Madison Medical Center

All Charges

Charge

Type

Setting

Price

CRYSTALS

Facility

$28.00

Hospital Charge Code	323159
Hospital Revenue Code	271
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

CRYSTALS

Facility

$28.00

Hospital Charge Code	323159
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

C-SECTION

Professional

Both

$3,357.00

Service Code	CPT 59510
Hospital Charge Code	4159510
Hospital Revenue Code	975
Min. Negotiated Rate	$1,174.95
Max. Negotiated Rate	$2,369.86
Rate for Payer: Cash Price	$3,021.30
Rate for Payer: Aetna Commercial/Medicare Advantage	$2,369.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,987.76
Rate for Payer: Cash Price	$3,021.30
Rate for Payer: Cigna Commercial HMO & PPO	$2,369.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,987.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2,186.54
Rate for Payer: Home State Health Plan Medicare Advantage	$2,369.86
Rate for Payer: Optum Medicare Advantage	$1,174.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,987.76

C SPINE OBL XRAY

Facility

$718.00

Service Code	CPT 72052
Hospital Charge Code	323120
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$512.65
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$425.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$512.65
Rate for Payer: Cash Price	$646.20
Rate for Payer: Cash Price	$646.20
Rate for Payer: Cash Price	$646.20
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$258.48

C SPINE OBL XRAY

Facility

$718.00

Service Code	CPT 72052
Hospital Charge Code	323120
Hospital Revenue Code	320
Rate for Payer: Cash Price	$646.20

C SPINE XRAY

Facility

$555.00

Service Code	CPT 72040
Hospital Charge Code	323119
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$396.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$328.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$396.27
Rate for Payer: Cash Price	$499.50
Rate for Payer: Cash Price	$499.50
Rate for Payer: Cash Price	$499.50
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$199.80

C SPINE XRAY

Facility

$555.00

Service Code	CPT 72040
Hospital Charge Code	323119
Hospital Revenue Code	320
Rate for Payer: Cash Price	$499.50

CTA ABD AND PELVIS

Facility

$4,521.00

Service Code	CPT 74175
Hospital Charge Code	3674174
Hospital Revenue Code	350
Rate for Payer: Cash Price	$4,068.90

CTA ABD AND PELVIS

Facility

$4,521.00

Service Code	CPT 74175
Hospital Charge Code	3674174
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$3,227.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$158.12
Rate for Payer: Aetna Medicare Advantage	$179.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$853.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3,227.99
Rate for Payer: Cash Price	$4,068.90
Rate for Payer: Cash Price	$4,068.90
Rate for Payer: Cash Price	$4,068.90
Rate for Payer: Cigna Commercial HMO & PPO	$179.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$158.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$169.19
Rate for Payer: Home State Health Plan Medicare Advantage	$179.20
Rate for Payer: Humana Commercial	$358.40
Rate for Payer: Humana Medicare Advantage	$179.20
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$158.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,627.56

CTA ABD AORTA W BIL FEMORAL EXT RUNOFF

Facility

$4,894.00

Service Code	CPT 75635
Hospital Charge Code	3675635
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$3,494.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$158.12
Rate for Payer: Aetna Medicare Advantage	$179.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$853.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3,494.32
Rate for Payer: Cash Price	$4,404.60
Rate for Payer: Cash Price	$4,404.60
Rate for Payer: Cash Price	$4,404.60
Rate for Payer: Cigna Commercial HMO & PPO	$179.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$158.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$169.19
Rate for Payer: Home State Health Plan Medicare Advantage	$179.20
Rate for Payer: Humana Commercial	$358.40
Rate for Payer: Humana Medicare Advantage	$179.20
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$158.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,761.84

CTA ABD AORTA W BIL FEMORAL EXT RUNOFF

Facility

$4,894.00

Service Code	CPT 75635
Hospital Charge Code	3675635
Hospital Revenue Code	350
Rate for Payer: Cash Price	$4,404.60

CTA ABDOMEN

Facility

$4,193.00

Service Code	CPT 74175
Hospital Charge Code	3674175
Hospital Revenue Code	350
Rate for Payer: Cash Price	$3,773.70

CTA ABDOMEN

Facility

$4,193.00

Service Code	CPT 74175
Hospital Charge Code	3674175
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$2,993.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$158.12
Rate for Payer: Aetna Medicare Advantage	$179.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$853.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,993.80
Rate for Payer: Cash Price	$3,773.70
Rate for Payer: Cash Price	$3,773.70
Rate for Payer: Cash Price	$3,773.70
Rate for Payer: Cigna Commercial HMO & PPO	$179.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$158.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$169.19
Rate for Payer: Home State Health Plan Medicare Advantage	$179.20
Rate for Payer: Humana Commercial	$358.40
Rate for Payer: Humana Medicare Advantage	$179.20
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$158.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,509.48

CT ABD PELVIS WO CONTRAST

Facility

$5,056.00

Service Code	CPT 74176
Hospital Charge Code	3674176
Hospital Revenue Code	350
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$3,609.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$853.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3,609.98
Rate for Payer: Cash Price	$4,550.40
Rate for Payer: Cash Price	$4,550.40
Rate for Payer: Cash Price	$4,550.40
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,820.16

CT ABD PELVIS WO CONTRAST

Facility

$5,056.00

Service Code	CPT 74176
Hospital Charge Code	3674176
Hospital Revenue Code	350
Rate for Payer: Cash Price	$4,550.40

CT ABD PELVIS WWO CONT

Facility

$6,376.00

Service Code	CPT 74178
Hospital Charge Code	3674178
Hospital Revenue Code	350
Rate for Payer: Cash Price	$5,738.40

CT ABD PELVIS WWO CONT

Facility

$6,376.00

Service Code	CPT 74178
Hospital Charge Code	3674178
Hospital Revenue Code	350
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$4,552.46
Rate for Payer: Aetna Better Health Medicaid/QHP	$314.49
Rate for Payer: Aetna Medicare Advantage	$356.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$853.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$4,552.46
Rate for Payer: Cash Price	$5,738.40
Rate for Payer: Cash Price	$5,738.40
Rate for Payer: Cash Price	$5,738.40
Rate for Payer: Cigna Commercial HMO & PPO	$356.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$314.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$336.50
Rate for Payer: Home State Health Plan Medicare Advantage	$356.43
Rate for Payer: Humana Commercial	$712.86
Rate for Payer: Humana Medicare Advantage	$356.43
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,295.36

CT ABD PEL W CONT

Facility

$5,919.00

Service Code	CPT 74177
Hospital Charge Code	3674177
Hospital Revenue Code	350
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$4,226.17
Rate for Payer: Humana Commercial	$712.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$314.49
Rate for Payer: Aetna Medicare Advantage	$356.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$853.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$4,226.17
Rate for Payer: Cash Price	$5,327.10
Rate for Payer: Cash Price	$5,327.10
Rate for Payer: Cash Price	$5,327.10
Rate for Payer: Cigna Commercial HMO & PPO	$356.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$314.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$336.50
Rate for Payer: Home State Health Plan Medicare Advantage	$356.43
Rate for Payer: Humana Medicare Advantage	$356.43
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,130.84

CT ABD PEL W CONT

Facility

$5,919.00

Service Code	CPT 74177
Hospital Charge Code	3674177
Hospital Revenue Code	350
Rate for Payer: Cash Price	$5,327.10

CT ABD W CONT

Facility

$2,918.00

Service Code	CPT 74160
Hospital Charge Code	3674160
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$2,083.45
Rate for Payer: Aetna Better Health Medicaid/QHP	$158.12
Rate for Payer: Aetna Medicare Advantage	$179.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$853.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,083.45
Rate for Payer: Cash Price	$2,626.20
Rate for Payer: Cash Price	$2,626.20
Rate for Payer: Cash Price	$2,626.20
Rate for Payer: Cigna Commercial HMO & PPO	$179.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$158.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$169.19
Rate for Payer: Home State Health Plan Medicare Advantage	$179.20
Rate for Payer: Humana Commercial	$358.40
Rate for Payer: Humana Medicare Advantage	$179.20
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$158.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,050.48

CT ABD W CONT

Facility

$2,918.00

Service Code	CPT 74160
Hospital Charge Code	3674160
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,626.20

CT ABD WO CONT

Facility

$2,643.00

Service Code	CPT 74150
Hospital Charge Code	3674150
Hospital Revenue Code	350
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$1,887.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$853.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,887.10
Rate for Payer: Cash Price	$2,378.70
Rate for Payer: Cash Price	$2,378.70
Rate for Payer: Cash Price	$2,378.70
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$951.48

CT ABD WO CONT

Facility

$2,643.00

Service Code	CPT 74150
Hospital Charge Code	3674150
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,378.70

CT ABD WWO

Facility

$3,204.00

Service Code	CPT 74170
Hospital Charge Code	3674170
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$2,287.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$158.12
Rate for Payer: Aetna Medicare Advantage	$179.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$853.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,287.66
Rate for Payer: Cash Price	$2,883.60
Rate for Payer: Cash Price	$2,883.60
Rate for Payer: Cash Price	$2,883.60
Rate for Payer: Cigna Commercial HMO & PPO	$179.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$158.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$169.19
Rate for Payer: Home State Health Plan Medicare Advantage	$179.20
Rate for Payer: Humana Commercial	$358.40
Rate for Payer: Humana Medicare Advantage	$179.20
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$158.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,153.44

CT ABD WWO

Facility

$3,204.00

Service Code	CPT 74170
Hospital Charge Code	3674170
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,883.60

Know your out-of-pocket cost for care.

All Charges