Madison Medical Center

All Charges

Charge

Type

Setting

Price

DAVIS GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9882962
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

DAVIS INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	9887804
Hospital Revenue Code	301
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$50.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.90
Rate for Payer: Aetna Medicare Advantage	$16.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.94
Rate for Payer: Home State Health Plan Medicare Advantage	$16.55
Rate for Payer: Humana Commercial	$33.10
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

DAVIS INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	9887804
Hospital Revenue Code	301
Rate for Payer: Cash Price	$63.90

DAVIS INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	9887502
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$191.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$86.22
Rate for Payer: Aetna Medicare Advantage	$95.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$72.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$87.82
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$95.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$86.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$92.26
Rate for Payer: Home State Health Plan Medicare Advantage	$95.80
Rate for Payer: Humana Commercial	$191.60
Rate for Payer: Humana Medicare Advantage	$95.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$86.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.28

DAVIS INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	9887502
Hospital Revenue Code	301
Rate for Payer: Cash Price	$110.70

DAVIS KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9887210
Hospital Revenue Code	301
Rate for Payer: Cash Price	$36.00

DAVIS KOH WET MOUNT

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	9887210
Hospital Revenue Code	301
Min. Negotiated Rate	$5.24
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.24
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$5.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.61
Rate for Payer: Home State Health Plan Medicare Advantage	$5.82
Rate for Payer: Humana Commercial	$11.64
Rate for Payer: Humana Medicare Advantage	$5.82
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

DAVIS OCCULT BLOOD

Facility

$30.00

Service Code	CPT 82270
Hospital Charge Code	9882270
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

DAVIS OCCULT BLOOD

Facility

$30.00

Service Code	CPT 82270
Hospital Charge Code	9882270
Hospital Revenue Code	301
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$21.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.94
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$4.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.22
Rate for Payer: Home State Health Plan Medicare Advantage	$4.38
Rate for Payer: Humana Commercial	$8.76
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

DAVIS RAPID STREP

Facility

$75.00

Service Code	CPT 87880
Hospital Charge Code	9887880
Hospital Revenue Code	301
Min. Negotiated Rate	$14.88
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.88
Rate for Payer: Aetna Medicare Advantage	$16.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$16.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.92
Rate for Payer: Home State Health Plan Medicare Advantage	$16.53
Rate for Payer: Humana Commercial	$33.06
Rate for Payer: Humana Medicare Advantage	$16.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

DAVIS RAPID STREP

Facility

$75.00

Service Code	CPT 87880
Hospital Charge Code	9887880
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

DAVIS RSV TEST

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	9887634
Hospital Revenue Code	301
Rate for Payer: Cash Price	$110.70

DAVIS RSV TEST

Facility

$123.00

Service Code	CPT 87634
Hospital Charge Code	9887634
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$63.18
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$72.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$87.82
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$70.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$63.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$67.60
Rate for Payer: Home State Health Plan Medicare Advantage	$70.20
Rate for Payer: Humana Commercial	$140.40
Rate for Payer: Humana Medicare Advantage	$70.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$63.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.28

DAVIS SEMEN ANALYSIS

Facility

$85.00

Service Code	CPT 89300
Hospital Charge Code	9889300
Hospital Revenue Code	301
Rate for Payer: Cash Price	$76.50

DAVIS SEMEN ANALYSIS

Facility

$85.00

Service Code	CPT 89300
Hospital Charge Code	9889300
Hospital Revenue Code	301
Min. Negotiated Rate	$8.86
Max. Negotiated Rate	$60.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.86
Rate for Payer: Aetna Medicare Advantage	$9.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$50.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$60.69
Rate for Payer: Cash Price	$76.50
Rate for Payer: Cash Price	$76.50
Rate for Payer: Cash Price	$76.50
Rate for Payer: Cigna Commercial HMO & PPO	$9.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.48
Rate for Payer: Home State Health Plan Medicare Advantage	$9.84
Rate for Payer: Humana Commercial	$19.68
Rate for Payer: Humana Medicare Advantage	$9.84
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.60

DAVIS STOMATITIS COCKTAIL 30ML

Facility

$208.00

Service Code	NDC 1E+11
Hospital Charge Code	2627203
Hospital Revenue Code	250
Rate for Payer: Cash Price	$187.20

DAVIS STOMATITIS COCKTAIL 30ML

Facility

$208.00

Service Code	NDC 1E+11
Hospital Charge Code	2627203
Hospital Revenue Code	250
Min. Negotiated Rate	$74.88
Max. Negotiated Rate	$148.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$123.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$148.51
Rate for Payer: Cash Price	$187.20
Rate for Payer: UnitedHealthcare Commercial	$138.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$74.88

DAVIS STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	9887651
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$70.18
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.58
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$35.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.79
Rate for Payer: Home State Health Plan Medicare Advantage	$35.09
Rate for Payer: Humana Commercial	$70.18
Rate for Payer: Humana Medicare Advantage	$35.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

DAVIS STREP

Facility

$75.00

Service Code	CPT 87651
Hospital Charge Code	9887651
Hospital Revenue Code	301
Rate for Payer: Cash Price	$67.50

DAVIS URINE DIP

Facility

$30.00

Service Code	CPT 81002
Hospital Charge Code	9881002
Hospital Revenue Code	307
Rate for Payer: Cash Price	$27.00

DAVIS URINE DIP

Facility

$30.00

Service Code	CPT 81002
Hospital Charge Code	9881002
Hospital Revenue Code	307
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$21.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$3.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.35
Rate for Payer: Home State Health Plan Medicare Advantage	$3.48
Rate for Payer: Humana Commercial	$6.96
Rate for Payer: Humana Medicare Advantage	$3.48
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

DAVIS URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9881025
Hospital Revenue Code	307
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.75
Rate for Payer: Aetna Medicare Advantage	$8.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.29
Rate for Payer: Home State Health Plan Medicare Advantage	$8.61
Rate for Payer: Humana Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$8.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

DAVIS URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9881025
Hospital Revenue Code	307
Rate for Payer: Cash Price	$36.00

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC

Facility

$35,772.94

Service Code	MSDRG 744
Min. Negotiated Rate	$17,886.47
Max. Negotiated Rate	$35,772.94
Rate for Payer: Aetna Medicare Advantage	$17,886.47
Rate for Payer: Cigna Commercial HMO & PPO	$17,886.47
Rate for Payer: Home State Health Plan Medicare Advantage	$17,886.47
Rate for Payer: Humana Commercial	$35,772.94
Rate for Payer: Humana Medicare Advantage	$17,886.47

D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC

Facility

$21,445.66

Service Code	MSDRG 745
Min. Negotiated Rate	$10,722.83
Max. Negotiated Rate	$21,445.66
Rate for Payer: Aetna Medicare Advantage	$10,722.83
Rate for Payer: Cigna Commercial HMO & PPO	$10,722.83
Rate for Payer: Home State Health Plan Medicare Advantage	$10,722.83
Rate for Payer: Humana Commercial	$21,445.66
Rate for Payer: Humana Medicare Advantage	$10,722.83

Know your out-of-pocket cost for care.

All Charges