Madison Medical Center

All Charges

Charge

Type

Setting

Price

ALLERGEN PINE

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218711
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN PINEAPPLE

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218620
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN PINEAPPLE

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218620
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 PUMPKIN

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218703
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 PUMPKIN

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218703
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN RABBIT DANDER

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218707
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN RABBIT DANDER

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218707
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 RICE

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218617
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN RICE

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218617
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 SALMON

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218700
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN SALMON

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218700
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 SESAME

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218625
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN SESAME

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218625
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 SHEEP DANDER

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218706
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN SHEEP DANDER

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218706
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 (SINGLE ALL) LAB USE ONLY

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218600
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

.ALLERGEN (SINGLE ALL) LAB USE ONLY

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218600
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 SWINE DANDER

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218709
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 SWINE DANDER

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218709
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN TOMATO

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218702
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN TOMATO

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218702
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 TUNA

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218701
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

ALLERGEN TUNA

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218701
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 TURKEY

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218618
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 TURKEY

Facility

$22.00

Service Code	CPT 86003
Hospital Charge Code	2218618
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

Know your out-of-pocket cost for care.

All Charges