Madison Medical Center

All Charges

Charge

Type

Setting

Price

H - CLAVICLE H

Facility

$86.00

Hospital Charge Code	283241
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

H - CLAVICLE H

Facility

$86.00

Hospital Charge Code	283241
Hospital Revenue Code	271
Rate for Payer: Cash Price	$77.40

HCV AB (LC140659)

Facility

$42.00

Service Code	CPT 86803
Hospital Charge Code	228599
Hospital Revenue Code	301
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$29.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.84
Rate for Payer: Aetna Medicare Advantage	$14.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cigna Commercial HMO & PPO	$14.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.74
Rate for Payer: Home State Health Plan Medicare Advantage	$14.27
Rate for Payer: Humana Commercial	$28.54
Rate for Payer: Humana Medicare Advantage	$14.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

HCV AB (LC140659)

Facility

$42.00

Service Code	CPT 86803
Hospital Charge Code	228599
Hospital Revenue Code	301
Rate for Payer: Cash Price	$37.80

HCV AB rfx POS to Quant PCR (LC144050)

Facility

$178.00

Service Code	CPT 86803
Hospital Charge Code	2286803
Hospital Revenue Code	301
Rate for Payer: Cash Price	$160.20

HCV AB rfx POS to Quant PCR (LC144050)

Facility

$178.00

Service Code	CPT 86803
Hospital Charge Code	2286803
Hospital Revenue Code	301
Min. Negotiated Rate	$12.84
Max. Negotiated Rate	$127.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.84
Rate for Payer: Aetna Medicare Advantage	$14.27
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	$14.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.74
Rate for Payer: Home State Health Plan Medicare Advantage	$14.27
Rate for Payer: Humana Commercial	$28.54
Rate for Payer: Humana Medicare Advantage	$14.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

HCV FIBROSURE (LC550123)

Facility

$394.00

Service Code	CPT 81596
Hospital Charge Code	2287520
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$281.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.97
Rate for Payer: Aetna Medicare Advantage	$72.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$233.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$281.32
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cigna Commercial HMO & PPO	$72.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.52
Rate for Payer: Home State Health Plan Medicare Advantage	$72.19
Rate for Payer: Humana Commercial	$144.38
Rate for Payer: Humana Medicare Advantage	$72.19
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$141.84

HCV FIBROSURE (LC550123)

Facility

$394.00

Service Code	CPT 81596
Hospital Charge Code	2287520
Hospital Revenue Code	305
Rate for Payer: Cash Price	$354.60

HCV GENOSURE NS34AG (LC550540)

Facility

$1,065.00

Service Code	CPT 87900
Hospital Charge Code	2287903
Hospital Revenue Code	305
Rate for Payer: Cash Price	$958.50

HCV GENOSURE NS34AG (LC550540)

Facility

$1,065.00

Service Code	CPT 87900
Hospital Charge Code	2287903
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$760.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$117.32
Rate for Payer: Aetna Medicare Advantage	$130.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$630.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$760.41
Rate for Payer: Cash Price	$958.50
Rate for Payer: Cash Price	$958.50
Rate for Payer: Cash Price	$958.50
Rate for Payer: Cigna Commercial HMO & PPO	$130.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$117.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$125.53
Rate for Payer: Home State Health Plan Medicare Advantage	$130.35
Rate for Payer: Humana Commercial	$260.70
Rate for Payer: Humana Medicare Advantage	$130.35
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$117.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$383.40

HCV GENOTYPING

Facility

$382.00

Service Code	CPT 87902
Hospital Charge Code	224052
Hospital Revenue Code	301
Rate for Payer: Cash Price	$343.80

HCV GENOTYPING

Facility

$382.00

Service Code	CPT 87902
Hospital Charge Code	224052
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	$226.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$272.75
Rate for Payer: Cash Price	$343.80
Rate for Payer: Cash Price	$343.80
Rate for Payer: Cash Price	$343.80
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	$137.52

HCV NAA QUAL(LC550713)

Facility

$297.00

Service Code	CPT 87521
Hospital Charge Code	2287521
Hospital Revenue Code	301
Rate for Payer: Cash Price	$267.30

HCV NAA QUAL(LC550713)

Facility

$297.00

Service Code	CPT 87521
Hospital Charge Code	2287521
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$212.06
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	$175.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$212.06
Rate for Payer: Cash Price	$267.30
Rate for Payer: Cash Price	$267.30
Rate for Payer: Cash Price	$267.30
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	$106.92

HCV NS5a (LC550325)

Facility

$768.00

Service Code	CPT 87902
Hospital Charge Code	2287550
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$548.35
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	$454.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$548.35
Rate for Payer: Cash Price	$691.20
Rate for Payer: Cash Price	$691.20
Rate for Payer: Cash Price	$691.20
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	$276.48

HCV NS5a (LC550325)

Facility

$768.00

Service Code	CPT 87902
Hospital Charge Code	2287550
Hospital Revenue Code	301
Rate for Payer: Cash Price	$691.20

.HCV QUANT PCR RFX CHARGE ONLY

Facility

$437.00

Service Code	CPT 87522
Hospital Charge Code	22550070
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$312.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$38.56
Rate for Payer: Aetna Medicare Advantage	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$258.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$312.02
Rate for Payer: Cash Price	$393.30
Rate for Payer: Cash Price	$393.30
Rate for Payer: Cash Price	$393.30
Rate for Payer: Cigna Commercial HMO & PPO	$42.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$38.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41.26
Rate for Payer: Home State Health Plan Medicare Advantage	$42.84
Rate for Payer: Humana Commercial	$85.68
Rate for Payer: Humana Medicare Advantage	$42.84
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$38.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$157.32

.HCV QUANT PCR RFX CHARGE ONLY

Facility

$437.00

Service Code	CPT 87522
Hospital Charge Code	22550070
Hospital Revenue Code	306
Rate for Payer: Cash Price	$393.30

HCV RNA PCR RFX HCV GEN NS3/4 (LC550072)

Facility

$659.00

Service Code	CPT 87522
Hospital Charge Code	2283950
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$470.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$38.56
Rate for Payer: Aetna Medicare Advantage	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$390.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$470.53
Rate for Payer: Cash Price	$593.10
Rate for Payer: Cash Price	$593.10
Rate for Payer: Cash Price	$593.10
Rate for Payer: Cigna Commercial HMO & PPO	$42.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$38.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41.26
Rate for Payer: Home State Health Plan Medicare Advantage	$42.84
Rate for Payer: Humana Commercial	$85.68
Rate for Payer: Humana Medicare Advantage	$42.84
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$38.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$237.24

HCV RNA PCR RFX HCV GEN NS3/4 (LC550072)

Facility

$659.00

Service Code	CPT 87522
Hospital Charge Code	2283950
Hospital Revenue Code	305
Rate for Payer: Cash Price	$593.10

HCV RNA QUANT (LC550080)

Facility

$342.00

Service Code	CPT 87522
Hospital Charge Code	2287522
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$244.19
Rate for Payer: Aetna Better Health Medicaid/QHP	$38.56
Rate for Payer: Aetna Medicare Advantage	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$202.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$244.19
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cigna Commercial HMO & PPO	$42.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$38.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41.26
Rate for Payer: Home State Health Plan Medicare Advantage	$42.84
Rate for Payer: Humana Commercial	$85.68
Rate for Payer: Humana Medicare Advantage	$42.84
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$38.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$123.12

HCV RNA QUANT (LC550080)

Facility

$342.00

Service Code	CPT 87522
Hospital Charge Code	2287522
Hospital Revenue Code	305
Rate for Payer: Cash Price	$307.80

HCV RT-PCR QUANT (LC550080)

Facility

$342.00

Service Code	CPT 87522
Hospital Charge Code	2287902
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$244.19
Rate for Payer: Cigna Commercial HMO & PPO	$42.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$38.56
Rate for Payer: Aetna Medicare Advantage	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$202.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$244.19
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Cash Price	$307.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$38.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$41.26
Rate for Payer: Home State Health Plan Medicare Advantage	$42.84
Rate for Payer: Humana Commercial	$85.68
Rate for Payer: Humana Medicare Advantage	$42.84
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$38.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$123.12

HCV RT-PCR QUANT (LC550080)

Facility

$342.00

Service Code	CPT 87522
Hospital Charge Code	2287902
Hospital Revenue Code	301
Rate for Payer: Cash Price	$307.80

HCV VIRAL LOAD RFX TO GEN (LC550090)

Facility

$342.00

Service Code	CPT 87522
Hospital Charge Code	2283895
Hospital Revenue Code	305
Rate for Payer: Cash Price	$307.80

Know your out-of-pocket cost for care.

All Charges