Madison Medical Center

All Charges

Charge

Type

Setting

Price

ALLERGEN BANANA

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	222742
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN BLACK PEPPER

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218605
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

ALLERGEN BLACK PEPPER

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218605
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN CARMINE RED DYE

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218615
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

ALLERGEN CARMINE RED DYE

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218615
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN CARROT

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218705
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

ALLERGEN CARROT

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218705
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN CHICKEN

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218616
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN CHICKEN

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218616
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

ALLERGEN CINNAMON

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2219223
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN CINNAMON

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2219223
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

ALLERGEN COCONUT

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218629
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN COCONUT

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218629
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

ALLERGEN COFFEE

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218613
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

ALLERGEN COFFEE

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218613
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN CRAB

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218623
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN CRAB

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218623
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

ALLERGEN CUCUMBER

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218704
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

ALLERGEN CUCUMBER

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218704
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN FISH

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218610
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

ALLERGEN FISH

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218610
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN FOOD PNL (LABCORP 608005)

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2226003
Hospital Revenue Code	302
Rate for Payer: Cash Price	$19.80

ALLERGEN FOOD PNL (LABCORP 608005)

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2226003
Hospital Revenue Code	302
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

.ALLERGEN (FOR PANEL TESTING)

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2286101
Hospital Revenue Code	301
Min. Negotiated Rate	$4.70
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.70
Rate for Payer: Aetna Medicare Advantage	$5.22
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: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.22
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.03
Rate for Payer: Home State Health Plan Medicare Advantage	$5.22
Rate for Payer: Humana Commercial	$10.44
Rate for Payer: Humana Medicare Advantage	$5.22
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

.ALLERGEN (FOR PANEL TESTING)

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2286101
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

Know your out-of-pocket cost for care.

All Charges