Madison Medical Center

All Charges

Charge

Type

Setting

Price

.R S V (LC CHARGE)

Facility

$21.00

Service Code	CPT 87280
Hospital Charge Code	2287280
Hospital Revenue Code	305
Rate for Payer: Cash Price	$18.90

RSV PCR

Facility

$178.00

Service Code	CPT 87634
Hospital Charge Code	2287634
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$63.18
Rate for Payer: Aetna Medicare Advantage	$70.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$105.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$127.09
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cash Price	$160.20
Rate for Payer: Cigna Commercial HMO & PPO	$70.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$63.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$67.60
Rate for Payer: Home State Health Plan Medicare Advantage	$70.20
Rate for Payer: Humana Commercial	$140.40
Rate for Payer: Humana Medicare Advantage	$70.20
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$63.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.08

RSV PCR

Facility

$178.00

Service Code	CPT 87634
Hospital Charge Code	2287634
Hospital Revenue Code	306
Rate for Payer: Cash Price	$160.20

RT: INITIAL DAILY DEMO/EVAL

Facility

$468.00

Service Code	CPT 94664
Hospital Charge Code	4500330
Hospital Revenue Code	412
Rate for Payer: Cash Price	$421.20

RT: INITIAL DAILY DEMO/EVAL

Facility

$468.00

Service Code	CPT 94664
Hospital Charge Code	4500330
Hospital Revenue Code	412
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$277.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$334.15
Rate for Payer: Cash Price	$421.20
Rate for Payer: Cash Price	$421.20
Rate for Payer: Cash Price	$421.20
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$312.16
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$168.48

R. TYPHI ANTIBODY IGG

Facility

$138.00

Service Code	CPT 86609
Hospital Charge Code	221904
Hospital Revenue Code	302
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$98.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.59
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$81.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$98.53
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cigna Commercial HMO & PPO	$12.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.40
Rate for Payer: Home State Health Plan Medicare Advantage	$12.88
Rate for Payer: Humana Commercial	$25.76
Rate for Payer: Humana Medicare Advantage	$12.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$49.68

R. TYPHI ANTIBODY IGG

Facility

$138.00

Service Code	CPT 86609
Hospital Charge Code	221904
Hospital Revenue Code	302
Rate for Payer: Cash Price	$124.20

R. TYPHI ANTIBODY IGM

Facility

$138.00

Service Code	CPT 86609
Hospital Charge Code	221951
Hospital Revenue Code	302
Rate for Payer: Cash Price	$124.20

R. TYPHI ANTIBODY IGM

Facility

$138.00

Service Code	CPT 86609
Hospital Charge Code	221951
Hospital Revenue Code	302
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$98.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.59
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$81.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$98.53
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cash Price	$124.20
Rate for Payer: Cigna Commercial HMO & PPO	$12.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.40
Rate for Payer: Home State Health Plan Medicare Advantage	$12.88
Rate for Payer: Humana Commercial	$25.76
Rate for Payer: Humana Medicare Advantage	$12.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$49.68

RUBBERBAND LIGATION HEMORRHOIDS

Facility

$290.00

Service Code	CPT 46221
Hospital Charge Code	4146221
Hospital Revenue Code	521
Rate for Payer: Cash Price	$261.00

RUBBERBAND LIGATION HEMORRHOIDS

Facility

$290.00

Service Code	CPT 46221
Hospital Charge Code	4146221
Hospital Revenue Code	521
Min. Negotiated Rate	$171.68
Max. Negotiated Rate	$1,900.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$838.31
Rate for Payer: Aetna Medicare Advantage	$950.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$171.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$207.06
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cigna Commercial HMO & PPO	$950.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$754.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$896.99
Rate for Payer: Home State Health Plan Medicare Advantage	$950.10
Rate for Payer: Humana Commercial	$1,900.20
Rate for Payer: Humana Medicare Advantage	$950.10
Rate for Payer: UnitedHealthcare Commercial	$193.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$838.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

RUBBER RING

Facility

$22.00

Hospital Charge Code	2818785
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
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: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

RUBBER RING

Facility

$22.00

Hospital Charge Code	2818785
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

RUBELLA ANTIBODY TITER

Facility

$37.00

Service Code	CPT 86280
Hospital Charge Code	4286280
Hospital Revenue Code	521
Min. Negotiated Rate	$6.63
Max. Negotiated Rate	$173.53
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	$21.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$26.42
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cigna Commercial HMO & PPO	$8.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.63
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	$24.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

RUBELLA ANTIBODY TITER

Facility

$37.00

Service Code	CPT 86280
Hospital Charge Code	4286280
Hospital Revenue Code	521
Rate for Payer: Cash Price	$33.30

RUBELLA IGG

Facility

$63.00

Service Code	CPT 86762
Hospital Charge Code	2218198
Hospital Revenue Code	301
Min. Negotiated Rate	$12.95
Max. Negotiated Rate	$44.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.95
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cigna Commercial HMO & PPO	$14.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.86
Rate for Payer: Home State Health Plan Medicare Advantage	$14.39
Rate for Payer: Humana Commercial	$28.78
Rate for Payer: Humana Medicare Advantage	$14.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

RUBELLA IGG

Facility

$63.00

Service Code	CPT 86762
Hospital Charge Code	2218198
Hospital Revenue Code	301
Rate for Payer: Cash Price	$56.70

RUBELLA IGM

Facility

$63.00

Service Code	CPT 86762
Hospital Charge Code	2218100
Hospital Revenue Code	301
Rate for Payer: Cash Price	$56.70

RUBELLA IGM

Facility

$63.00

Service Code	CPT 86762
Hospital Charge Code	2218100
Hospital Revenue Code	301
Min. Negotiated Rate	$12.95
Max. Negotiated Rate	$44.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.95
Rate for Payer: Aetna Medicare Advantage	$14.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cigna Commercial HMO & PPO	$14.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.86
Rate for Payer: Home State Health Plan Medicare Advantage	$14.39
Rate for Payer: Humana Commercial	$28.78
Rate for Payer: Humana Medicare Advantage	$14.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

RUBEOLA IGG

Facility

$63.00

Service Code	CPT 86765
Hospital Charge Code	2286765
Hospital Revenue Code	301
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$44.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.59
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cigna Commercial HMO & PPO	$12.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.40
Rate for Payer: Home State Health Plan Medicare Advantage	$12.88
Rate for Payer: Humana Commercial	$25.76
Rate for Payer: Humana Medicare Advantage	$12.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

RUBEOLA IGG

Facility

$70.00

Service Code	CPT 86765
Hospital Charge Code	2286763
Hospital Revenue Code	301
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$49.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.59
Rate for Payer: Aetna Medicare Advantage	$12.88
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	$12.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.40
Rate for Payer: Home State Health Plan Medicare Advantage	$12.88
Rate for Payer: Humana Commercial	$25.76
Rate for Payer: Humana Medicare Advantage	$12.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

RUBEOLA IGG

Facility

$63.00

Service Code	CPT 86765
Hospital Charge Code	2286765
Hospital Revenue Code	301
Rate for Payer: Cash Price	$56.70

RUBEOLA IGG

Facility

$70.00

Service Code	CPT 86765
Hospital Charge Code	2286763
Hospital Revenue Code	301
Rate for Payer: Cash Price	$63.00

RUBEOLA IGM

Facility

$161.00

Service Code	CPT 86765
Hospital Charge Code	2286766
Hospital Revenue Code	301
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$114.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.59
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$95.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.95
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cigna Commercial HMO & PPO	$12.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.40
Rate for Payer: Home State Health Plan Medicare Advantage	$12.88
Rate for Payer: Humana Commercial	$25.76
Rate for Payer: Humana Medicare Advantage	$12.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$57.96

RUBEOLA IGM

Facility

$161.00

Service Code	CPT 86765
Hospital Charge Code	2286766
Hospital Revenue Code	301
Rate for Payer: Cash Price	$144.90

Know your out-of-pocket cost for care.

All Charges