Madison Medical Center

All Charges

Charge

Type

Setting

Price

HOSPITAL FOLLOW UP (35 MIN)

Facility

$245.00

Service Code	CPT 99233
Hospital Charge Code	9699233
Rate for Payer: Cash Price	$220.50

HOSPITAL INP SERVICE .

Professional

Both

$260.00

Service Code	CPT 99221
Hospital Charge Code	4199221
Hospital Revenue Code	987
Min. Negotiated Rate	$72.43
Max. Negotiated Rate	$91.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$72.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$82.38
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cigna Commercial HMO & PPO	$72.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$82.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$90.62
Rate for Payer: Home State Health Plan Medicare Advantage	$72.43
Rate for Payer: Optum Medicare Advantage	$91.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$82.38

H PYLORI BREATH PEDIATRIC

Facility

$387.00

Service Code	CPT 83013
Hospital Charge Code	2283014
Hospital Revenue Code	301
Rate for Payer: Cash Price	$348.30

H PYLORI BREATH PEDIATRIC

Facility

$387.00

Service Code	CPT 83013
Hospital Charge Code	2283014
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$276.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$60.62
Rate for Payer: Aetna Medicare Advantage	$67.36
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: Cash Price	$348.30
Rate for Payer: Cash Price	$348.30
Rate for Payer: Cigna Commercial HMO & PPO	$67.36
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$60.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$64.86
Rate for Payer: Home State Health Plan Medicare Advantage	$67.36
Rate for Payer: Humana Commercial	$134.72
Rate for Payer: Humana Medicare Advantage	$67.36
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$60.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$139.32

H PYLORI BREATH TEST

Facility

$387.00

Service Code	CPT 83013
Hospital Charge Code	2283013
Hospital Revenue Code	301
Rate for Payer: Cash Price	$348.30

H PYLORI BREATH TEST

Facility

$387.00

Service Code	CPT 83013
Hospital Charge Code	2283013
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$276.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$60.62
Rate for Payer: Aetna Medicare Advantage	$67.36
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: Cash Price	$348.30
Rate for Payer: Cash Price	$348.30
Rate for Payer: Cigna Commercial HMO & PPO	$67.36
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$60.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$64.86
Rate for Payer: Home State Health Plan Medicare Advantage	$67.36
Rate for Payer: Humana Commercial	$134.72
Rate for Payer: Humana Medicare Advantage	$67.36
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$60.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$139.32

.H PYLORI, IGA

Facility

$67.00

Service Code	CPT 86677
Hospital Charge Code	228136
Hospital Revenue Code	301
Rate for Payer: Cash Price	$60.30

.H PYLORI, IGA

Facility

$67.00

Service Code	CPT 86677
Hospital Charge Code	228136
Hospital Revenue Code	301
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$47.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.17
Rate for Payer: Aetna Medicare Advantage	$16.85
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	$16.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.23
Rate for Payer: Home State Health Plan Medicare Advantage	$16.85
Rate for Payer: Humana Commercial	$33.70
Rate for Payer: Humana Medicare Advantage	$16.85
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

H PYLORI, IGG

Facility

$67.00

Service Code	CPT 86677
Hospital Charge Code	228137
Hospital Revenue Code	301
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$47.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.17
Rate for Payer: Aetna Medicare Advantage	$16.85
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	$16.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.23
Rate for Payer: Home State Health Plan Medicare Advantage	$16.85
Rate for Payer: Humana Commercial	$33.70
Rate for Payer: Humana Medicare Advantage	$16.85
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

H PYLORI, IGG

Facility

$67.00

Service Code	CPT 86677
Hospital Charge Code	228137
Hospital Revenue Code	301
Rate for Payer: Cash Price	$60.30

.H PYLORI, IGM

Facility

$67.00

Service Code	CPT 86677
Hospital Charge Code	228138
Hospital Revenue Code	301
Rate for Payer: Cash Price	$60.30

.H PYLORI, IGM

Facility

$67.00

Service Code	CPT 86677
Hospital Charge Code	228138
Hospital Revenue Code	301
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$47.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.17
Rate for Payer: Aetna Medicare Advantage	$16.85
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	$16.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.23
Rate for Payer: Home State Health Plan Medicare Advantage	$16.85
Rate for Payer: Humana Commercial	$33.70
Rate for Payer: Humana Medicare Advantage	$16.85
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

.H PYLORI QUALITATIVE

Facility

$250.00

Service Code	CPT 86677
Hospital Charge Code	228134
Hospital Revenue Code	301
Rate for Payer: Cash Price	$225.00

.H PYLORI QUALITATIVE

Facility

$250.00

Service Code	CPT 86677
Hospital Charge Code	228134
Hospital Revenue Code	301
Min. Negotiated Rate	$15.17
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.17
Rate for Payer: Aetna Medicare Advantage	$16.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial HMO & PPO	$16.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.23
Rate for Payer: Home State Health Plan Medicare Advantage	$16.85
Rate for Payer: Humana Commercial	$33.70
Rate for Payer: Humana Medicare Advantage	$16.85
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.00

H PYLORI STOOL

Facility

$294.00

Service Code	CPT 87338
Hospital Charge Code	2287338
Hospital Revenue Code	301
Min. Negotiated Rate	$12.94
Max. Negotiated Rate	$209.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.94
Rate for Payer: Aetna Medicare Advantage	$14.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$174.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$209.92
Rate for Payer: Cash Price	$264.60
Rate for Payer: Cash Price	$264.60
Rate for Payer: Cash Price	$264.60
Rate for Payer: Cigna Commercial HMO & PPO	$14.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.85
Rate for Payer: Home State Health Plan Medicare Advantage	$14.38
Rate for Payer: Humana Commercial	$28.76
Rate for Payer: Humana Medicare Advantage	$14.38
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$105.84

H PYLORI STOOL

Facility

$294.00

Service Code	CPT 87338
Hospital Charge Code	2287338
Hospital Revenue Code	301
Rate for Payer: Cash Price	$264.60

HSP-70

Facility

$549.00

Service Code	CPT 84181
Hospital Charge Code	2284181
Hospital Revenue Code	301
Min. Negotiated Rate	$15.33
Max. Negotiated Rate	$391.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.33
Rate for Payer: Aetna Medicare Advantage	$17.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$325.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$391.99
Rate for Payer: Cash Price	$494.10
Rate for Payer: Cash Price	$494.10
Rate for Payer: Cash Price	$494.10
Rate for Payer: Cigna Commercial HMO & PPO	$17.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.40
Rate for Payer: Home State Health Plan Medicare Advantage	$17.03
Rate for Payer: Humana Commercial	$34.06
Rate for Payer: Humana Medicare Advantage	$17.03
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$197.64

HSP-70

Facility

$549.00

Service Code	CPT 84181
Hospital Charge Code	2284181
Hospital Revenue Code	301
Rate for Payer: Cash Price	$494.10

HSV 1 IGG ANTIBODIES

Facility

$28.00

Service Code	CPT 86695
Hospital Charge Code	229003
Hospital Revenue Code	301
Rate for Payer: Cash Price	$25.20

HSV 1 IGG ANTIBODIES

Facility

$28.00

Service Code	CPT 86695
Hospital Charge Code	229003
Hospital Revenue Code	301
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$26.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.87
Rate for Payer: Aetna Medicare Advantage	$13.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cash Price	$25.20
Rate for Payer: Cigna Commercial HMO & PPO	$13.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.70
Rate for Payer: Home State Health Plan Medicare Advantage	$13.19
Rate for Payer: Humana Commercial	$26.38
Rate for Payer: Humana Medicare Advantage	$13.19
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

.HSV 2, IGG AB

Facility

$46.00

Service Code	CPT 86696
Hospital Charge Code	228999
Hospital Revenue Code	301
Rate for Payer: Cash Price	$41.40

.HSV 2, IGG AB

Facility

$46.00

Service Code	CPT 86696
Hospital Charge Code	228999
Hospital Revenue Code	301
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$38.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$17.42
Rate for Payer: Aetna Medicare Advantage	$19.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$27.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.84
Rate for Payer: Cash Price	$41.40
Rate for Payer: Cash Price	$41.40
Rate for Payer: Cash Price	$41.40
Rate for Payer: Cigna Commercial HMO & PPO	$19.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18.64
Rate for Payer: Home State Health Plan Medicare Advantage	$19.35
Rate for Payer: Humana Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$19.35
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.56

HSV 2 IGG ANTIBODIES

Facility

$73.00

Service Code	CPT 86696
Hospital Charge Code	229002
Hospital Revenue Code	301
Rate for Payer: Cash Price	$65.70

HSV 2 IGG ANTIBODIES

Facility

$73.00

Service Code	CPT 86696
Hospital Charge Code	229002
Hospital Revenue Code	301
Min. Negotiated Rate	$17.42
Max. Negotiated Rate	$52.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$17.42
Rate for Payer: Aetna Medicare Advantage	$19.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$43.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$52.12
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cash Price	$65.70
Rate for Payer: Cigna Commercial HMO & PPO	$19.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18.64
Rate for Payer: Home State Health Plan Medicare Advantage	$19.35
Rate for Payer: Humana Commercial	$38.70
Rate for Payer: Humana Medicare Advantage	$19.35
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$26.28

HSV CULTURE

Facility

$117.00

Service Code	CPT 87255
Hospital Charge Code	3087255
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$83.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$30.47
Rate for Payer: Aetna Medicare Advantage	$33.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$69.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$83.54
Rate for Payer: Cash Price	$105.30
Rate for Payer: Cash Price	$105.30
Rate for Payer: Cash Price	$105.30
Rate for Payer: Cigna Commercial HMO & PPO	$33.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32.60
Rate for Payer: Home State Health Plan Medicare Advantage	$33.86
Rate for Payer: Humana Commercial	$67.72
Rate for Payer: Humana Medicare Advantage	$33.86
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$30.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.12

Know your out-of-pocket cost for care.

All Charges