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.94
Rate for Payer: Home State Health Plan Medicare Advantage	$10.32
Rate for Payer: Humana Commercial	$20.64
Rate for Payer: Humana Medicare Advantage	$10.32
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$78.12

CULTURE BLOOD 2ND SET

Facility

$217.00

Service Code	CPT 87040
Hospital Charge Code	302003
Hospital Revenue Code	306
Rate for Payer: Cash Price	$195.30

CULTURE BLOOD 2ND SET (AEL)

Facility

$217.00

Service Code	CPT 87040
Hospital Charge Code	301000
Hospital Revenue Code	306
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$154.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.29
Rate for Payer: Aetna Medicare Advantage	$10.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$128.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$154.94
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cash Price	$195.30
Rate for Payer: Cigna Commercial HMO & PPO	$10.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.94
Rate for Payer: Home State Health Plan Medicare Advantage	$10.32
Rate for Payer: Humana Commercial	$20.64
Rate for Payer: Humana Medicare Advantage	$10.32
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$78.12

CULTURE BLOOD 2ND SET (AEL)

Facility

$217.00

Service Code	CPT 87040
Hospital Charge Code	301000
Hospital Revenue Code	306
Rate for Payer: Cash Price	$195.30

CULTURE BLOOD POS WKUP

Facility

$44.00

Service Code	CPT 87040
Hospital Charge Code	302001
Hospital Revenue Code	306
Min. Negotiated Rate	$9.29
Max. Negotiated Rate	$31.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.29
Rate for Payer: Aetna Medicare Advantage	$10.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cigna Commercial HMO & PPO	$10.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.94
Rate for Payer: Home State Health Plan Medicare Advantage	$10.32
Rate for Payer: Humana Commercial	$20.64
Rate for Payer: Humana Medicare Advantage	$10.32
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

CULTURE BLOOD POS WKUP

Facility

$44.00

Service Code	CPT 87040
Hospital Charge Code	302001
Hospital Revenue Code	306
Rate for Payer: Cash Price	$39.60

CULTURE BODY FLUID

Facility

$221.00

Service Code	CPT 87070
Hospital Charge Code	3087070
Hospital Revenue Code	306
Rate for Payer: Cash Price	$198.90

CULTURE BODY FLUID

Facility

$221.00

Service Code	CPT 87070
Hospital Charge Code	3087070
Hospital Revenue Code	306
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$157.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.76
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$130.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.79
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cigna Commercial HMO & PPO	$8.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.30
Rate for Payer: Home State Health Plan Medicare Advantage	$8.62
Rate for Payer: Humana Commercial	$17.24
Rate for Payer: Humana Medicare Advantage	$8.62
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$79.56

CULTURE B PERTUSSIS, NASAL SWAB

Facility

$80.00

Service Code	CPT 87070
Hospital Charge Code	3087071
Hospital Revenue Code	306
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$57.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.76
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna Commercial HMO & PPO	$8.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.30
Rate for Payer: Home State Health Plan Medicare Advantage	$8.62
Rate for Payer: Humana Commercial	$17.24
Rate for Payer: Humana Medicare Advantage	$8.62
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.80

CULTURE B PERTUSSIS, NASAL SWAB

Facility

$80.00

Service Code	CPT 87070
Hospital Charge Code	3087071
Hospital Revenue Code	306
Rate for Payer: Cash Price	$72.00

CULTURE CHLAMYDIA

Facility

$178.00

Service Code	CPT 87140
Hospital Charge Code	303005
Hospital Revenue Code	306
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$127.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.01
Rate for Payer: Aetna Medicare Advantage	$5.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cigna Commercial HMO & PPO	$5.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.36
Rate for Payer: Home State Health Plan Medicare Advantage	$5.57
Rate for Payer: Humana Commercial	$11.14
Rate for Payer: Humana Medicare Advantage	$5.57
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

CULTURE CHLAMYDIA

Facility

$178.00

Service Code	CPT 87140
Hospital Charge Code	303005
Hospital Revenue Code	306
Rate for Payer: Cash Price	$160.20

CULTURE - CHLAMYDIA

Facility

$53.00

Service Code	CPT 87110
Hospital Charge Code	4287110
Hospital Revenue Code	521
Min. Negotiated Rate	$15.88
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$17.64
Rate for Payer: Aetna Medicare Advantage	$19.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$31.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.84
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cash Price	$47.70
Rate for Payer: Cigna Commercial HMO & PPO	$19.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18.87
Rate for Payer: Home State Health Plan Medicare Advantage	$19.60
Rate for Payer: Humana Commercial	$39.20
Rate for Payer: Humana Medicare Advantage	$19.60
Rate for Payer: UnitedHealthcare Commercial	$35.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CULTURE - CHLAMYDIA

Facility

$53.00

Service Code	CPT 87110
Hospital Charge Code	4287110
Hospital Revenue Code	521
Rate for Payer: Cash Price	$47.70

CULTURE EAR

Facility

$221.00

Service Code	CPT 87070
Hospital Charge Code	304000
Hospital Revenue Code	306
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$157.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.76
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$130.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.79
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cigna Commercial HMO & PPO	$8.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.30
Rate for Payer: Home State Health Plan Medicare Advantage	$8.62
Rate for Payer: Humana Commercial	$17.24
Rate for Payer: Humana Medicare Advantage	$8.62
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$79.56

CULTURE EAR

Facility

$221.00

Service Code	CPT 87070
Hospital Charge Code	304000
Hospital Revenue Code	306
Rate for Payer: Cash Price	$198.90

CULTURE EYE

Facility

$171.00

Service Code	CPT 87070
Hospital Charge Code	305000
Hospital Revenue Code	306
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$122.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.76
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$101.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$122.09
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cash Price	$153.90
Rate for Payer: Cigna Commercial HMO & PPO	$8.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.30
Rate for Payer: Home State Health Plan Medicare Advantage	$8.62
Rate for Payer: Humana Commercial	$17.24
Rate for Payer: Humana Medicare Advantage	$8.62
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$61.56

CULTURE EYE

Facility

$171.00

Service Code	CPT 87070
Hospital Charge Code	305000
Hospital Revenue Code	306
Rate for Payer: Cash Price	$153.90

CULTURE FUNGAL BLOOD

Facility

$81.00

Service Code	CPT 87103
Hospital Charge Code	3087103
Hospital Revenue Code	306
Min. Negotiated Rate	$18.41
Max. Negotiated Rate	$57.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.41
Rate for Payer: Aetna Medicare Advantage	$20.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cigna Commercial HMO & PPO	$20.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19.70
Rate for Payer: Home State Health Plan Medicare Advantage	$20.46
Rate for Payer: Humana Commercial	$40.92
Rate for Payer: Humana Medicare Advantage	$20.46
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

CULTURE FUNGAL BLOOD

Facility

$81.00

Service Code	CPT 87103
Hospital Charge Code	3087103
Hospital Revenue Code	306
Rate for Payer: Cash Price	$72.90

Know your out-of-pocket cost for care.

All Charges