Madison Medical Center

All Charges

Charge

Type

Setting

Price

HEPATITIS A TOTAL, RFX IGM

Facility

$178.00

Service Code	CPT 86708
Hospital Charge Code	228302
Hospital Revenue Code	301
Min. Negotiated Rate	$11.15
Max. Negotiated Rate	$127.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.15
Rate for Payer: Aetna Medicare Advantage	$12.39
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	$12.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.93
Rate for Payer: Home State Health Plan Medicare Advantage	$12.39
Rate for Payer: Humana Commercial	$24.78
Rate for Payer: Humana Medicare Advantage	$12.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

HEPATITIS-A VACCINE 1ML INJ (HAVRIX)

Facility

$413.00

Service Code	HCPCS 90632
Hospital Charge Code	2697157
Hospital Revenue Code	250
Rate for Payer: Cash Price	$371.70

HEPATITIS-A VACCINE 1ML INJ (HAVRIX)

Facility

$413.00

Service Code	HCPCS 90632
Hospital Charge Code	2697157
Hospital Revenue Code	250
Min. Negotiated Rate	$148.68
Max. Negotiated Rate	$294.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$244.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$294.88
Rate for Payer: Cash Price	$371.70
Rate for Payer: UnitedHealthcare Commercial	$275.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$148.68

HEPATITIS B CORE IGM

Facility

$44.00

Service Code	CPT 86705
Hospital Charge Code	228603
Hospital Revenue Code	301
Min. Negotiated Rate	$10.59
Max. Negotiated Rate	$31.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.59
Rate for Payer: Aetna Medicare Advantage	$11.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cigna Commercial HMO & PPO	$11.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.33
Rate for Payer: Home State Health Plan Medicare Advantage	$11.77
Rate for Payer: Humana Commercial	$23.54
Rate for Payer: Humana Medicare Advantage	$11.77
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

HEPATITIS B CORE IGM

Facility

$44.00

Service Code	CPT 86705
Hospital Charge Code	228603
Hospital Revenue Code	301
Rate for Payer: Cash Price	$39.60

HEPATITIS B CORE TOTAL

Facility

$44.00

Service Code	CPT 86704
Hospital Charge Code	228602
Hospital Revenue Code	301
Rate for Payer: Cash Price	$39.60

HEPATITIS B CORE TOTAL

Facility

$44.00

Service Code	CPT 86704
Hospital Charge Code	228602
Hospital Revenue Code	301
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$31.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.85
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cigna Commercial HMO & PPO	$12.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.61
Rate for Payer: Home State Health Plan Medicare Advantage	$12.05
Rate for Payer: Humana Commercial	$24.10
Rate for Payer: Humana Medicare Advantage	$12.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

HEPATITIS B DNA QUANT RFX GENOTYPE

Facility

$798.00

Service Code	CPT 87517
Hospital Charge Code	2287517
Hospital Revenue Code	305
Rate for Payer: Cash Price	$718.20

HEPATITIS B DNA QUANT RFX GENOTYPE

Facility

$798.00

Service Code	CPT 87517
Hospital Charge Code	2287517
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$569.77
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	$472.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$569.77
Rate for Payer: Cash Price	$718.20
Rate for Payer: Cash Price	$718.20
Rate for Payer: Cash Price	$718.20
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	$287.28

HEPATITIS Be ANTIBODY 006635

Facility

$47.00

Service Code	CPT 86707
Hospital Charge Code	2284731
Hospital Revenue Code	301
Min. Negotiated Rate	$10.41
Max. Negotiated Rate	$33.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.41
Rate for Payer: Aetna Medicare Advantage	$11.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$27.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$33.56
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cigna Commercial HMO & PPO	$11.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.14
Rate for Payer: Home State Health Plan Medicare Advantage	$11.57
Rate for Payer: Humana Commercial	$23.14
Rate for Payer: Humana Medicare Advantage	$11.57
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.92

HEPATITIS Be ANTIBODY 006635

Facility

$47.00

Service Code	CPT 86707
Hospital Charge Code	2284731
Hospital Revenue Code	301
Rate for Payer: Cash Price	$42.30

HEPATITIS Be ANTIGEN (LABCORP 006619)

Facility

$178.00

Service Code	CPT 87350
Hospital Charge Code	2284733
Hospital Revenue Code	301
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$127.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
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	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

HEPATITIS Be ANTIGEN (LABCORP 006619)

Facility

$178.00

Service Code	CPT 87350
Hospital Charge Code	2284733
Hospital Revenue Code	301
Rate for Payer: Cash Price	$160.20

HEPATITIS B VAC ADULT 1ML PFS PF

Facility

$387.00

Service Code	NDC 6409402
Hospital Charge Code	2697948
Hospital Revenue Code	250
Rate for Payer: Cash Price	$348.30

HEPATITIS B VAC ADULT 1ML PFS PF

Facility

$387.00

Service Code	NDC 6409402
Hospital Charge Code	2697948
Hospital Revenue Code	250
Min. Negotiated Rate	$139.32
Max. Negotiated Rate	$276.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$229.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$276.32
Rate for Payer: Cash Price	$348.30
Rate for Payer: UnitedHealthcare Commercial	$258.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$139.32

HEPATITIS B VIRAL LOAD

Facility

$643.00

Service Code	CPT 87517
Hospital Charge Code	2287179
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$459.10
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	$380.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$459.10
Rate for Payer: Cash Price	$578.70
Rate for Payer: Cash Price	$578.70
Rate for Payer: Cash Price	$578.70
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	$231.48

HEPATITIS B VIRAL LOAD

Facility

$643.00

Service Code	CPT 87517
Hospital Charge Code	2287179
Hospital Revenue Code	301
Rate for Payer: Cash Price	$578.70

HEPATITIS DIAGNOSTIC (ACUTE)

Facility

$292.00

Service Code	CPT 80074
Hospital Charge Code	228601
Hospital Revenue Code	301
Rate for Payer: Cash Price	$262.80

HEPATITIS DIAGNOSTIC (ACUTE)

Facility

$292.00

Service Code	CPT 80074
Hospital Charge Code	228601
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$208.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$42.87
Rate for Payer: Aetna Medicare Advantage	$47.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$172.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$208.49
Rate for Payer: Cash Price	$262.80
Rate for Payer: Cash Price	$262.80
Rate for Payer: Cash Price	$262.80
Rate for Payer: Cigna Commercial HMO & PPO	$47.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$42.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$45.87
Rate for Payer: Home State Health Plan Medicare Advantage	$47.63
Rate for Payer: Humana Commercial	$95.26
Rate for Payer: Humana Medicare Advantage	$47.63
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$42.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$105.12

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC

Facility

$30,864.06

Service Code	MSDRG 421
Min. Negotiated Rate	$15,432.03
Max. Negotiated Rate	$30,864.06
Rate for Payer: Aetna Medicare Advantage	$15,432.03
Rate for Payer: Cigna Commercial HMO & PPO	$15,432.03
Rate for Payer: Home State Health Plan Medicare Advantage	$15,432.03
Rate for Payer: Humana Commercial	$30,864.06
Rate for Payer: Humana Medicare Advantage	$15,432.03

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC

Facility

$57,231.78

Service Code	MSDRG 420
Min. Negotiated Rate	$28,615.89
Max. Negotiated Rate	$57,231.78
Rate for Payer: Aetna Medicare Advantage	$28,615.89
Rate for Payer: Cigna Commercial HMO & PPO	$28,615.89
Rate for Payer: Home State Health Plan Medicare Advantage	$28,615.89
Rate for Payer: Humana Commercial	$57,231.78
Rate for Payer: Humana Medicare Advantage	$28,615.89

HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC

Facility

$25,547.66

Service Code	MSDRG 422
Min. Negotiated Rate	$12,773.83
Max. Negotiated Rate	$25,547.66
Rate for Payer: Aetna Medicare Advantage	$12,773.83
Rate for Payer: Cigna Commercial HMO & PPO	$12,773.83
Rate for Payer: Home State Health Plan Medicare Advantage	$12,773.83
Rate for Payer: Humana Commercial	$25,547.66
Rate for Payer: Humana Medicare Advantage	$12,773.83

HEP B SURF AB

Facility

$67.00

Service Code	CPT 86706
Hospital Charge Code	228306
Hospital Revenue Code	301
Rate for Payer: Cash Price	$60.30

HEP B SURF AB

Facility

$67.00

Service Code	CPT 86706
Hospital Charge Code	228306
Hospital Revenue Code	301
Min. Negotiated Rate	$9.67
Max. Negotiated Rate	$47.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.67
Rate for Payer: Aetna Medicare Advantage	$10.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cigna Commercial HMO & PPO	$10.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10.35
Rate for Payer: Home State Health Plan Medicare Advantage	$10.74
Rate for Payer: Humana Commercial	$21.48
Rate for Payer: Humana Medicare Advantage	$10.74
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

HEP B SURF AG

Facility

$178.00

Service Code	CPT 87340
Hospital Charge Code	228605
Hospital Revenue Code	301
Rate for Payer: Cash Price	$160.20

Know your out-of-pocket cost for care.

All Charges