Madison Medical Center

All Charges

Charge

Type

Setting

Price

OUTREACH-RETIC COUNT

Facility

$21.00

Service Code	CPT 85044
Hospital Charge Code	2485044
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

OUTREACH-RH (D)

Facility

$65.00

Service Code	CPT 86901
Hospital Charge Code	2486901
Hospital Revenue Code	301
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$46.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.67
Rate for Payer: Aetna Medicare Advantage	$2.99
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	$2.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$33.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$36.03
Rate for Payer: Home State Health Plan Medicare Advantage	$2.99
Rate for Payer: Humana Commercial	$5.98
Rate for Payer: Humana Medicare Advantage	$2.99
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

OUTREACH-RH (D)

Facility

$65.00

Service Code	CPT 86901
Hospital Charge Code	2486901
Hospital Revenue Code	301
Rate for Payer: Cash Price	$58.50

OUTREACH-SALICYLATES

Facility

$42.00

Service Code	CPT 80196
Hospital Charge Code	2480196
Hospital Revenue Code	301
Rate for Payer: Cash Price	$37.80

OUTREACH-SALICYLATES

Facility

$42.00

Service Code	CPT 80196
Hospital Charge Code	2480196
Hospital Revenue Code	301
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

OUTREACH-SED RATE WINTROBE

Facility

$16.00

Service Code	CPT 85651
Hospital Charge Code	2485651
Hospital Revenue Code	301
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.84
Rate for Payer: Aetna Medicare Advantage	$4.27
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	$4.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.11
Rate for Payer: Home State Health Plan Medicare Advantage	$4.27
Rate for Payer: Humana Commercial	$8.54
Rate for Payer: Humana Medicare Advantage	$4.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

OUTREACH-SED RATE WINTROBE

Facility

$16.00

Service Code	CPT 85651
Hospital Charge Code	2485651
Hospital Revenue Code	301
Rate for Payer: Cash Price	$14.40

OUTREACH-SGOT (AST)

Facility

$21.00

Service Code	CPT 84450
Hospital Charge Code	2484450
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	$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	$5.18
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	$7.56

OUTREACH-SGOT (AST)

Facility

$21.00

Service Code	CPT 84450
Hospital Charge Code	2484450
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

OUTREACH-SGPT (ALT)

Facility

$21.00

Service Code	CPT 84460
Hospital Charge Code	2484460
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

OUTREACH-SGPT (ALT)

Facility

$21.00

Service Code	CPT 84460
Hospital Charge Code	2484460
Hospital Revenue Code	301
Min. Negotiated Rate	$4.77
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.77
Rate for Payer: Aetna Medicare Advantage	$5.30
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	$5.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.10
Rate for Payer: Home State Health Plan Medicare Advantage	$5.30
Rate for Payer: Humana Commercial	$10.60
Rate for Payer: Humana Medicare Advantage	$5.30
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

OUTREACH-SODIUM

Facility

$20.00

Service Code	CPT 84295
Hospital Charge Code	2484295
Hospital Revenue Code	301
Min. Negotiated Rate	$4.33
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.33
Rate for Payer: Aetna Medicare Advantage	$4.81
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	$4.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.63
Rate for Payer: Home State Health Plan Medicare Advantage	$4.81
Rate for Payer: Humana Commercial	$9.62
Rate for Payer: Humana Medicare Advantage	$4.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

OUTREACH-SODIUM

Facility

$20.00

Service Code	CPT 84295
Hospital Charge Code	2484295
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.00

OUTREACH-T3 UPTAKE

Facility

$22.00

Service Code	CPT 84479
Hospital Charge Code	2484479
Hospital Revenue Code	301
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$21.00
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	$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	$6.47
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 Commercial	$12.94
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	$7.92

OUTREACH-T3 UPTAKE

Facility

$22.00

Service Code	CPT 84479
Hospital Charge Code	2484479
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

OUTREACH-T4

Facility

$22.00

Service Code	CPT 84436
Hospital Charge Code	2484436
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

OUTREACH-T4

Facility

$22.00

Service Code	CPT 84436
Hospital Charge Code	2484436
Hospital Revenue Code	301
Min. Negotiated Rate	$6.18
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.18
Rate for Payer: Aetna Medicare Advantage	$6.87
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	$6.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.61
Rate for Payer: Home State Health Plan Medicare Advantage	$6.87
Rate for Payer: Humana Commercial	$13.74
Rate for Payer: Humana Medicare Advantage	$6.87
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

OUTREACH-THEOPHYLLINE

Facility

$58.00

Service Code	CPT 80198
Hospital Charge Code	2480198
Hospital Revenue Code	301
Rate for Payer: Cash Price	$52.20

OUTREACH-THEOPHYLLINE

Facility

$58.00

Service Code	CPT 80198
Hospital Charge Code	2480198
Hospital Revenue Code	301
Min. Negotiated Rate	$12.73
Max. Negotiated Rate	$41.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.73
Rate for Payer: Aetna Medicare Advantage	$14.14
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	$14.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.62
Rate for Payer: Home State Health Plan Medicare Advantage	$14.14
Rate for Payer: Humana Commercial	$28.28
Rate for Payer: Humana Medicare Advantage	$14.14
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

OUTREACH-TRIGLYCERIDES

Facility

$21.00

Service Code	CPT 84478
Hospital Charge Code	2484478
Hospital Revenue Code	301
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.17
Rate for Payer: Aetna Medicare Advantage	$5.74
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	$5.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.53
Rate for Payer: Home State Health Plan Medicare Advantage	$5.74
Rate for Payer: Humana Commercial	$11.48
Rate for Payer: Humana Medicare Advantage	$5.74
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

OUTREACH-TRIGLYCERIDES

Facility

$21.00

Service Code	CPT 84478
Hospital Charge Code	2484478
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

OUTREACH-TSH

Facility

$65.00

Service Code	CPT 84443
Hospital Charge Code	2484443
Hospital Revenue Code	301
Rate for Payer: Cash Price	$58.50

OUTREACH-TSH

Facility

$65.00

Service Code	CPT 84443
Hospital Charge Code	2484443
Hospital Revenue Code	301
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$46.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.12
Rate for Payer: Aetna Medicare Advantage	$16.80
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	$16.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.18
Rate for Payer: Home State Health Plan Medicare Advantage	$16.80
Rate for Payer: Humana Commercial	$33.60
Rate for Payer: Humana Medicare Advantage	$16.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

OUTREACH-URIC ACID

Facility

$20.00

Service Code	CPT 84550
Hospital Charge Code	2484550
Hospital Revenue Code	301
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.07
Rate for Payer: Aetna Medicare Advantage	$4.52
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	$4.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.35
Rate for Payer: Home State Health Plan Medicare Advantage	$4.52
Rate for Payer: Humana Commercial	$9.04
Rate for Payer: Humana Medicare Advantage	$4.52
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

OUTREACH-URIC ACID

Facility

$20.00

Service Code	CPT 84550
Hospital Charge Code	2484550
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.00

Know your out-of-pocket cost for care.

All Charges