Madison Medical Center

All Charges

Charge

Type

Setting

Price

HIV AG/AB W/RFX

Facility

$178.00

Service Code	CPT 87389
Hospital Charge Code	228950
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$127.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.67
Rate for Payer: Aetna Medicare Advantage	$24.08
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	$24.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.19
Rate for Payer: Home State Health Plan Medicare Advantage	$24.08
Rate for Payer: Humana Commercial	$48.16
Rate for Payer: Humana Medicare Advantage	$24.08
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

HIV GENOSURE INTEGRASE

Facility

$452.00

Service Code	CPT 87906
Hospital Charge Code	2287906
Hospital Revenue Code	305
Rate for Payer: Cash Price	$406.80

HIV GENOSURE INTEGRASE

Facility

$452.00

Service Code	CPT 87906
Hospital Charge Code	2287906
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$322.73
Rate for Payer: Aetna Better Health Medicaid/QHP	$115.86
Rate for Payer: Aetna Medicare Advantage	$128.73
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	$128.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$115.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$123.97
Rate for Payer: Home State Health Plan Medicare Advantage	$128.73
Rate for Payer: Humana Commercial	$257.46
Rate for Payer: Humana Medicare Advantage	$128.73
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$115.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$162.72

.HIV GENOSURE PRIME INTERPRETATION

Facility

$437.00

Service Code	CPT 87900
Hospital Charge Code	2287992
Hospital Revenue Code	301
Rate for Payer: Cash Price	$393.30

.HIV GENOSURE PRIME INTERPRETATION

Facility

$437.00

Service Code	CPT 87900
Hospital Charge Code	2287992
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$312.02
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	$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	$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	$157.32

HIV GENOSURE PRIME (LABCORP 551700)

Facility

$668.00

Service Code	CPT 87536
Hospital Charge Code	2287538
Hospital Revenue Code	305
Rate for Payer: Cash Price	$601.20

HIV GENOSURE PRIME (LABCORP 551700)

Facility

$668.00

Service Code	CPT 87536
Hospital Charge Code	2287538
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$476.95
Rate for Payer: Humana Commercial	$170.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$76.59
Rate for Payer: Aetna Medicare Advantage	$85.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$395.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$476.95
Rate for Payer: Cash Price	$601.20
Rate for Payer: Cash Price	$601.20
Rate for Payer: Cash Price	$601.20
Rate for Payer: Cigna Commercial HMO & PPO	$85.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$76.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$81.95
Rate for Payer: Home State Health Plan Medicare Advantage	$85.10
Rate for Payer: Humana Medicare Advantage	$85.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$76.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$240.48

.HIV GENOSURE RFX CHARGE ONLY

Facility

$192.00

Service Code	CPT 87901
Hospital Charge Code	2287990
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	$113.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$137.09
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
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	$69.12

.HIV GENOSURE RFX CHARGE ONLY

Facility

$248.00

Service Code	CPT 87906
Hospital Charge Code	2287991
Hospital Revenue Code	301
Rate for Payer: Cash Price	$223.20

.HIV GENOSURE RFX CHARGE ONLY

Facility

$192.00

Service Code	CPT 87901
Hospital Charge Code	2287990
Hospital Revenue Code	301
Rate for Payer: Cash Price	$172.80

.HIV GENOSURE RFX CHARGE ONLY

Facility

$248.00

Service Code	CPT 87906
Hospital Charge Code	2287991
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$257.46
Rate for Payer: Aetna Better Health Medicaid/QHP	$115.86
Rate for Payer: Aetna Medicare Advantage	$128.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$146.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$177.07
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cigna Commercial HMO & PPO	$128.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$115.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$123.97
Rate for Payer: Home State Health Plan Medicare Advantage	$128.73
Rate for Payer: Humana Commercial	$257.46
Rate for Payer: Humana Medicare Advantage	$128.73
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$115.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$89.28

HIV GENOTYPE

Facility

$668.00

Service Code	CPT 87900
Hospital Charge Code	2287901
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$476.95
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	$395.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$476.95
Rate for Payer: Cash Price	$601.20
Rate for Payer: Cash Price	$601.20
Rate for Payer: Cash Price	$601.20
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	$240.48

HIV GENOTYPE

Facility

$668.00

Service Code	CPT 87900
Hospital Charge Code	2287901
Hospital Revenue Code	305
Rate for Payer: Cash Price	$601.20

.HIV INF AGENT PHENO, CHG ONLY

Facility

$983.00

Service Code	CPT 87903
Hospital Charge Code	2287907
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$977.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$439.79
Rate for Payer: Aetna Medicare Advantage	$488.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$581.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$701.86
Rate for Payer: Cash Price	$884.70
Rate for Payer: Cash Price	$884.70
Rate for Payer: Cash Price	$884.70
Rate for Payer: Cigna Commercial HMO & PPO	$488.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$439.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$470.58
Rate for Payer: Home State Health Plan Medicare Advantage	$488.66
Rate for Payer: Humana Commercial	$977.32
Rate for Payer: Humana Medicare Advantage	$488.66
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$439.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$353.88

.HIV INF AGENT PHENO, CHG ONLY

Facility

$518.00

Service Code	CPT 87901
Hospital Charge Code	2287905
Hospital Revenue Code	305
Rate for Payer: Cash Price	$466.20

.HIV INF AGENT PHENO, CHG ONLY

Facility

$983.00

Service Code	CPT 87903
Hospital Charge Code	2287907
Hospital Revenue Code	305
Rate for Payer: Cash Price	$884.70

.HIV INF AGENT PHENO, CHG ONLY

Facility

$518.00

Service Code	CPT 87901
Hospital Charge Code	2287905
Hospital Revenue Code	305
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	$306.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$369.85
Rate for Payer: Cash Price	$466.20
Rate for Payer: Cash Price	$466.20
Rate for Payer: Cash Price	$466.20
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	$186.48

.HIV INF AGENT PHENO, CHG ONLY

Facility

$238.00

Service Code	CPT 87903
Hospital Charge Code	22887906
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$977.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$439.79
Rate for Payer: Aetna Medicare Advantage	$488.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$140.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$169.93
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cigna Commercial HMO & PPO	$488.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$439.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$470.58
Rate for Payer: Home State Health Plan Medicare Advantage	$488.66
Rate for Payer: Humana Commercial	$977.32
Rate for Payer: Humana Medicare Advantage	$488.66
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$439.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.68

.HIV INF AGENT PHENO, CHG ONLY

Facility

$238.00

Service Code	CPT 87903
Hospital Charge Code	22887906
Hospital Revenue Code	305
Rate for Payer: Cash Price	$214.20

.HIV INF AGENT PHENOTYPE, CHG ONLY X11

Facility

$238.00

Service Code	CPT 87904
Hospital Charge Code	2287904
Hospital Revenue Code	305
Rate for Payer: Cash Price	$214.20

.HIV INF AGENT PHENOTYPE, CHG ONLY X11

Facility

$238.00

Service Code	CPT 87904
Hospital Charge Code	2287904
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$169.93
Rate for Payer: Aetna Better Health Medicaid/QHP	$23.46
Rate for Payer: Aetna Medicare Advantage	$26.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$140.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$169.93
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cash Price	$214.20
Rate for Payer: Cigna Commercial HMO & PPO	$26.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25.10
Rate for Payer: Home State Health Plan Medicare Advantage	$26.07
Rate for Payer: Humana Commercial	$52.14
Rate for Payer: Humana Medicare Advantage	$26.07
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$85.68

.HIV INFECTIOUS AGENT PHENOTYPE

Facility

$101.00

Service Code	CPT 87904
Hospital Charge Code	22287904
Hospital Revenue Code	307
Rate for Payer: Cash Price	$90.90

.HIV INFECTIOUS AGENT PHENOTYPE

Facility

$101.00

Service Code	CPT 87904
Hospital Charge Code	22287904
Hospital Revenue Code	307
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$72.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$23.46
Rate for Payer: Aetna Medicare Advantage	$26.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cigna Commercial HMO & PPO	$26.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$25.10
Rate for Payer: Home State Health Plan Medicare Advantage	$26.07
Rate for Payer: Humana Commercial	$52.14
Rate for Payer: Humana Medicare Advantage	$26.07
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

HIV PCR RFC GENO (LABCORP 550422)

Facility

$495.00

Service Code	CPT 87536
Hospital Charge Code	2287536
Hospital Revenue Code	301
Rate for Payer: Cash Price	$445.50

HIV PCR RFC GENO (LABCORP 550422)

Facility

$495.00

Service Code	CPT 87536
Hospital Charge Code	2287536
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$353.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$76.59
Rate for Payer: Aetna Medicare Advantage	$85.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$293.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$353.43
Rate for Payer: Cash Price	$445.50
Rate for Payer: Cash Price	$445.50
Rate for Payer: Cash Price	$445.50
Rate for Payer: Cigna Commercial HMO & PPO	$85.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$76.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$81.95
Rate for Payer: Home State Health Plan Medicare Advantage	$85.10
Rate for Payer: Humana Commercial	$170.20
Rate for Payer: Humana Medicare Advantage	$85.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$76.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$178.20

Know your out-of-pocket cost for care.

All Charges