Madison Medical Center

All Charges

Charge

Type

Setting

Price

CTA CHEST

Facility

$4,429.00

Service Code	CPT 71275
Hospital Charge Code	3671275
Hospital Revenue Code	350
Rate for Payer: Cash Price	$3,986.10

CTA CHEST

Facility

$4,429.00

Service Code	CPT 71275
Hospital Charge Code	3671275
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$3,162.31
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	$3,162.31
Rate for Payer: Cash Price	$3,986.10
Rate for Payer: Cash Price	$3,986.10
Rate for Payer: Cash Price	$3,986.10
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	$1,594.44

CTA HEAD

Facility

$4,429.00

Service Code	CPT 70496
Hospital Charge Code	3670496
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$3,162.31
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	$3,162.31
Rate for Payer: Cash Price	$3,986.10
Rate for Payer: Cash Price	$3,986.10
Rate for Payer: Cash Price	$3,986.10
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	$1,594.44

CTA HEAD

Facility

$4,429.00

Service Code	CPT 70496
Hospital Charge Code	3670496
Hospital Revenue Code	350
Rate for Payer: Cash Price	$3,986.10

CTA LOWER EXT LT

Facility

$4,429.00

Service Code	CPT 73706
Hospital Charge Code	3673707
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$3,162.31
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	$3,162.31
Rate for Payer: Cash Price	$3,986.10
Rate for Payer: Cash Price	$3,986.10
Rate for Payer: Cash Price	$3,986.10
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	$1,594.44

CTA LOWER EXT LT

Facility

$4,429.00

Service Code	CPT 73706
Hospital Charge Code	3673707
Hospital Revenue Code	350
Rate for Payer: Cash Price	$3,986.10

CTA LOWER EXT RT

Facility

$4,429.00

Service Code	CPT 73706
Hospital Charge Code	3673706
Hospital Revenue Code	350
Rate for Payer: Cash Price	$3,986.10

CTA LOWER EXT RT

Facility

$4,429.00

Service Code	CPT 73706
Hospital Charge Code	3673706
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$3,162.31
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	$3,162.31
Rate for Payer: Cash Price	$3,986.10
Rate for Payer: Cash Price	$3,986.10
Rate for Payer: Cash Price	$3,986.10
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	$1,594.44

CTA NECK

Facility

$4,429.00

Service Code	CPT 70498
Hospital Charge Code	3670498
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$3,162.31
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	$3,162.31
Rate for Payer: Cash Price	$3,986.10
Rate for Payer: Cash Price	$3,986.10
Rate for Payer: Cash Price	$3,986.10
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	$1,594.44

CTA NECK

Facility

$4,429.00

Service Code	CPT 70498
Hospital Charge Code	3670498
Hospital Revenue Code	350
Rate for Payer: Cash Price	$3,986.10

CTA PELVIS

Facility

$4,193.00

Service Code	CPT 72191
Hospital Charge Code	3672191
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

CTA PELVIS

Facility

$4,193.00

Service Code	CPT 72191
Hospital Charge Code	3672191
Hospital Revenue Code	350
Rate for Payer: Cash Price	$3,773.70

CTA UPPER EXTREMITY LT

Facility

$3,964.00

Service Code	CPT 73206
Hospital Charge Code	3673207
Hospital Revenue Code	350
Rate for Payer: Cash Price	$3,567.60

CTA UPPER EXTREMITY LT

Facility

$3,964.00

Service Code	CPT 73206
Hospital Charge Code	3673207
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$2,830.30
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	$2,830.30
Rate for Payer: Cash Price	$3,567.60
Rate for Payer: Cash Price	$3,567.60
Rate for Payer: Cash Price	$3,567.60
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	$1,427.04

CTA UPPER EXTREMITY RT

Facility

$3,964.00

Service Code	CPT 73206
Hospital Charge Code	3673206
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$2,830.30
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	$2,830.30
Rate for Payer: Cash Price	$3,567.60
Rate for Payer: Cash Price	$3,567.60
Rate for Payer: Cash Price	$3,567.60
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	$1,427.04

CTA UPPER EXTREMITY RT

Facility

$3,964.00

Service Code	CPT 73206
Hospital Charge Code	3673206
Hospital Revenue Code	350
Rate for Payer: Cash Price	$3,567.60

CT BMD STUDY AXIAL SKEL 1 OR MORE SITES

Facility

$551.00

Service Code	CPT 77078
Hospital Charge Code	3677078
Hospital Revenue Code	350
Rate for Payer: Cash Price	$495.90

CT BMD STUDY AXIAL SKEL 1 OR MORE SITES

Facility

$551.00

Service Code	CPT 77078
Hospital Charge Code	3677078
Hospital Revenue Code	350
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$853.00
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	$853.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$393.41
Rate for Payer: Cash Price	$495.90
Rate for Payer: Cash Price	$495.90
Rate for Payer: Cash Price	$495.90
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	$585.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$198.36

CT CALL BACK

Facility

$294.00

Hospital Charge Code	3600042
Hospital Revenue Code	350
Rate for Payer: Cash Price	$264.60

CT CALL BACK

Facility

$294.00

Hospital Charge Code	3600042
Hospital Revenue Code	350
Min. Negotiated Rate	$105.84
Max. Negotiated Rate	$853.00
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	$209.92
Rate for Payer: Cash Price	$264.60
Rate for Payer: Cash Price	$264.60
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$105.84

CT CHEST LOW DOSE

Facility

$2,415.00

Service Code	CPT 71271
Hospital Charge Code	3671271
Hospital Revenue Code	350
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$1,724.31
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	$1,724.31
Rate for Payer: Cash Price	$2,173.50
Rate for Payer: Cash Price	$2,173.50
Rate for Payer: Cash Price	$2,173.50
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	$869.40

CT CHEST LOW DOSE

Facility

$2,415.00

Service Code	CPT 71271
Hospital Charge Code	3671271
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,173.50

CT CHEST W CONT

Facility

$2,690.00

Service Code	CPT 71260
Hospital Charge Code	3671260
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$1,920.66
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	$1,920.66
Rate for Payer: Cash Price	$2,421.00
Rate for Payer: Cash Price	$2,421.00
Rate for Payer: Cash Price	$2,421.00
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	$968.40

CT CHEST W CONT

Facility

$2,690.00

Service Code	CPT 71260
Hospital Charge Code	3671260
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,421.00

CT CHEST WO CONTRAST

Facility

$2,415.00

Service Code	CPT 71250
Hospital Charge Code	3671250
Hospital Revenue Code	350
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$1,724.31
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	$1,724.31
Rate for Payer: Cash Price	$2,173.50
Rate for Payer: Cash Price	$2,173.50
Rate for Payer: Cash Price	$2,173.50
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	$869.40

Know your out-of-pocket cost for care.

All Charges