Madison Medical Center

All Charges

Charge

Type

Setting

Price

EGG BUR 6.0(STRYKER)

Facility

$389.00

Hospital Charge Code	127783
Hospital Revenue Code	271
Rate for Payer: Cash Price	$350.10

EHRLICHIA AB PANE

Facility

$270.00

Service Code	CPT 86666
Hospital Charge Code	228000
Hospital Revenue Code	302
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$192.78
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$159.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$192.78
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cigna Commercial HMO & PPO	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.20

EHRLICHIA AB PANE

Facility

$270.00

Service Code	CPT 86666
Hospital Charge Code	228000
Hospital Revenue Code	302
Rate for Payer: Cash Price	$243.00

..EHRLICHIA IGG AEL

Facility

$156.00

Service Code	CPT 86666
Hospital Charge Code	2281463
Hospital Revenue Code	302
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$111.38
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial HMO & PPO	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

..EHRLICHIA IGG AEL

Facility

$156.00

Service Code	CPT 86666
Hospital Charge Code	2281463
Hospital Revenue Code	302
Rate for Payer: Cash Price	$140.40

..EHRLICHIA IGM AEL

Facility

$156.00

Service Code	CPT 86666
Hospital Charge Code	2281466
Hospital Revenue Code	302
Rate for Payer: Cash Price	$140.40

..EHRLICHIA IGM AEL

Facility

$156.00

Service Code	CPT 86666
Hospital Charge Code	2281466
Hospital Revenue Code	302
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$111.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cigna Commercial HMO & PPO	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

EHRLICHIA SP PCR (LC138412)

Facility

$312.00

Hospital Charge Code	2287712
Hospital Revenue Code	305
Rate for Payer: Cash Price	$280.80

EHRLICHIA SP PCR (LC138412)

Facility

$312.00

Hospital Charge Code	2287712
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$222.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$184.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$222.77
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$112.32

EKG 12 LEAD W/INTERPRETATION AND REPORT

Facility

$223.00

Service Code	CPT 93000
Hospital Charge Code	9893000
Hospital Revenue Code	730
Rate for Payer: Cash Price	$200.70

EKG 12 LEAD W/INTERPRETATION AND REPORT

Facility

$223.00

Service Code	CPT 93000
Hospital Charge Code	9893000
Hospital Revenue Code	730
Min. Negotiated Rate	$80.28
Max. Negotiated Rate	$159.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$132.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$159.22
Rate for Payer: Cash Price	$200.70
Rate for Payer: UnitedHealthcare Commercial	$148.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$80.28

EKG AND PADS

Facility

$76.00

Service Code	CPT 93005
Hospital Charge Code	4593005
Hospital Revenue Code	730
Rate for Payer: Cash Price	$68.40

EKG AND PADS

Facility

$76.00

Service Code	CPT 93005
Hospital Charge Code	4593005
Hospital Revenue Code	730
Min. Negotiated Rate	$27.36
Max. Negotiated Rate	$120.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
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	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$53.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$50.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.36

EKG IN OFFICE W/REPORT & INTERPRETATION

Facility

$223.00

Service Code	CPT 93000
Hospital Charge Code	5293000
Hospital Revenue Code	521
Min. Negotiated Rate	$132.02
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$132.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$159.22
Rate for Payer: Cash Price	$200.70
Rate for Payer: Cash Price	$200.70
Rate for Payer: UnitedHealthcare Commercial	$148.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EKG IN OFFICE W/REPORT & INTERPRETATION

Facility

$223.00

Service Code	CPT 93000
Hospital Charge Code	5293000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$200.70

EKG INTERP AND REPORT

Facility

$49.00

Service Code	CPT 93010
Hospital Charge Code	4493010
Hospital Revenue Code	521
Rate for Payer: Cash Price	$44.10

EKG INTERP AND REPORT

Facility

$49.00

Service Code	CPT 93010
Hospital Charge Code	4493010
Hospital Revenue Code	521
Min. Negotiated Rate	$29.01
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.99
Rate for Payer: Cash Price	$44.10
Rate for Payer: Cash Price	$44.10
Rate for Payer: UnitedHealthcare Commercial	$32.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EKG, INTERPRETATION AND REPORT ONLY

Professional

Both

$119.00

Service Code	CPT 93010
Hospital Charge Code	4593010
Hospital Revenue Code	985
Min. Negotiated Rate	$8.02
Max. Negotiated Rate	$41.65
Rate for Payer: Aetna Commercial/Medicare Advantage	$8.02
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cigna Commercial HMO & PPO	$8.02
Rate for Payer: Home State Health Plan Medicare Advantage	$8.02
Rate for Payer: Optum Medicare Advantage	$41.65

EKG OFFICE

Facility

$90.00

Service Code	CPT 93000
Hospital Charge Code	4293000
Hospital Revenue Code	521
Min. Negotiated Rate	$53.28
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EKG OFFICE

Facility

$90.00

Service Code	CPT 93000
Hospital Charge Code	4293000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$81.00

EKG (OR)

Facility

$156.00

Hospital Charge Code	2024470
Hospital Revenue Code	271
Min. Negotiated Rate	$56.16
Max. Negotiated Rate	$111.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: UnitedHealthcare Commercial	$104.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

EKG (OR)

Facility

$156.00

Hospital Charge Code	2024470
Hospital Revenue Code	271
Rate for Payer: Cash Price	$140.40

EKG PADS

Facility

$48.00

Hospital Charge Code	4500242
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

EKG PADS

Facility

$48.00

Hospital Charge Code	4500242
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

EKG WITH INTERPRETATION & REPORT

Facility

$223.00

Service Code	CPT 93000
Hospital Charge Code	4193000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$200.70

Know your out-of-pocket cost for care.

All Charges