Madison Medical Center

All Charges

Charge

Type

Setting

Price

BB ANTIBODY SCREEN EA

Facility

$140.00

Service Code	CPT 86850
Hospital Charge Code	221166
Hospital Revenue Code	302
Rate for Payer: Cash Price	$126.00

BB ANTIBODY SCREEN EA

Facility

$140.00

Service Code	CPT 86850
Hospital Charge Code	221166
Hospital Revenue Code	302
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$99.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$46.98
Rate for Payer: Aetna Medicare Advantage	$9.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$82.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$99.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cigna Commercial HMO & PPO	$9.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$50.27
Rate for Payer: Home State Health Plan Medicare Advantage	$9.77
Rate for Payer: Humana Commercial	$19.54
Rate for Payer: Humana Medicare Advantage	$9.77
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$50.40

BB ARC-ABO

Facility

$59.00

Service Code	CPT 86900
Hospital Charge Code	2286861
Hospital Revenue Code	302
Rate for Payer: Cash Price	$53.10

BB ARC-ABO

Facility

$59.00

Service Code	CPT 86900
Hospital Charge Code	2286861
Hospital Revenue Code	302
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$128.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
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	$34.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.13
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cigna Commercial HMO & PPO	$2.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$119.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
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	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.24

BB ARC-Ag SCREEN SERUM/UNIT, EA

Facility

$208.00

Service Code	CPT 86904
Hospital Charge Code	2286904
Hospital Revenue Code	302
Rate for Payer: Cash Price	$187.20

BB ARC-Ag SCREEN SERUM/UNIT, EA

Facility

$208.00

Service Code	CPT 86904
Hospital Charge Code	2286904
Hospital Revenue Code	302
Min. Negotiated Rate	$16.34
Max. Negotiated Rate	$148.51
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$16.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$123.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$148.51
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cigna Commercial HMO & PPO	$16.34
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$53.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$16.34
Rate for Payer: Humana Commercial	$32.68
Rate for Payer: Humana Medicare Advantage	$16.34
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$74.88

BB ARC-AGT PHASE CROSSMATCH

Facility

$230.00

Service Code	CPT 86922
Hospital Charge Code	226922
Hospital Revenue Code	302
Rate for Payer: Cash Price	$207.00

BB ARC-AGT PHASE CROSSMATCH

Facility

$230.00

Service Code	CPT 86922
Hospital Charge Code	226922
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$348.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$153.58
Rate for Payer: Aetna Medicare Advantage	$174.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$136.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$164.22
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cigna Commercial HMO & PPO	$174.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$153.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$164.33
Rate for Payer: Home State Health Plan Medicare Advantage	$174.06
Rate for Payer: Humana Commercial	$348.12
Rate for Payer: Humana Medicare Advantage	$174.06
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$153.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$82.80

BB ARC-ANTIBODY ID,EA

Facility

$264.00

Service Code	CPT 86885
Hospital Charge Code	226885
Hospital Revenue Code	302
Rate for Payer: Cash Price	$237.60

BB ARC-ANTIBODY ID,EA

Facility

$264.00

Service Code	CPT 86885
Hospital Charge Code	226885
Hospital Revenue Code	302
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$188.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$153.58
Rate for Payer: Aetna Medicare Advantage	$5.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$156.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$188.50
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cigna Commercial HMO & PPO	$5.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$153.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$164.33
Rate for Payer: Home State Health Plan Medicare Advantage	$5.72
Rate for Payer: Humana Commercial	$11.44
Rate for Payer: Humana Medicare Advantage	$5.72
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$153.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.04

BB ARC-ANTIBODY PANEL,EA

Facility

$264.00

Service Code	CPT 86870
Hospital Charge Code	2219024
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$732.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$323.12
Rate for Payer: Aetna Medicare Advantage	$366.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$156.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$188.50
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cigna Commercial HMO & PPO	$366.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$323.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$345.74
Rate for Payer: Home State Health Plan Medicare Advantage	$366.21
Rate for Payer: Humana Commercial	$732.42
Rate for Payer: Humana Medicare Advantage	$366.21
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$323.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.04

BB ARC-ANTIBODY PANEL,EA

Facility

$264.00

Service Code	CPT 86870
Hospital Charge Code	2219024
Hospital Revenue Code	302
Rate for Payer: Cash Price	$237.60

BB ARC-ANTIBODY SCREEN,EA

Facility

$264.00

Service Code	CPT 86850
Hospital Charge Code	2286851
Hospital Revenue Code	302
Rate for Payer: Cash Price	$237.60

BB ARC-ANTIBODY SCREEN,EA

Facility

$264.00

Service Code	CPT 86850
Hospital Charge Code	2286851
Hospital Revenue Code	302
Min. Negotiated Rate	$9.77
Max. Negotiated Rate	$188.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$46.98
Rate for Payer: Aetna Medicare Advantage	$9.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$156.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$188.50
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cigna Commercial HMO & PPO	$9.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$46.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$50.27
Rate for Payer: Home State Health Plan Medicare Advantage	$9.77
Rate for Payer: Humana Commercial	$19.54
Rate for Payer: Humana Medicare Advantage	$9.77
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$46.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.04

BB ARC-CROSSMATCH, IS

Facility

$137.00

Service Code	CPT 86920
Hospital Charge Code	226920
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$348.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$153.58
Rate for Payer: Aetna Medicare Advantage	$174.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$81.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$97.82
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cash Price	$123.30
Rate for Payer: Cigna Commercial HMO & PPO	$174.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$153.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$164.33
Rate for Payer: Home State Health Plan Medicare Advantage	$174.06
Rate for Payer: Humana Commercial	$348.12
Rate for Payer: Humana Medicare Advantage	$174.06
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$153.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$49.32

BB ARC-CROSSMATCH, IS

Facility

$137.00

Service Code	CPT 86920
Hospital Charge Code	226920
Hospital Revenue Code	302
Rate for Payer: Cash Price	$123.30

BB ARC-DAT

Facility

$59.00

Service Code	CPT 86880
Hospital Charge Code	2286863
Hospital Revenue Code	302
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$56.90
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$5.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.13
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cash Price	$53.10
Rate for Payer: Cigna Commercial HMO & PPO	$5.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$53.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$5.39
Rate for Payer: Humana Commercial	$10.78
Rate for Payer: Humana Medicare Advantage	$5.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.24

BB ARC-DAT

Facility

$59.00

Service Code	CPT 86880
Hospital Charge Code	2286863
Hospital Revenue Code	302
Rate for Payer: Cash Price	$53.10

BB ARC-DIFF/AUTO ADS

Facility

$305.00

Service Code	CPT 86978
Hospital Charge Code	2286978
Hospital Revenue Code	302
Rate for Payer: Cash Price	$274.50

BB ARC-DIFF/AUTO ADS

Facility

$305.00

Service Code	CPT 86978
Hospital Charge Code	2286978
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$217.77
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$180.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$217.77
Rate for Payer: Cash Price	$274.50
Rate for Payer: Cash Price	$274.50
Rate for Payer: Cash Price	$274.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$53.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$109.80

BB ARC-ELUTION,PER UNIT

Facility

$300.00

Service Code	CPT 86860
Hospital Charge Code	226860
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$348.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$153.58
Rate for Payer: Aetna Medicare Advantage	$174.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.20
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cigna Commercial HMO & PPO	$174.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$153.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$164.33
Rate for Payer: Home State Health Plan Medicare Advantage	$174.06
Rate for Payer: Humana Commercial	$348.12
Rate for Payer: Humana Medicare Advantage	$174.06
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$153.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.00

BB ARC-ELUTION,PER UNIT

Facility

$300.00

Service Code	CPT 86860
Hospital Charge Code	226860
Hospital Revenue Code	302
Rate for Payer: Cash Price	$270.00

BB ARC-RBC ANTIGEN,EA

Facility

$354.00

Service Code	CPT 86902
Hospital Charge Code	2286905
Hospital Revenue Code	302
Min. Negotiated Rate	$6.35
Max. Negotiated Rate	$345.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$323.12
Rate for Payer: Aetna Medicare Advantage	$6.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$209.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$252.76
Rate for Payer: Cash Price	$318.60
Rate for Payer: Cash Price	$318.60
Rate for Payer: Cash Price	$318.60
Rate for Payer: Cigna Commercial HMO & PPO	$6.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$323.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$345.74
Rate for Payer: Home State Health Plan Medicare Advantage	$6.35
Rate for Payer: Humana Commercial	$12.70
Rate for Payer: Humana Medicare Advantage	$6.35
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$323.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$127.44

BB ARC-RBC ANTIGEN,EA

Facility

$354.00

Service Code	CPT 86902
Hospital Charge Code	2286905
Hospital Revenue Code	302
Rate for Payer: Cash Price	$318.60

BB ARC-RBC CELL PREP

Facility

$302.00

Service Code	CPT 86970
Hospital Charge Code	228970
Hospital Revenue Code	302
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$215.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$178.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$215.63
Rate for Payer: Cash Price	$271.80
Rate for Payer: Cash Price	$271.80
Rate for Payer: Cash Price	$271.80
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$53.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.72

Know your out-of-pocket cost for care.

All Charges