Madison Medical Center

All Charges

Charge

Type

Setting

Price

.CULTURE STOOL (SALMONELLA/SHIGELLA)

Facility

$55.00

Service Code	CPT 87045
Hospital Charge Code	3087899
Hospital Revenue Code	306
Min. Negotiated Rate	$8.50
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.50
Rate for Payer: Aetna Medicare Advantage	$9.44
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: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$9.44
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.10
Rate for Payer: Home State Health Plan Medicare Advantage	$9.44
Rate for Payer: Humana Commercial	$18.88
Rate for Payer: Humana Medicare Advantage	$9.44
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

CULTURE THROAT

Facility

$221.00

Service Code	CPT 87070
Hospital Charge Code	3013000
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 THROAT

Facility

$221.00

Service Code	CPT 87070
Hospital Charge Code	3013000
Hospital Revenue Code	306
Rate for Payer: Cash Price	$198.90

CULTURE URINE

Facility

$32.00

Service Code	CPT 87088
Hospital Charge Code	5287088
Hospital Revenue Code	521
Rate for Payer: Cash Price	$28.80

CULTURE URINE

Facility

$32.00

Service Code	CPT 87088
Hospital Charge Code	5287088
Hospital Revenue Code	521
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.28
Rate for Payer: Aetna Medicare Advantage	$8.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna Commercial HMO & PPO	$8.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.79
Rate for Payer: Home State Health Plan Medicare Advantage	$8.09
Rate for Payer: Humana Commercial	$16.18
Rate for Payer: Humana Medicare Advantage	$8.09
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CULTURE-URINE

Facility

$32.00

Service Code	CPT 87088
Hospital Charge Code	4287088
Hospital Revenue Code	521
Min. Negotiated Rate	$6.55
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.28
Rate for Payer: Aetna Medicare Advantage	$8.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cigna Commercial HMO & PPO	$8.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.79
Rate for Payer: Home State Health Plan Medicare Advantage	$8.09
Rate for Payer: Humana Commercial	$16.18
Rate for Payer: Humana Medicare Advantage	$8.09
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CULTURE-URINE

Facility

$32.00

Service Code	CPT 87088
Hospital Charge Code	4287088
Hospital Revenue Code	521
Rate for Payer: Cash Price	$28.80

CULTURE VIRAL

Facility

$305.00

Service Code	CPT 87252
Hospital Charge Code	3087251
Hospital Revenue Code	306
Rate for Payer: Cash Price	$274.50

CULTURE VIRAL

Facility

$305.00

Service Code	CPT 87252
Hospital Charge Code	3087251
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$217.77
Rate for Payer: Humana Commercial	$52.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$23.46
Rate for Payer: Aetna Medicare Advantage	$26.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$180.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$217.77
Rate for Payer: Cash Price	$274.50
Rate for Payer: Cash Price	$274.50
Rate for Payer: Cash Price	$274.50
Rate for Payer: Cigna Commercial HMO & PPO	$26.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25.10
Rate for Payer: Home State Health Plan Medicare Advantage	$26.07
Rate for Payer: Humana Medicare Advantage	$26.07
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$109.80

CULTURE-VIRAL

Facility

$33.00

Service Code	CPT 87207
Hospital Charge Code	4287207
Hospital Revenue Code	521
Rate for Payer: Cash Price	$29.70

CULTURE-VIRAL

Facility

$33.00

Service Code	CPT 87207
Hospital Charge Code	4287207
Hospital Revenue Code	521
Min. Negotiated Rate	$4.85
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.39
Rate for Payer: Aetna Medicare Advantage	$5.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$19.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$23.56
Rate for Payer: Cash Price	$29.70
Rate for Payer: Cash Price	$29.70
Rate for Payer: Cash Price	$29.70
Rate for Payer: Cash Price	$29.70
Rate for Payer: Cigna Commercial HMO & PPO	$5.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.77
Rate for Payer: Home State Health Plan Medicare Advantage	$5.99
Rate for Payer: Humana Commercial	$11.98
Rate for Payer: Humana Medicare Advantage	$5.99
Rate for Payer: UnitedHealthcare Commercial	$22.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CULTURE VRE

Facility

$217.00

Service Code	CPT 87181
Hospital Charge Code	3017010
Hospital Revenue Code	306
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$154.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.28
Rate for Payer: Aetna Medicare Advantage	$4.75
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	$4.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.58
Rate for Payer: Home State Health Plan Medicare Advantage	$4.75
Rate for Payer: Humana Commercial	$9.50
Rate for Payer: Humana Medicare Advantage	$4.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$78.12

CULTURE VRE

Facility

$217.00

Service Code	CPT 87181
Hospital Charge Code	3017010
Hospital Revenue Code	306
Rate for Payer: Cash Price	$195.30

CULTURE YEAST

Facility

$178.00

Service Code	CPT 87101
Hospital Charge Code	307000
Hospital Revenue Code	306
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$127.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.94
Rate for Payer: Aetna Medicare Advantage	$7.71
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	$7.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.43
Rate for Payer: Home State Health Plan Medicare Advantage	$7.71
Rate for Payer: Humana Commercial	$15.42
Rate for Payer: Humana Medicare Advantage	$7.71
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

CULTURE YEAST

Facility

$178.00

Service Code	CPT 87101
Hospital Charge Code	307000
Hospital Revenue Code	306
Rate for Payer: Cash Price	$160.20

CULTURE YEAST STOOL

Facility

$65.00

Service Code	CPT 87101
Hospital Charge Code	3087102
Hospital Revenue Code	306
Rate for Payer: Cash Price	$58.50

CULTURE YEAST STOOL

Facility

$65.00

Service Code	CPT 87101
Hospital Charge Code	3087102
Hospital Revenue Code	306
Min. Negotiated Rate	$6.94
Max. Negotiated Rate	$46.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.94
Rate for Payer: Aetna Medicare Advantage	$7.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial HMO & PPO	$7.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.43
Rate for Payer: Home State Health Plan Medicare Advantage	$7.71
Rate for Payer: Humana Commercial	$15.42
Rate for Payer: Humana Medicare Advantage	$7.71
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

CUP INFUSOR 17 GA

Facility

$86.00

Hospital Charge Code	2811289
Hospital Revenue Code	271
Min. Negotiated Rate	$30.96
Max. Negotiated Rate	$61.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$50.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$61.40
Rate for Payer: Cash Price	$77.40
Rate for Payer: UnitedHealthcare Commercial	$57.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.96

CUP INFUSOR 17 GA

Facility

$86.00

Hospital Charge Code	2811289
Hospital Revenue Code	271
Rate for Payer: Cash Price	$77.40

CUPS C+A TEST PKG-8

Facility

$16.00

Hospital Charge Code	283347
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

CUPS C+A TEST PKG-8

Facility

$16.00

Hospital Charge Code	283347
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

CURAFIL HYDROGEL GAUZE 4X4

Facility

$28.00

Hospital Charge Code	289256
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

CURAFIL HYDROGEL GAUZE 4X4

Facility

$28.00

Hospital Charge Code	289256
Hospital Revenue Code	271
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

CURAGEL HYDROGEL DRESSING 4X4

Facility

$22.00

Hospital Charge Code	289901
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

CURAGEL HYDROGEL DRESSING 4X4

Facility

$22.00

Hospital Charge Code	289901
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

Know your out-of-pocket cost for care.

All Charges