Madison Medical Center

All Charges

Charge

Type

Setting

Price

CLOSED TX DISTAL RADIAL FX

Facility

$1,015.00

Service Code	CPT 25600
Hospital Charge Code	9125600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$913.50

CLOSED TX DISTAL RADIAL FX

Facility

$1,015.00

Service Code	CPT 25600
Hospital Charge Code	9125600
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$724.71
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$600.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$724.71
Rate for Payer: Cash Price	$913.50
Rate for Payer: Cash Price	$913.50
Rate for Payer: Cash Price	$913.50
Rate for Payer: Cash Price	$913.50
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$677.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX DISTAL RADIAL FX

Facility

$1,080.00

Service Code	CPT 25600
Hospital Charge Code	9325600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$972.00

CLOSED TX DISTAL RADIAL FX

Facility

$1,080.00

Service Code	CPT 25600
Hospital Charge Code	9325600
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$771.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$639.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$771.12
Rate for Payer: Cash Price	$972.00
Rate for Payer: Cash Price	$972.00
Rate for Payer: Cash Price	$972.00
Rate for Payer: Cash Price	$972.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$720.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX KNEE DISLOCATION

Facility

$1,100.00

Service Code	CPT 27550
Hospital Charge Code	5427550
Hospital Revenue Code	521
Rate for Payer: Cash Price	$990.00

CLOSED TX KNEE DISLOCATION

Facility

$1,100.00

Service Code	CPT 27550
Hospital Charge Code	5427550
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$785.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$651.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$785.40
Rate for Payer: Cash Price	$990.00
Rate for Payer: Cash Price	$990.00
Rate for Payer: Cash Price	$990.00
Rate for Payer: Cash Price	$990.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$733.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX METACARPAL FX WITH MANIP EA BO

Facility

$990.00

Service Code	CPT 26605
Hospital Charge Code	9126605
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$706.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$586.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$706.86
Rate for Payer: Cash Price	$891.00
Rate for Payer: Cash Price	$891.00
Rate for Payer: Cash Price	$891.00
Rate for Payer: Cash Price	$891.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$660.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX METACARPAL FX WITH MANIP EA BO

Facility

$990.00

Service Code	CPT 26605
Hospital Charge Code	9126605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$891.00

CLOSED TX METACARPAL FX WITH MANIPULATIO

Facility

$985.00

Service Code	CPT 26605
Hospital Charge Code	5426605
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$703.29
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$583.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$703.29
Rate for Payer: Cash Price	$886.50
Rate for Payer: Cash Price	$886.50
Rate for Payer: Cash Price	$886.50
Rate for Payer: Cash Price	$886.50
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$657.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX METACARPAL FX WITH MANIPULATIO

Facility

$985.00

Service Code	CPT 26605
Hospital Charge Code	5426605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$886.50

CLOSED TX METACARPAL FX W/O MANI

Facility

$880.00

Service Code	CPT 26600
Hospital Charge Code	9326600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$792.00

CLOSED TX METACARPAL FX W/O MANI

Facility

$880.00

Service Code	CPT 26600
Hospital Charge Code	9326600
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$628.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$520.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$628.32
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cash Price	$792.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$586.96
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX METATARSAL FX W/O MANIP EACH

Facility

$722.00

Service Code	CPT 28470
Hospital Charge Code	9128470
Hospital Revenue Code	521
Rate for Payer: Cash Price	$649.80

CLOSED TX METATARSAL FX W/O MANIP EACH

Facility

$722.00

Service Code	CPT 28470
Hospital Charge Code	9128470
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$515.51
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$427.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$515.51
Rate for Payer: Cash Price	$649.80
Rate for Payer: Cash Price	$649.80
Rate for Payer: Cash Price	$649.80
Rate for Payer: Cash Price	$649.80
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$481.57
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX OF CALCANEAL FX

Facility

$368.00

Service Code	CPT 28400
Hospital Charge Code	4428400
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$504.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$217.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$262.75
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$245.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX OF CALCANEAL FX

Facility

$368.00

Service Code	CPT 28400
Hospital Charge Code	4428400
Hospital Revenue Code	521
Rate for Payer: Cash Price	$331.20

CLOSED TX OF COLLES FX

Facility

$925.00

Service Code	CPT 25600
Hospital Charge Code	5425600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$832.50

CLOSED TX OF COLLES FX

Facility

$925.00

Service Code	CPT 25600
Hospital Charge Code	5425600
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$660.45
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$547.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$660.45
Rate for Payer: Cash Price	$832.50
Rate for Payer: Cash Price	$832.50
Rate for Payer: Cash Price	$832.50
Rate for Payer: Cash Price	$832.50
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$616.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX OF PHALANGEAL SHAFT FX

Facility

$590.00

Service Code	CPT 26720
Hospital Charge Code	9126720
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$504.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$349.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$421.26
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$393.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX OF PHALANGEAL SHAFT FX

Facility

$590.00

Service Code	CPT 26720
Hospital Charge Code	9126720
Hospital Revenue Code	521
Rate for Payer: Cash Price	$531.00

CLOSED TX OF SCAPHOID FX

Facility

$925.00

Service Code	CPT 25622
Hospital Charge Code	5425622
Hospital Revenue Code	521
Rate for Payer: Cash Price	$832.50

CLOSED TX OF SCAPHOID FX

Facility

$925.00

Service Code	CPT 25622
Hospital Charge Code	5425622
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$660.45
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$547.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$660.45
Rate for Payer: Cash Price	$832.50
Rate for Payer: Cash Price	$832.50
Rate for Payer: Cash Price	$832.50
Rate for Payer: Cash Price	$832.50
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$616.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX OF SCAPHOID FX W/O MANIP

Facility

$988.00

Service Code	CPT 25622
Hospital Charge Code	9125622
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$705.43
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$584.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$705.43
Rate for Payer: Cash Price	$889.20
Rate for Payer: Cash Price	$889.20
Rate for Payer: Cash Price	$889.20
Rate for Payer: Cash Price	$889.20
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$659.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CLOSED TX OF SCAPHOID FX W/O MANIP

Facility

$988.00

Service Code	CPT 25622
Hospital Charge Code	9125622
Hospital Revenue Code	521
Rate for Payer: Cash Price	$889.20

CLOSED TX PHALANGEAL SHAFT FX W/O MANIPU

Facility

$935.00

Service Code	CPT 26720
Hospital Charge Code	9326720
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$667.59
Rate for Payer: Aetna Better Health Medicaid/QHP	$222.36
Rate for Payer: Aetna Medicare Advantage	$252.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$553.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$667.59
Rate for Payer: Cash Price	$841.50
Rate for Payer: Cash Price	$841.50
Rate for Payer: Cash Price	$841.50
Rate for Payer: Cash Price	$841.50
Rate for Payer: Cigna Commercial HMO & PPO	$252.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$237.93
Rate for Payer: Home State Health Plan Medicare Advantage	$252.01
Rate for Payer: Humana Commercial	$504.02
Rate for Payer: Humana Medicare Advantage	$252.01
Rate for Payer: UnitedHealthcare Commercial	$623.64
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$222.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges