Madison Medical Center

All Charges

Charge

Type

Setting

Price

.HANTAVIRUS IGM

Facility

$317.00

Service Code	CPT 86790
Hospital Charge Code	2286790
Hospital Revenue Code	302
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$226.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.59
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$187.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$226.34
Rate for Payer: Cash Price	$285.30
Rate for Payer: Cash Price	$285.30
Rate for Payer: Cash Price	$285.30
Rate for Payer: Cigna Commercial HMO & PPO	$12.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.40
Rate for Payer: Home State Health Plan Medicare Advantage	$12.88
Rate for Payer: Humana Commercial	$25.76
Rate for Payer: Humana Medicare Advantage	$12.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$114.12

HAPTOGLOBIN

Facility

$119.00

Service Code	CPT 83010
Hospital Charge Code	228263
Hospital Revenue Code	301
Rate for Payer: Cash Price	$107.10

HAPTOGLOBIN

Facility

$119.00

Service Code	CPT 83010
Hospital Charge Code	228263
Hospital Revenue Code	301
Min. Negotiated Rate	$11.32
Max. Negotiated Rate	$84.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.32
Rate for Payer: Aetna Medicare Advantage	$12.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$70.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$84.97
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cigna Commercial HMO & PPO	$12.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.11
Rate for Payer: Home State Health Plan Medicare Advantage	$12.58
Rate for Payer: Humana Commercial	$25.16
Rate for Payer: Humana Medicare Advantage	$12.58
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84

.HAPTOGLOBIN CPT 83010

Facility

$55.00

Service Code	CPT 83010
Hospital Charge Code	22283010
Hospital Revenue Code	307
Min. Negotiated Rate	$11.32
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.32
Rate for Payer: Aetna Medicare Advantage	$12.58
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	$12.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.11
Rate for Payer: Home State Health Plan Medicare Advantage	$12.58
Rate for Payer: Humana Commercial	$25.16
Rate for Payer: Humana Medicare Advantage	$12.58
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

.HAPTOGLOBIN CPT 83010

Facility

$55.00

Service Code	CPT 83010
Hospital Charge Code	22283010
Hospital Revenue Code	307
Rate for Payer: Cash Price	$49.50

Facility

$60.00

Service Code	CPT 83036
Hospital Charge Code	9583036
Hospital Revenue Code	301
Rate for Payer: Cash Price	$54.00

Facility

$60.00

Service Code	CPT 83036
Hospital Charge Code	3983036
Hospital Revenue Code	301
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$42.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.74
Rate for Payer: Aetna Medicare Advantage	$9.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$9.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.35
Rate for Payer: Home State Health Plan Medicare Advantage	$9.71
Rate for Payer: Humana Commercial	$19.42
Rate for Payer: Humana Medicare Advantage	$9.71
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

Facility

$60.00

Service Code	CPT 83036
Hospital Charge Code	5283036
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.00

Facility

$60.00

Service Code	CPT 83036
Hospital Charge Code	9583036
Hospital Revenue Code	301
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$42.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.74
Rate for Payer: Aetna Medicare Advantage	$9.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$9.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.35
Rate for Payer: Home State Health Plan Medicare Advantage	$9.71
Rate for Payer: Humana Commercial	$19.42
Rate for Payer: Humana Medicare Advantage	$9.71
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

Facility

$60.00

Service Code	CPT 83036
Hospital Charge Code	3983036
Hospital Revenue Code	301
Rate for Payer: Cash Price	$54.00

Facility

$60.00

Service Code	CPT 83036
Hospital Charge Code	9683036
Hospital Revenue Code	301
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$42.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.74
Rate for Payer: Aetna Medicare Advantage	$9.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$9.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.35
Rate for Payer: Home State Health Plan Medicare Advantage	$9.71
Rate for Payer: Humana Commercial	$19.42
Rate for Payer: Humana Medicare Advantage	$9.71
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

Facility

$60.00

Service Code	CPT 83036
Hospital Charge Code	5283036
Hospital Revenue Code	521
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.74
Rate for Payer: Aetna Medicare Advantage	$9.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$9.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.35
Rate for Payer: Home State Health Plan Medicare Advantage	$9.71
Rate for Payer: Humana Commercial	$19.42
Rate for Payer: Humana Medicare Advantage	$9.71
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Facility

$60.00

Service Code	CPT 83036
Hospital Charge Code	9683036
Hospital Revenue Code	301
Rate for Payer: Cash Price	$54.00

Facility

$60.00

Service Code	CPT 83036
Hospital Charge Code	4483036
Hospital Revenue Code	307
Min. Negotiated Rate	$8.74
Max. Negotiated Rate	$42.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.74
Rate for Payer: Aetna Medicare Advantage	$9.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$9.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.35
Rate for Payer: Home State Health Plan Medicare Advantage	$9.71
Rate for Payer: Humana Commercial	$19.42
Rate for Payer: Humana Medicare Advantage	$9.71
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

Facility

$60.00

Service Code	CPT 83036
Hospital Charge Code	4483036
Hospital Revenue Code	307
Rate for Payer: Cash Price	$54.00

.HBV QUANT PCR RFX CHARGE ONLY

Facility

$452.00

Service Code	CPT 87912
Hospital Charge Code	2287912
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$514.90
Rate for Payer: Aetna Better Health Medicaid/QHP	$231.71
Rate for Payer: Aetna Medicare Advantage	$257.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$267.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$322.73
Rate for Payer: Cash Price	$406.80
Rate for Payer: Cash Price	$406.80
Rate for Payer: Cash Price	$406.80
Rate for Payer: Cigna Commercial HMO & PPO	$257.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$231.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$247.93
Rate for Payer: Home State Health Plan Medicare Advantage	$257.45
Rate for Payer: Humana Commercial	$514.90
Rate for Payer: Humana Medicare Advantage	$257.45
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$231.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$162.72

.HBV QUANT PCR RFX CHARGE ONLY

Facility

$452.00

Service Code	CPT 87912
Hospital Charge Code	2287912
Hospital Revenue Code	301
Rate for Payer: Cash Price	$406.80

HCG2 TOTAL QUANTITATIVE

Facility

$190.00

Service Code	CPT 84702
Hospital Charge Code	2227061
Hospital Revenue Code	305
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$135.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.55
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cigna Commercial HMO & PPO	$15.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.50
Rate for Payer: Home State Health Plan Medicare Advantage	$15.05
Rate for Payer: Humana Commercial	$30.10
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.40

HCG2 TOTAL QUANTITATIVE

Facility

$190.00

Service Code	CPT 84702
Hospital Charge Code	2227061
Hospital Revenue Code	305
Rate for Payer: Cash Price	$171.00

..HCG (LABCORP)

Facility

$86.00

Service Code	CPT 84702
Hospital Charge Code	2284704
Hospital Revenue Code	301
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$61.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.55
Rate for Payer: Aetna Medicare Advantage	$15.05
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: Cash Price	$77.40
Rate for Payer: Cash Price	$77.40
Rate for Payer: Cigna Commercial HMO & PPO	$15.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.50
Rate for Payer: Home State Health Plan Medicare Advantage	$15.05
Rate for Payer: Humana Commercial	$30.10
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.96

..HCG (LABCORP)

Facility

$86.00

Service Code	CPT 84702
Hospital Charge Code	2284704
Hospital Revenue Code	301
Rate for Payer: Cash Price	$77.40

.HCG TOTAL QUANTITATIVE

Facility

$190.00

Service Code	CPT 84702
Hospital Charge Code	2227057
Hospital Revenue Code	305
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$135.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.55
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cigna Commercial HMO & PPO	$15.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.50
Rate for Payer: Home State Health Plan Medicare Advantage	$15.05
Rate for Payer: Humana Commercial	$30.10
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.40

.HCG TOTAL QUANTITATIVE

Facility

$190.00

Service Code	CPT 84702
Hospital Charge Code	2227057
Hospital Revenue Code	305
Rate for Payer: Cash Price	$171.00

HCG TUMOR MARKER

Facility

$48.00

Service Code	CPT 84702
Hospital Charge Code	2284702
Hospital Revenue Code	301
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$34.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.55
Rate for Payer: Aetna Medicare Advantage	$15.05
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: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cigna Commercial HMO & PPO	$15.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.50
Rate for Payer: Home State Health Plan Medicare Advantage	$15.05
Rate for Payer: Humana Commercial	$30.10
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

HCG TUMOR MARKER

Facility

$48.00

Service Code	CPT 84702
Hospital Charge Code	2284702
Hospital Revenue Code	301
Rate for Payer: Cash Price	$43.20

Know your out-of-pocket cost for care.

All Charges