Madison Medical Center

All Charges

Charge

Type

Setting

Price

INFLUEN VACC 6M - 64Y TRI 0.5ML PFS

Facility

$207.00

Service Code	HCPCS 90661
Hospital Charge Code	2626238
Hospital Revenue Code	250
Rate for Payer: Cash Price	$186.30

INFLUEN VACC PED 6M-35M PFS 0.25ML

Facility

$179.00

Service Code	HCPCS 90656
Hospital Charge Code	2655295
Hospital Revenue Code	250
Min. Negotiated Rate	$64.44
Max. Negotiated Rate	$127.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.81
Rate for Payer: Cash Price	$161.10
Rate for Payer: UnitedHealthcare Commercial	$119.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.44

INFLUEN VACC PED 6M-35M PFS 0.25ML

Facility

$179.00

Service Code	HCPCS 90656
Hospital Charge Code	2655295
Hospital Revenue Code	250
Rate for Payer: Cash Price	$161.10

.INFLUENZA A

Facility

$65.00

Service Code	CPT 87400
Hospital Charge Code	2287402
Hospital Revenue Code	301
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$46.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.72
Rate for Payer: Aetna Medicare Advantage	$14.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial HMO & PPO	$14.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.61
Rate for Payer: Home State Health Plan Medicare Advantage	$14.13
Rate for Payer: Humana Commercial	$28.26
Rate for Payer: Humana Medicare Advantage	$14.13
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

.INFLUENZA A

Facility

$65.00

Service Code	CPT 87400
Hospital Charge Code	2287402
Hospital Revenue Code	301
Rate for Payer: Cash Price	$58.50

INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	9687804
Hospital Revenue Code	301
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$50.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.90
Rate for Payer: Aetna Medicare Advantage	$16.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.94
Rate for Payer: Home State Health Plan Medicare Advantage	$16.55
Rate for Payer: Humana Commercial	$33.10
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	5287804
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.90

INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	4187804
Hospital Revenue Code	301
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$50.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.90
Rate for Payer: Aetna Medicare Advantage	$16.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.94
Rate for Payer: Home State Health Plan Medicare Advantage	$16.55
Rate for Payer: Humana Commercial	$33.10
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	4287804
Hospital Revenue Code	301
Rate for Payer: Cash Price	$63.90

INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	5287804
Hospital Revenue Code	521
Min. Negotiated Rate	$13.41
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.90
Rate for Payer: Aetna Medicare Advantage	$16.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.94
Rate for Payer: Home State Health Plan Medicare Advantage	$16.55
Rate for Payer: Humana Commercial	$33.10
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: UnitedHealthcare Commercial	$47.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	9687804
Hospital Revenue Code	301
Rate for Payer: Cash Price	$63.90

INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	4287804
Hospital Revenue Code	301
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$50.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.90
Rate for Payer: Aetna Medicare Advantage	$16.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.94
Rate for Payer: Home State Health Plan Medicare Advantage	$16.55
Rate for Payer: Humana Commercial	$33.10
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	4187804
Hospital Revenue Code	301
Rate for Payer: Cash Price	$63.90

INFLUENZA A/B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	9187804
Hospital Revenue Code	521
Min. Negotiated Rate	$13.41
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.90
Rate for Payer: Aetna Medicare Advantage	$16.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.94
Rate for Payer: Home State Health Plan Medicare Advantage	$16.55
Rate for Payer: Humana Commercial	$33.10
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: UnitedHealthcare Commercial	$47.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INFLUENZA A/B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	9187804
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.90

INFLUENZA A&B PCR

Facility

$195.00

Service Code	CPT 87502
Hospital Charge Code	2287502
Hospital Revenue Code	306
Rate for Payer: Cash Price	$175.50

INFLUENZA A&B PCR

Facility

$195.00

Service Code	CPT 87502
Hospital Charge Code	2287502
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$191.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$86.22
Rate for Payer: Aetna Medicare Advantage	$95.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$115.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.23
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cigna Commercial HMO & PPO	$95.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$86.22
Rate for Payer: Home State Health Plan Medicaid Managed Care	$92.26
Rate for Payer: Home State Health Plan Medicare Advantage	$95.80
Rate for Payer: Humana Commercial	$191.60
Rate for Payer: Humana Medicare Advantage	$95.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$86.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.20

.INFLUENZA A DFA (LC CHARGE)

Facility

$50.00

Service Code	CPT 87275
Hospital Charge Code	2287275
Hospital Revenue Code	305
Min. Negotiated Rate	$11.03
Max. Negotiated Rate	$35.70
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.03
Rate for Payer: Aetna Medicare Advantage	$12.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$12.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.80
Rate for Payer: Home State Health Plan Medicare Advantage	$12.25
Rate for Payer: Humana Commercial	$24.50
Rate for Payer: Humana Medicare Advantage	$12.25
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

.INFLUENZA A DFA (LC CHARGE)

Facility

$50.00

Service Code	CPT 87275
Hospital Charge Code	2287275
Hospital Revenue Code	305
Rate for Payer: Cash Price	$45.00

.INFLUENZA B

Facility

$65.00

Service Code	CPT 87400
Hospital Charge Code	2287401
Hospital Revenue Code	301
Min. Negotiated Rate	$12.72
Max. Negotiated Rate	$46.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.72
Rate for Payer: Aetna Medicare Advantage	$14.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial HMO & PPO	$14.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.61
Rate for Payer: Home State Health Plan Medicare Advantage	$14.13
Rate for Payer: Humana Commercial	$28.26
Rate for Payer: Humana Medicare Advantage	$14.13
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

.INFLUENZA B

Facility

$65.00

Service Code	CPT 87400
Hospital Charge Code	2287401
Hospital Revenue Code	301
Rate for Payer: Cash Price	$58.50

INFLUENZA B ANTIBODY

Facility

$45.00

Service Code	CPT 86710
Hospital Charge Code	2286713
Hospital Revenue Code	301
Rate for Payer: Cash Price	$40.50

INFLUENZA B ANTIBODY

Facility

$45.00

Service Code	CPT 86710
Hospital Charge Code	2286713
Hospital Revenue Code	301
Min. Negotiated Rate	$12.20
Max. Negotiated Rate	$32.13
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.20
Rate for Payer: Aetna Medicare Advantage	$13.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna Commercial HMO & PPO	$13.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.05
Rate for Payer: Home State Health Plan Medicare Advantage	$13.55
Rate for Payer: Humana Commercial	$27.10
Rate for Payer: Humana Medicare Advantage	$13.55
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

.INFLUENZA B DFA (LC CHARGE)

Facility

$70.00

Service Code	CPT 87276
Hospital Charge Code	2287276
Hospital Revenue Code	305
Rate for Payer: Cash Price	$63.00

.INFLUENZA B DFA (LC CHARGE)

Facility

$70.00

Service Code	CPT 87276
Hospital Charge Code	2287276
Hospital Revenue Code	305
Min. Negotiated Rate	$14.46
Max. Negotiated Rate	$49.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.46
Rate for Payer: Aetna Medicare Advantage	$16.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$16.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.47
Rate for Payer: Home State Health Plan Medicare Advantage	$16.07
Rate for Payer: Humana Commercial	$32.14
Rate for Payer: Humana Medicare Advantage	$16.07
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.46
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

Know your out-of-pocket cost for care.

All Charges