Madison Medical Center

All Charges

Charge

Type

Setting

Price

.SALIVARY PROTEIN 1 IGA

Facility

$30.00

Service Code	CPT 83520
Hospital Charge Code	22816832
Hospital Revenue Code	302
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$34.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.54
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$17.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.63
Rate for Payer: Home State Health Plan Medicare Advantage	$17.27
Rate for Payer: Humana Commercial	$34.54
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

.SALIVARY PROTIEN 1 IGA

Facility

$55.00

Service Code	CPT 83520
Hospital Charge Code	22816750
Hospital Revenue Code	302
Rate for Payer: Cash Price	$49.50

.SALIVARY PROTIEN 1 IGA

Facility

$55.00

Service Code	CPT 83520
Hospital Charge Code	22816750
Hospital Revenue Code	302
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.54
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$17.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.63
Rate for Payer: Home State Health Plan Medicare Advantage	$17.27
Rate for Payer: Humana Commercial	$34.54
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

.SALIVARY PROTIEN 1 IGG

Facility

$55.00

Service Code	CPT 83520
Hospital Charge Code	22816751
Hospital Revenue Code	302
Rate for Payer: Cash Price	$49.50

.SALIVARY PROTIEN 1 IGG

Facility

$55.00

Service Code	CPT 83520
Hospital Charge Code	22816751
Hospital Revenue Code	302
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.54
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$17.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.63
Rate for Payer: Home State Health Plan Medicare Advantage	$17.27
Rate for Payer: Humana Commercial	$34.54
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

.SALIVARY PROTIEN 1 IGM

Facility

$55.00

Service Code	CPT 83520
Hospital Charge Code	22816856
Hospital Revenue Code	302
Rate for Payer: Cash Price	$49.50

.SALIVARY PROTIEN 1 IGM

Facility

$55.00

Service Code	CPT 83520
Hospital Charge Code	22816856
Hospital Revenue Code	302
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.54
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$17.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.63
Rate for Payer: Home State Health Plan Medicare Advantage	$17.27
Rate for Payer: Humana Commercial	$34.54
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

SALPINGIOGRAM CONTRA

Facility

$131.00

Hospital Charge Code	2800122
Hospital Revenue Code	271
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$93.53
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: UnitedHealthcare Commercial	$87.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.16

SALPINGIOGRAM CONTRA

Facility

$131.00

Hospital Charge Code	2800122
Hospital Revenue Code	271
Rate for Payer: Cash Price	$117.90

SALPINGO-OOPHORECTOMY COMPLETE

Facility

$2,315.00

Service Code	CPT 58720
Hospital Charge Code	5258720
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,652.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,370.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,652.91
Rate for Payer: Cash Price	$2,083.50
Rate for Payer: Cash Price	$2,083.50
Rate for Payer: UnitedHealthcare Commercial	$1,544.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SALPINGO-OOPHORECTOMY COMPLETE

Facility

$2,315.00

Service Code	CPT 58720
Hospital Charge Code	5258720
Hospital Revenue Code	521
Rate for Payer: Cash Price	$2,083.50

SAME DAY ADMIT/DISCHARGE BRIEF

Facility

$355.00

Service Code	CPT 99234
Hospital Charge Code	9799234
Hospital Revenue Code	525
Rate for Payer: Cash Price	$319.50

SAME DAY ADMIT/DISCHARGE BRIEF

Facility

$355.00

Service Code	CPT 99234
Hospital Charge Code	9799234
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$253.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$210.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$253.47
Rate for Payer: Cash Price	$319.50
Rate for Payer: Cash Price	$319.50
Rate for Payer: UnitedHealthcare Commercial	$236.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SAME DAY ADMIT/DISCHARGE INTERMEDIATE

Facility

$470.00

Service Code	CPT 99235
Hospital Charge Code	9799235
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$335.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$278.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$335.58
Rate for Payer: Cash Price	$423.00
Rate for Payer: Cash Price	$423.00
Rate for Payer: UnitedHealthcare Commercial	$313.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SAME DAY ADMIT/DISCHARGE INTERMEDIATE

Facility

$470.00

Service Code	CPT 99235
Hospital Charge Code	9799235
Hospital Revenue Code	525
Rate for Payer: Cash Price	$423.00

SAME DAY HOSP ADMIT/DISC BRIEF

Facility

$353.00

Service Code	CPT 99234
Hospital Charge Code	4299234
Rate for Payer: Cash Price	$317.70

SAME DAY HOSP ADMIT/DISC EXTENDED

Facility

$604.00

Service Code	CPT 99236
Hospital Charge Code	4299236
Rate for Payer: Cash Price	$543.60

SAME DAY HOSP ADMIT/DISC INTERMEDIATE

Facility

$465.00

Service Code	CPT 99235
Hospital Charge Code	4299235
Rate for Payer: Cash Price	$418.50

.SARS-COV-2 AB IGA (LABCORP)

Facility

$187.00

Service Code	CPT 86769
Hospital Charge Code	2286771
Hospital Revenue Code	302
Rate for Payer: Cash Price	$168.30

.SARS-COV-2 AB IGA (LABCORP)

Facility

$187.00

Service Code	CPT 86769
Hospital Charge Code	2286771
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$133.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$37.92
Rate for Payer: Aetna Medicare Advantage	$42.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$110.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$133.52
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cigna Commercial HMO & PPO	$42.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$40.57
Rate for Payer: Home State Health Plan Medicare Advantage	$42.13
Rate for Payer: Humana Commercial	$84.26
Rate for Payer: Humana Medicare Advantage	$42.13
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.32

.SARS-COV-2 AB IGG (LABCORP)

Facility

$187.00

Service Code	CPT 86769
Hospital Charge Code	2286770
Hospital Revenue Code	302
Rate for Payer: Cash Price	$168.30

.SARS-COV-2 AB IGG (LABCORP)

Facility

$187.00

Service Code	CPT 86769
Hospital Charge Code	2286770
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$133.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$37.92
Rate for Payer: Aetna Medicare Advantage	$42.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$110.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$133.52
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cigna Commercial HMO & PPO	$42.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$40.57
Rate for Payer: Home State Health Plan Medicare Advantage	$42.13
Rate for Payer: Humana Commercial	$84.26
Rate for Payer: Humana Medicare Advantage	$42.13
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.32

.SARS-COV-2 AB IGM (LABCORP)

Facility

$187.00

Service Code	CPT 86769
Hospital Charge Code	2286769
Hospital Revenue Code	302
Rate for Payer: Cash Price	$168.30

.SARS-COV-2 AB IGM (LABCORP)

Facility

$187.00

Service Code	CPT 86769
Hospital Charge Code	2286769
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$133.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$37.92
Rate for Payer: Aetna Medicare Advantage	$42.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$110.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$133.52
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cash Price	$168.30
Rate for Payer: Cigna Commercial HMO & PPO	$42.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$40.57
Rate for Payer: Home State Health Plan Medicare Advantage	$42.13
Rate for Payer: Humana Commercial	$84.26
Rate for Payer: Humana Medicare Advantage	$42.13
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$67.32

SARS-COV-2 AB TOTAL (LABCORP 164090)

Facility

$158.00

Service Code	CPT 87635
Hospital Charge Code	2286773
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$112.81
Rate for Payer: Aetna Better Health Medicaid/QHP	$46.18
Rate for Payer: Aetna Medicare Advantage	$51.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$93.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$112.81
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cigna Commercial HMO & PPO	$51.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$49.41
Rate for Payer: Home State Health Plan Medicare Advantage	$51.31
Rate for Payer: Humana Commercial	$102.62
Rate for Payer: Humana Medicare Advantage	$51.31
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.88

Know your out-of-pocket cost for care.

All Charges