Madison Medical Center

All Charges

Charge

Type

Setting

Price

.HIV PHENOSENSE ASSOCIATED (87904) X15

Facility

$1,509.00

Service Code	CPT 87904
Hospital Charge Code	2287540
Hospital Revenue Code	301
Rate for Payer: Cash Price	$1,358.10

.HIV PHENOSENSE ASSOCIATED (87904) X15

Facility

$1,509.00

Service Code	CPT 87904
Hospital Charge Code	2287540
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$1,077.43
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	$893.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,077.43
Rate for Payer: Cash Price	$1,358.10
Rate for Payer: Cash Price	$1,358.10
Rate for Payer: Cash Price	$1,358.10
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	$543.24

HIV QUAN PCR RFX HIV PHOTOSENSE (550625)

Facility

$519.00

Service Code	CPT 87536
Hospital Charge Code	2287500
Hospital Revenue Code	301
Rate for Payer: Cash Price	$467.10

HIV QUAN PCR RFX HIV PHOTOSENSE (550625)

Facility

$519.00

Service Code	CPT 87536
Hospital Charge Code	2287500
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$370.57
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	$307.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$370.57
Rate for Payer: Cash Price	$467.10
Rate for Payer: Cash Price	$467.10
Rate for Payer: Cash Price	$467.10
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	$186.84

HIV RNA REALTIME PCR (LABCORP 550420)

Facility

$302.00

Service Code	CPT 87536
Hospital Charge Code	2287537
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$215.63
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	$178.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$215.63
Rate for Payer: Cash Price	$271.80
Rate for Payer: Cash Price	$271.80
Rate for Payer: Cash Price	$271.80
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	$108.72

HIV RNA REALTIME PCR (LABCORP 550420)

Facility

$302.00

Service Code	CPT 87536
Hospital Charge Code	2287537
Hospital Revenue Code	305
Rate for Payer: Cash Price	$271.80

HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC

Facility

$100,308.00

Service Code	MSDRG 969
Min. Negotiated Rate	$50,154.00
Max. Negotiated Rate	$100,308.00
Rate for Payer: Aetna Medicare Advantage	$50,154.00
Rate for Payer: Cigna Commercial HMO & PPO	$50,154.00
Rate for Payer: Home State Health Plan Medicare Advantage	$50,154.00
Rate for Payer: Humana Commercial	$100,308.00
Rate for Payer: Humana Medicare Advantage	$50,154.00

HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC

Facility

$45,050.92

Service Code	MSDRG 970
Min. Negotiated Rate	$22,525.46
Max. Negotiated Rate	$45,050.92
Rate for Payer: Aetna Medicare Advantage	$22,525.46
Rate for Payer: Cigna Commercial HMO & PPO	$22,525.46
Rate for Payer: Home State Health Plan Medicare Advantage	$22,525.46
Rate for Payer: Humana Commercial	$45,050.92
Rate for Payer: Humana Medicare Advantage	$22,525.46

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$14,484.99

Service Code	APR-DRG 8923
Min. Negotiated Rate	$14,484.99
Max. Negotiated Rate	$14,484.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,484.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,484.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,484.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,484.99

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$12,263.80

Service Code	APR-DRG 8922
Min. Negotiated Rate	$12,263.80
Max. Negotiated Rate	$12,263.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,263.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,263.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,263.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,263.80

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$9,208.14

Service Code	APR-DRG 8921
Min. Negotiated Rate	$9,208.14
Max. Negotiated Rate	$9,208.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,208.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,208.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,208.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,208.14

HIV WITH MAJOR HIV RELATED CONDITION

Facility

$28,474.64

Service Code	APR-DRG 8924
Min. Negotiated Rate	$28,474.64
Max. Negotiated Rate	$28,474.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$28,474.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28,474.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28,474.64
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28,474.64

HIV WITH MAJOR RELATED CONDITION WITH CC

Facility

$23,910.44

Service Code	MSDRG 975
Min. Negotiated Rate	$11,955.22
Max. Negotiated Rate	$23,910.44
Rate for Payer: Aetna Medicare Advantage	$11,955.22
Rate for Payer: Cigna Commercial HMO & PPO	$11,955.22
Rate for Payer: Home State Health Plan Medicare Advantage	$11,955.22
Rate for Payer: Humana Commercial	$23,910.44
Rate for Payer: Humana Medicare Advantage	$11,955.22

HIV WITH MAJOR RELATED CONDITION WITH MCC

Facility

$48,983.78

Service Code	MSDRG 974
Min. Negotiated Rate	$24,491.89
Max. Negotiated Rate	$48,983.78
Rate for Payer: Aetna Medicare Advantage	$24,491.89
Rate for Payer: Cigna Commercial HMO & PPO	$24,491.89
Rate for Payer: Home State Health Plan Medicare Advantage	$24,491.89
Rate for Payer: Humana Commercial	$48,983.78
Rate for Payer: Humana Medicare Advantage	$24,491.89

HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC

Facility

$17,771.22

Service Code	MSDRG 976
Min. Negotiated Rate	$8,885.61
Max. Negotiated Rate	$17,771.22
Rate for Payer: Aetna Medicare Advantage	$8,885.61
Rate for Payer: Cigna Commercial HMO & PPO	$8,885.61
Rate for Payer: Home State Health Plan Medicare Advantage	$8,885.61
Rate for Payer: Humana Commercial	$17,771.22
Rate for Payer: Humana Medicare Advantage	$8,885.61

HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$10,724.47

Service Code	APR-DRG 8901
Min. Negotiated Rate	$10,724.47
Max. Negotiated Rate	$10,724.47
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,724.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,724.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,724.47
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,724.47

HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$22,944.67

Service Code	APR-DRG 8903
Min. Negotiated Rate	$22,944.67
Max. Negotiated Rate	$22,944.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,944.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,944.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,944.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,944.67

HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$42,641.11

Service Code	APR-DRG 8904
Min. Negotiated Rate	$42,641.11
Max. Negotiated Rate	$42,641.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$42,641.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$42,641.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$42,641.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$42,641.11

HIV WITH MULTIPLE MAJOR HIV RELATED CONDITIONS

Facility

$15,848.71

Service Code	APR-DRG 8902
Min. Negotiated Rate	$15,848.71
Max. Negotiated Rate	$15,848.71
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,848.71
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,848.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,848.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,848.71

HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$10,271.51

Service Code	APR-DRG 8931
Min. Negotiated Rate	$10,271.51
Max. Negotiated Rate	$10,271.51
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,271.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,271.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,271.51
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,271.51

HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$13,052.24

Service Code	APR-DRG 8932
Min. Negotiated Rate	$13,052.24
Max. Negotiated Rate	$13,052.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,052.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,052.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,052.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,052.24

HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$14,132.56

Service Code	APR-DRG 8933
Min. Negotiated Rate	$14,132.56
Max. Negotiated Rate	$14,132.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,132.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,132.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,132.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,132.56

HIV WITH MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS

Facility

$28,141.58

Service Code	APR-DRG 8934
Min. Negotiated Rate	$28,141.58
Max. Negotiated Rate	$28,141.58
Rate for Payer: Aetna Better Health Medicaid/QHP	$28,141.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28,141.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$28,141.58
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28,141.58

HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS

Facility

$9,013.15

Service Code	APR-DRG 8942
Min. Negotiated Rate	$9,013.15
Max. Negotiated Rate	$9,013.15
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,013.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,013.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,013.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,013.15

HIV WITH ONE SIGNIFICANT HIV CONDITION OR WITHOUT SIGNIFICANT RELATED CONDITIONS

Facility

$24,147.31

Service Code	APR-DRG 8944
Min. Negotiated Rate	$24,147.31
Max. Negotiated Rate	$24,147.31
Rate for Payer: Aetna Better Health Medicaid/QHP	$24,147.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24,147.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24,147.31
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24,147.31

Know your out-of-pocket cost for care.

All Charges