Madison Medical Center

All Charges

Charge

Type

Setting

Price

OUTREACH-CHOLESTEROL

Facility

$21.00

Service Code	CPT 82465
Hospital Charge Code	2482465
Hospital Revenue Code	301
Min. Negotiated Rate	$3.92
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.92
Rate for Payer: Aetna Medicare Advantage	$4.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cigna Commercial HMO & PPO	$4.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.19
Rate for Payer: Home State Health Plan Medicare Advantage	$4.35
Rate for Payer: Humana Commercial	$8.70
Rate for Payer: Humana Medicare Advantage	$4.35
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

OUTREACH-COLD AGGLUTININS

Facility

$44.00

Service Code	CPT 86157
Hospital Charge Code	2486157
Hospital Revenue Code	301
Rate for Payer: Cash Price	$39.60

OUTREACH-COLD AGGLUTININS

Facility

$44.00

Service Code	CPT 86157
Hospital Charge Code	2486157
Hospital Revenue Code	301
Min. Negotiated Rate	$7.25
Max. Negotiated Rate	$31.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.25
Rate for Payer: Aetna Medicare Advantage	$8.06
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	$8.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.76
Rate for Payer: Home State Health Plan Medicare Advantage	$8.06
Rate for Payer: Humana Commercial	$16.12
Rate for Payer: Humana Medicare Advantage	$8.06
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.25
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

OUTREACH-CPK TOTAL

Facility

$22.00

Service Code	CPT 82550
Hospital Charge Code	2482550
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

OUTREACH-CPK TOTAL

Facility

$22.00

Service Code	CPT 82550
Hospital Charge Code	2482550
Hospital Revenue Code	301
Min. Negotiated Rate	$5.86
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.86
Rate for Payer: Aetna Medicare Advantage	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$6.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.27
Rate for Payer: Home State Health Plan Medicare Advantage	$6.51
Rate for Payer: Humana Commercial	$13.02
Rate for Payer: Humana Medicare Advantage	$6.51
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

OUTREACH-CREAT CLEARANCE

Facility

$110.00

Service Code	CPT 82575
Hospital Charge Code	2482575
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

OUTREACH-CREAT CLEARANCE

Facility

$110.00

Service Code	CPT 82575
Hospital Charge Code	2482575
Hospital Revenue Code	301
Min. Negotiated Rate	$8.51
Max. Negotiated Rate	$78.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.51
Rate for Payer: Aetna Medicare Advantage	$9.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$9.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.11
Rate for Payer: Home State Health Plan Medicare Advantage	$9.46
Rate for Payer: Humana Commercial	$18.92
Rate for Payer: Humana Medicare Advantage	$9.46
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

OUTREACH-CREATININE

Facility

$21.00

Service Code	CPT 82565
Hospital Charge Code	2482565
Hospital Revenue Code	301
Min. Negotiated Rate	$4.61
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.61
Rate for Payer: Aetna Medicare Advantage	$5.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cigna Commercial HMO & PPO	$5.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.93
Rate for Payer: Home State Health Plan Medicare Advantage	$5.12
Rate for Payer: Humana Commercial	$10.24
Rate for Payer: Humana Medicare Advantage	$5.12
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

OUTREACH-CREATININE

Facility

$21.00

Service Code	CPT 82565
Hospital Charge Code	2482565
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

OUTREACH-DIGOXINE

Facility

$58.00

Service Code	CPT 80162
Hospital Charge Code	2480162
Hospital Revenue Code	301
Min. Negotiated Rate	$11.95
Max. Negotiated Rate	$41.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.95
Rate for Payer: Aetna Medicare Advantage	$13.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cigna Commercial HMO & PPO	$13.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.79
Rate for Payer: Home State Health Plan Medicare Advantage	$13.28
Rate for Payer: Humana Commercial	$26.56
Rate for Payer: Humana Medicare Advantage	$13.28
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

OUTREACH-DIGOXINE

Facility

$58.00

Service Code	CPT 80162
Hospital Charge Code	2480162
Hospital Revenue Code	301
Rate for Payer: Cash Price	$52.20

OUTREACH-DILANTIN

Facility

$65.00

Service Code	CPT 80185
Hospital Charge Code	2480185
Hospital Revenue Code	301
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$46.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.93
Rate for Payer: Aetna Medicare Advantage	$13.25
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	$13.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.77
Rate for Payer: Home State Health Plan Medicare Advantage	$13.25
Rate for Payer: Humana Commercial	$26.50
Rate for Payer: Humana Medicare Advantage	$13.25
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

OUTREACH-DILANTIN

Facility

$65.00

Service Code	CPT 80185
Hospital Charge Code	2480185
Hospital Revenue Code	301
Rate for Payer: Cash Price	$58.50

OUTREACH-GGTP

Facility

$21.00

Service Code	CPT 82977
Hospital Charge Code	2482977
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

OUTREACH-GGTP

Facility

$21.00

Service Code	CPT 82977
Hospital Charge Code	2482977
Hospital Revenue Code	301
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.48
Rate for Payer: Aetna Medicare Advantage	$7.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cigna Commercial HMO & PPO	$7.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.93
Rate for Payer: Home State Health Plan Medicare Advantage	$7.20
Rate for Payer: Humana Commercial	$14.40
Rate for Payer: Humana Medicare Advantage	$7.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

OUTREACH-GLUCOSE FAST. OR 2HR

Facility

$16.00

Service Code	CPT 82947
Hospital Charge Code	2482947
Hospital Revenue Code	301
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.54
Rate for Payer: Aetna Medicare Advantage	$3.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna Commercial HMO & PPO	$3.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.79
Rate for Payer: Home State Health Plan Medicare Advantage	$3.93
Rate for Payer: Humana Commercial	$7.86
Rate for Payer: Humana Medicare Advantage	$3.93
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

OUTREACH-GLUCOSE FAST. OR 2HR

Facility

$16.00

Service Code	CPT 82947
Hospital Charge Code	2482947
Hospital Revenue Code	301
Rate for Payer: Cash Price	$14.40

OUTREACH-HEPATIC PROFILE

Facility

$62.00

Service Code	CPT 80076
Hospital Charge Code	2480058
Hospital Revenue Code	301
Rate for Payer: Cash Price	$55.80

OUTREACH-HEPATIC PROFILE

Facility

$62.00

Service Code	CPT 80076
Hospital Charge Code	2480058
Hospital Revenue Code	301
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$44.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.35
Rate for Payer: Aetna Medicare Advantage	$8.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cash Price	$55.80
Rate for Payer: Cigna Commercial HMO & PPO	$8.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.86
Rate for Payer: Home State Health Plan Medicare Advantage	$8.17
Rate for Payer: Humana Commercial	$16.34
Rate for Payer: Humana Medicare Advantage	$8.17
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

OUTREACH-IRON

Facility

$44.00

Service Code	CPT 83540
Hospital Charge Code	2483540
Hospital Revenue Code	301
Rate for Payer: Cash Price	$39.60

OUTREACH-IRON

Facility

$44.00

Service Code	CPT 83540
Hospital Charge Code	2483540
Hospital Revenue Code	301
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$31.42
Rate for Payer: Humana Commercial	$12.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.82
Rate for Payer: Aetna Medicare Advantage	$6.47
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	$6.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.23
Rate for Payer: Home State Health Plan Medicare Advantage	$6.47
Rate for Payer: Humana Medicare Advantage	$6.47
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

OUTREACH-IRON-TIBC

Facility

$44.00

Service Code	CPT 83550
Hospital Charge Code	2483550
Hospital Revenue Code	301
Min. Negotiated Rate	$7.87
Max. Negotiated Rate	$31.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.87
Rate for Payer: Aetna Medicare Advantage	$8.74
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	$8.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.42
Rate for Payer: Home State Health Plan Medicare Advantage	$8.74
Rate for Payer: Humana Commercial	$17.48
Rate for Payer: Humana Medicare Advantage	$8.74
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

OUTREACH-IRON-TIBC

Facility

$44.00

Service Code	CPT 83550
Hospital Charge Code	2483550
Hospital Revenue Code	301
Rate for Payer: Cash Price	$39.60

OUTREACH-LDH

Facility

$21.00

Service Code	CPT 83615
Hospital Charge Code	2483615
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

OUTREACH-LDH

Facility

$21.00

Service Code	CPT 83615
Hospital Charge Code	2483615
Hospital Revenue Code	301
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.44
Rate for Payer: Aetna Medicare Advantage	$6.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cigna Commercial HMO & PPO	$6.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.44
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.82
Rate for Payer: Home State Health Plan Medicare Advantage	$6.04
Rate for Payer: Humana Commercial	$12.08
Rate for Payer: Humana Medicare Advantage	$6.04
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

Know your out-of-pocket cost for care.

All Charges