Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

BB ARC-RED CELL PREP,GEL,EA

Facility

$52.00

Service Code	CPT 86971
Hospital Charge Code	226970
Hospital Revenue Code	302
Rate for Payer: Cash Price	$46.80

BB ARC-RED CELL PREP,GEL,EA

Facility

$52.00

Service Code	CPT 86971
Hospital Charge Code	226970
Hospital Revenue Code	302
Min. Negotiated Rate	$18.72
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	$30.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.13
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
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	$18.72

BB ARC-RH

Facility

$59.00

Service Code	CPT 86901
Hospital Charge Code	2286862
Hospital Revenue Code	302
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$42.13
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	$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	$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	$21.24

BB ARC-RH

Facility

$59.00

Service Code	CPT 86901
Hospital Charge Code	2286862
Hospital Revenue Code	302
Rate for Payer: Cash Price	$53.10

BB ARC-RH PHENOTYPE,EA

Facility

$301.00

Service Code	CPT 86906
Hospital Charge Code	226906
Hospital Revenue Code	302
Rate for Payer: Cash Price	$270.90

BB ARC-RH PHENOTYPE,EA

Facility

$301.00

Service Code	CPT 86906
Hospital Charge Code	226906
Hospital Revenue Code	302
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$214.91
Rate for Payer: Aetna Better Health Medicaid/QHP	$33.67
Rate for Payer: Aetna Medicare Advantage	$7.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$178.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.91
Rate for Payer: Cash Price	$270.90
Rate for Payer: Cash Price	$270.90
Rate for Payer: Cash Price	$270.90
Rate for Payer: Cigna Commercial HMO & PPO	$7.75
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	$7.75
Rate for Payer: Humana Commercial	$15.50
Rate for Payer: Humana Medicare Advantage	$7.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$33.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.36

BB BLOOD (LEUKOCYTE POOR)

Facility

$863.00

Service Code	CPT P9016
Hospital Charge Code	222147
Hospital Revenue Code	390
Rate for Payer: Cash Price	$776.70

BB BLOOD (LEUKOCYTE POOR)

Facility

$863.00

Service Code	CPT P9016
Hospital Charge Code	222147
Hospital Revenue Code	390
Min. Negotiated Rate	$184.91
Max. Negotiated Rate	$616.18
Rate for Payer: Aetna Medicare Advantage	$184.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$510.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$616.18
Rate for Payer: Cash Price	$776.70
Rate for Payer: Cash Price	$776.70
Rate for Payer: Cigna Commercial HMO & PPO	$184.91
Rate for Payer: Home State Health Plan Medicare Advantage	$184.91
Rate for Payer: Humana Commercial	$369.82
Rate for Payer: Humana Medicare Advantage	$184.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$310.68

BB COMPATABILITY SC, IS

Facility

$264.00

Service Code	CPT 86920
Hospital Charge Code	2286920
Hospital Revenue Code	302
Rate for Payer: Cash Price	$237.60

BB COMPATABILITY SC, IS

Facility

$264.00

Service Code	CPT 86920
Hospital Charge Code	2286920
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	$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	$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	$95.04

BB CROSSMATCH /UNIT (LAB USE ONLY)

Facility

$264.00

Service Code	CPT 86922
Hospital Charge Code	2224145
Hospital Revenue Code	302
Rate for Payer: Cash Price	$237.60

BB CROSSMATCH /UNIT (LAB USE ONLY)

Facility

$264.00

Service Code	CPT 86922
Hospital Charge Code	2224145
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	$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	$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	$95.04

BB DAT

Facility

$156.00

Service Code	CPT 86880
Hospital Charge Code	223172
Hospital Revenue Code	302
Rate for Payer: Cash Price	$140.40

BB DAT

Facility

$156.00

Service Code	CPT 86880
Hospital Charge Code	223172
Hospital Revenue Code	302
Min. Negotiated Rate	$5.39
Max. Negotiated Rate	$111.38
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	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
Rate for Payer: Cash Price	$140.40
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	$56.16

BB PLATELET (Leuko-reduced)

Facility

$810.00

Service Code	CPT P9031
Hospital Charge Code	229031
Hospital Revenue Code	390
Min. Negotiated Rate	$144.26
Max. Negotiated Rate	$578.34
Rate for Payer: Aetna Medicare Advantage	$144.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$479.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$578.34
Rate for Payer: Cash Price	$729.00
Rate for Payer: Cash Price	$729.00
Rate for Payer: Cigna Commercial HMO & PPO	$144.26
Rate for Payer: Home State Health Plan Medicare Advantage	$144.26
Rate for Payer: Humana Commercial	$288.52
Rate for Payer: Humana Medicare Advantage	$144.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$291.60

BB PLATELET (Leuko-reduced)

Facility

$810.00

Service Code	CPT P9031
Hospital Charge Code	229031
Hospital Revenue Code	390
Rate for Payer: Cash Price	$729.00

BB TRANSFUSION (LAB USE ONLY)

Facility

$908.00

Service Code	CPT 36430
Hospital Charge Code	536430
Hospital Revenue Code	391
Rate for Payer: Cash Price	$817.20

BB TRANSFUSION (LAB USE ONLY)

Facility

$908.00

Service Code	CPT 36430
Hospital Charge Code	536430
Hospital Revenue Code	391
Min. Negotiated Rate	$326.88
Max. Negotiated Rate	$901.46
Rate for Payer: Aetna Better Health Medicaid/QHP	$397.70
Rate for Payer: Aetna Medicare Advantage	$450.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$537.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$648.31
Rate for Payer: Cash Price	$817.20
Rate for Payer: Cash Price	$817.20
Rate for Payer: Cash Price	$817.20
Rate for Payer: Cigna Commercial HMO & PPO	$450.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$397.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$425.54
Rate for Payer: Home State Health Plan Medicare Advantage	$450.73
Rate for Payer: Humana Commercial	$901.46
Rate for Payer: Humana Medicare Advantage	$450.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$397.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$326.88

.BCR-ABL1 P190

Facility

$518.00

Service Code	CPT 81207
Hospital Charge Code	2281207
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$369.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$130.36
Rate for Payer: Aetna Medicare Advantage	$144.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$306.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$369.85
Rate for Payer: Cash Price	$466.20
Rate for Payer: Cash Price	$466.20
Rate for Payer: Cash Price	$466.20
Rate for Payer: Cigna Commercial HMO & PPO	$144.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$130.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$139.49
Rate for Payer: Home State Health Plan Medicare Advantage	$144.84
Rate for Payer: Humana Commercial	$289.68
Rate for Payer: Humana Medicare Advantage	$144.84
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$130.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$186.48

.BCR-ABL1 P190

Facility

$518.00

Service Code	CPT 81207
Hospital Charge Code	2281207
Hospital Revenue Code	301
Rate for Payer: Cash Price	$466.20

.BCR-ABL1 P210

Facility

$518.00

Service Code	CPT 81206
Hospital Charge Code	2281206
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$369.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$147.56
Rate for Payer: Aetna Medicare Advantage	$163.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$306.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$369.85
Rate for Payer: Cash Price	$466.20
Rate for Payer: Cash Price	$466.20
Rate for Payer: Cash Price	$466.20
Rate for Payer: Cigna Commercial HMO & PPO	$163.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$147.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$157.89
Rate for Payer: Home State Health Plan Medicare Advantage	$163.96
Rate for Payer: Humana Commercial	$327.92
Rate for Payer: Humana Medicare Advantage	$163.96
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$147.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$186.48

.BCR-ABL1 P210

Facility

$518.00

Service Code	CPT 81206
Hospital Charge Code	2281206
Hospital Revenue Code	301
Rate for Payer: Cash Price	$466.20

BECLOMETH DIP (QVAR) 40MCG INHALER 8.7GM

Facility

$466.00

Hospital Charge Code	2619255
Hospital Revenue Code	250
Rate for Payer: Cash Price	$419.40

BECLOMETH DIP (QVAR) 40MCG INHALER 8.7GM

Facility

$466.00

Hospital Charge Code	2619255
Hospital Revenue Code	250
Min. Negotiated Rate	$167.76
Max. Negotiated Rate	$332.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$275.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$332.72
Rate for Payer: Cash Price	$419.40
Rate for Payer: UnitedHealthcare Commercial	$310.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$167.76

Know your out-of-pocket cost for care.

All Charges