Madison Medical Center

All Charges

Charge

Type

Setting

Price

OUTREACH-LIPOPROTEIN CHOL, FIAC

Facility

$131.00

Service Code	CPT 83718
Hospital Charge Code	2483718
Hospital Revenue Code	301
Min. Negotiated Rate	$7.37
Max. Negotiated Rate	$93.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.37
Rate for Payer: Aetna Medicare Advantage	$8.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$77.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$93.53
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cigna Commercial HMO & PPO	$8.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.89
Rate for Payer: Home State Health Plan Medicare Advantage	$8.19
Rate for Payer: Humana Commercial	$16.38
Rate for Payer: Humana Medicare Advantage	$8.19
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.16

OUTREACH-LIPOPROTEIN CHOL, FIAC

Facility

$131.00

Service Code	CPT 83718
Hospital Charge Code	2483718
Hospital Revenue Code	301
Rate for Payer: Cash Price	$117.90

OUTREACH-LITHIUM

Facility

$22.00

Service Code	CPT 80178
Hospital Charge Code	2480178
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

OUTREACH-LITHIUM

Facility

$22.00

Service Code	CPT 80178
Hospital Charge Code	2480178
Hospital Revenue Code	301
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.95
Rate for Payer: Aetna Medicare Advantage	$6.61
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	$6.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.37
Rate for Payer: Home State Health Plan Medicare Advantage	$6.61
Rate for Payer: Humana Commercial	$13.22
Rate for Payer: Humana Medicare Advantage	$6.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

OUTREACH-MAGNESIUM

Facility

$40.00

Service Code	CPT 83735
Hospital Charge Code	2483735
Hospital Revenue Code	301
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.03
Rate for Payer: Aetna Medicare Advantage	$6.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$6.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.45
Rate for Payer: Home State Health Plan Medicare Advantage	$6.70
Rate for Payer: Humana Commercial	$13.40
Rate for Payer: Humana Medicare Advantage	$6.70
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

OUTREACH-MAGNESIUM

Facility

$40.00

Service Code	CPT 83735
Hospital Charge Code	2483735
Hospital Revenue Code	301
Rate for Payer: Cash Price	$36.00

OUTREACH-MONO SPOT

Facility

$24.00

Service Code	CPT 86308
Hospital Charge Code	2486308
Hospital Revenue Code	301
Rate for Payer: Cash Price	$21.60

OUTREACH-MONO SPOT

Facility

$24.00

Service Code	CPT 86308
Hospital Charge Code	2486308
Hospital Revenue Code	301
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.66
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cigna Commercial HMO & PPO	$5.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.99
Rate for Payer: Home State Health Plan Medicare Advantage	$5.18
Rate for Payer: Humana Commercial	$10.36
Rate for Payer: Humana Medicare Advantage	$5.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

OUTREACH-PARTIAL THROMBOPLASTI

Facility

$39.00

Service Code	CPT 85730
Hospital Charge Code	2485730
Hospital Revenue Code	301
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$27.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.41
Rate for Payer: Aetna Medicare Advantage	$6.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cash Price	$35.10
Rate for Payer: Cigna Commercial HMO & PPO	$6.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.79
Rate for Payer: Home State Health Plan Medicare Advantage	$6.01
Rate for Payer: Humana Commercial	$12.02
Rate for Payer: Humana Medicare Advantage	$6.01
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

OUTREACH-PARTIAL THROMBOPLASTI

Facility

$39.00

Service Code	CPT 85730
Hospital Charge Code	2485730
Hospital Revenue Code	301
Rate for Payer: Cash Price	$35.10

OUTREACH-PHENOBARBITAL

Facility

$58.00

Service Code	CPT 80184
Hospital Charge Code	2480184
Hospital Revenue Code	301
Rate for Payer: Cash Price	$52.20

OUTREACH-PHENOBARBITAL

Facility

$58.00

Service Code	CPT 80184
Hospital Charge Code	2480184
Hospital Revenue Code	301
Min. Negotiated Rate	$13.77
Max. Negotiated Rate	$41.41
Rate for Payer: Cigna Commercial HMO & PPO	$15.30
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.77
Rate for Payer: Aetna Medicare Advantage	$15.30
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: Healthy Blue CHP/Medicaid Managed Care	$13.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.73
Rate for Payer: Home State Health Plan Medicare Advantage	$15.30
Rate for Payer: Humana Commercial	$30.60
Rate for Payer: Humana Medicare Advantage	$15.30
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

OUTREACH-PHOSPHORUS

Facility

$21.00

Service Code	CPT 84100
Hospital Charge Code	2484100
Hospital Revenue Code	301
Min. Negotiated Rate	$4.27
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.27
Rate for Payer: Aetna Medicare Advantage	$4.74
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	$4.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.57
Rate for Payer: Home State Health Plan Medicare Advantage	$4.74
Rate for Payer: Humana Commercial	$9.48
Rate for Payer: Humana Medicare Advantage	$4.74
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

OUTREACH-PHOSPHORUS

Facility

$21.00

Service Code	CPT 84100
Hospital Charge Code	2484100
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

OUTREACH-POTASSIUM

Facility

$20.00

Service Code	CPT 84132
Hospital Charge Code	2484132
Hospital Revenue Code	301
Min. Negotiated Rate	$4.28
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.28
Rate for Payer: Aetna Medicare Advantage	$4.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cigna Commercial HMO & PPO	$4.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.58
Rate for Payer: Home State Health Plan Medicare Advantage	$4.76
Rate for Payer: Humana Commercial	$9.52
Rate for Payer: Humana Medicare Advantage	$4.76
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

OUTREACH-POTASSIUM

Facility

$20.00

Service Code	CPT 84132
Hospital Charge Code	2484132
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.00

OUTREACH-PREG. TEST UA

Facility

$22.00

Service Code	CPT 81025
Hospital Charge Code	2481025
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

OUTREACH-PREG. TEST UA

Facility

$22.00

Service Code	CPT 81025
Hospital Charge Code	2481025
Hospital Revenue Code	301
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.75
Rate for Payer: Aetna Medicare Advantage	$8.61
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	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.29
Rate for Payer: Home State Health Plan Medicare Advantage	$8.61
Rate for Payer: Humana Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$8.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

OUTREACH-PROTEIN TOTAL

Facility

$21.00

Service Code	CPT 84155
Hospital Charge Code	2484155
Hospital Revenue Code	301
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.30
Rate for Payer: Aetna Medicare Advantage	$3.67
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	$3.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.53
Rate for Payer: Home State Health Plan Medicare Advantage	$3.67
Rate for Payer: Humana Commercial	$7.34
Rate for Payer: Humana Medicare Advantage	$3.67
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

OUTREACH-PROTEIN TOTAL

Facility

$21.00

Service Code	CPT 84155
Hospital Charge Code	2484155
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

OUTREACH-PROTHROMBIN TIME

Facility

$21.00

Service Code	CPT 85610
Hospital Charge Code	2485610
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

OUTREACH-PROTHROMBIN TIME

Facility

$21.00

Service Code	CPT 85610
Hospital Charge Code	2485610
Hospital Revenue Code	301
Min. Negotiated Rate	$3.86
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.86
Rate for Payer: Aetna Medicare Advantage	$4.29
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	$4.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.13
Rate for Payer: Home State Health Plan Medicare Advantage	$4.29
Rate for Payer: Humana Commercial	$8.58
Rate for Payer: Humana Medicare Advantage	$4.29
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

OUTREACH-RAPID STREP SCREEN

Facility

$60.00

Hospital Charge Code	2485732
Hospital Revenue Code	301
Rate for Payer: Cash Price	$54.00

OUTREACH-RAPID STREP SCREEN

Facility

$60.00

Hospital Charge Code	2485732
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

OUTREACH-RETIC COUNT

Facility

$21.00

Service Code	CPT 85044
Hospital Charge Code	2485044
Hospital Revenue Code	301
Min. Negotiated Rate	$3.88
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.88
Rate for Payer: Aetna Medicare Advantage	$4.31
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	$4.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.15
Rate for Payer: Home State Health Plan Medicare Advantage	$4.31
Rate for Payer: Humana Commercial	$8.62
Rate for Payer: Humana Medicare Advantage	$4.31
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.88
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

Know your out-of-pocket cost for care.

All Charges