Madison Medical Center

All Charges

Charge

Type

Setting

Price

CT CHEST WO CONTRAST

Facility

$2,415.00

Service Code	CPT 71250
Hospital Charge Code	3671250
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,173.50

CT CHEST WO WITH CONT

Facility

$3,178.00

Service Code	CPT 71270
Hospital Charge Code	3671270
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$2,269.09
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	$2,269.09
Rate for Payer: Cash Price	$2,860.20
Rate for Payer: Cash Price	$2,860.20
Rate for Payer: Cash Price	$2,860.20
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	$1,144.08

CT CHEST WO WITH CONT

Facility

$3,178.00

Service Code	CPT 71270
Hospital Charge Code	3671270
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,860.20

CT CONTRAST KIT

Facility

$268.00

Hospital Charge Code	3600132
Hospital Revenue Code	350
Rate for Payer: Cash Price	$241.20

CT CONTRAST KIT

Facility

$268.00

Hospital Charge Code	3600132
Hospital Revenue Code	350
Min. Negotiated Rate	$96.48
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	$191.35
Rate for Payer: Cash Price	$241.20
Rate for Payer: Cash Price	$241.20
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$96.48

CT C SPINE WITH CONTRAST

Facility

$2,751.00

Service Code	CPT 72126
Hospital Charge Code	3672126
Hospital Revenue Code	350
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$1,964.21
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	$1,964.21
Rate for Payer: Cash Price	$2,475.90
Rate for Payer: Cash Price	$2,475.90
Rate for Payer: Cash Price	$2,475.90
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	$990.36

CT C SPINE WITH CONTRAST

Facility

$2,751.00

Service Code	CPT 72126
Hospital Charge Code	3672126
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,475.90

CT C SPINE WO CONTRAST

Facility

$2,415.00

Service Code	CPT 72125
Hospital Charge Code	3672125
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 C SPINE WO CONTRAST

Facility

$2,415.00

Service Code	CPT 72125
Hospital Charge Code	3672125
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,173.50

CT C SPINE WO W CONT

Facility

$1,711.00

Service Code	CPT 72127
Hospital Charge Code	3672127
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$1,221.65
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	$1,221.65
Rate for Payer: Cash Price	$1,539.90
Rate for Payer: Cash Price	$1,539.90
Rate for Payer: Cash Price	$1,539.90
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	$615.96

CT C SPINE WO W CONT

Facility

$1,711.00

Service Code	CPT 72127
Hospital Charge Code	3672127
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,539.90

CT DRAINAGE OF PELVIC ABCESS

Facility

$1,611.00

Service Code	CPT 58823
Hospital Charge Code	3658823
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,449.90

CT DRAINAGE OF PELVIC ABCESS

Facility

$1,611.00

Service Code	CPT 58823
Hospital Charge Code	3658823
Hospital Revenue Code	350
Min. Negotiated Rate	$579.96
Max. Negotiated Rate	$1,150.25
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	$1,150.25
Rate for Payer: Cash Price	$1,449.90
Rate for Payer: Cash Price	$1,449.90
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$579.96

C TELOPEPTIDE

Facility

$387.00

Service Code	CPT 82523
Hospital Charge Code	2284683
Hospital Revenue Code	301
Min. Negotiated Rate	$16.81
Max. Negotiated Rate	$276.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.81
Rate for Payer: Aetna Medicare Advantage	$18.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$229.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$276.32
Rate for Payer: Cash Price	$348.30
Rate for Payer: Cash Price	$348.30
Rate for Payer: Cash Price	$348.30
Rate for Payer: Cigna Commercial HMO & PPO	$18.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.99
Rate for Payer: Home State Health Plan Medicare Advantage	$18.68
Rate for Payer: Humana Commercial	$37.36
Rate for Payer: Humana Medicare Advantage	$18.68
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$139.32

C TELOPEPTIDE

Facility

$387.00

Service Code	CPT 82523
Hospital Charge Code	2284683
Hospital Revenue Code	301
Rate for Payer: Cash Price	$348.30

CT EXTRA SLICES

Facility

$70.00

Hospital Charge Code	3600024
Hospital Revenue Code	350
Rate for Payer: Cash Price	$63.00

CT EXTRA SLICES

Facility

$70.00

Hospital Charge Code	3600024
Hospital Revenue Code	350
Min. Negotiated Rate	$25.20
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	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

CT EXTRA VIEWS

Facility

$126.00

Service Code	CPT 73200
Hospital Charge Code	3600017
Hospital Revenue Code	350
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$853.00
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	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$113.40
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	$45.36

CT EXTRA VIEWS

Facility

$126.00

Service Code	CPT 73200
Hospital Charge Code	3600017
Hospital Revenue Code	350
Rate for Payer: Cash Price	$113.40

CT EXTREMITY LOWER WO LT

Facility

$1,966.00

Service Code	CPT 73700
Hospital Charge Code	3673699
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,769.40

CT EXTREMITY LOWER WO LT

Facility

$1,966.00

Service Code	CPT 73700
Hospital Charge Code	3673699
Hospital Revenue Code	350
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$1,403.72
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	$1,403.72
Rate for Payer: Cash Price	$1,769.40
Rate for Payer: Cash Price	$1,769.40
Rate for Payer: Cash Price	$1,769.40
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	$707.76

CT EXTREMITY LOWER WO RT

Facility

$1,966.00

Service Code	CPT 73700
Hospital Charge Code	3673700
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,769.40

CT EXTREMITY LOWER WO RT

Facility

$1,966.00

Service Code	CPT 73700
Hospital Charge Code	3673700
Hospital Revenue Code	350
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$1,403.72
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	$1,403.72
Rate for Payer: Cash Price	$1,769.40
Rate for Payer: Cash Price	$1,769.40
Rate for Payer: Cash Price	$1,769.40
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	$707.76

CT EXTREMITY LOWER WWO LT

Facility

$1,834.00

Service Code	CPT 73702
Hospital Charge Code	3673702
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$1,309.48
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	$1,309.48
Rate for Payer: Cash Price	$1,650.60
Rate for Payer: Cash Price	$1,650.60
Rate for Payer: Cash Price	$1,650.60
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	$660.24

CT EXTREMITY LOWER WWO LT

Facility

$1,834.00

Service Code	CPT 73702
Hospital Charge Code	3673702
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,650.60

Know your out-of-pocket cost for care.

All Charges