Madison Medical Center

All Charges

Charge

Type

Setting

Price

CT EXTREMITY LOWER WWO RT

Facility

$1,834.00

Service Code	CPT 73702
Hospital Charge Code	3673703
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 RT

Facility

$1,834.00

Service Code	CPT 73702
Hospital Charge Code	3673703
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,650.60

CT EXTREMITY UPPER WO LT

Facility

$1,966.00

Service Code	CPT 73200
Hospital Charge Code	3673201
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,769.40

CT EXTREMITY UPPER WO LT

Facility

$1,966.00

Service Code	CPT 73200
Hospital Charge Code	3673201
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 UPPER WO RT

Facility

$1,966.00

Service Code	CPT 73200
Hospital Charge Code	3673200
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,769.40

CT EXTREMITY UPPER WO RT

Facility

$1,966.00

Service Code	CPT 73200
Hospital Charge Code	3673200
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 UPPER W WO LT

Facility

$1,966.00

Service Code	CPT 73202
Hospital Charge Code	3673202
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,769.40

CT EXTREMITY UPPER W WO LT

Facility

$1,966.00

Service Code	CPT 73202
Hospital Charge Code	3673202
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$1,403.72
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	$1,403.72
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	$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	$707.76

CT EXTREMITY UPPER W WO RT

Facility

$1,966.00

Service Code	CPT 73202
Hospital Charge Code	3673203
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$1,403.72
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	$1,403.72
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	$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	$707.76

CT EXTREMITY UPPER W WO RT

Facility

$1,966.00

Service Code	CPT 73202
Hospital Charge Code	3673203
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,769.40

CT GUIDED SI INJECTION W/ANESTH & STEROI

Professional

Both

$760.00

Service Code	CPT 27096
Hospital Charge Code	4127096
Hospital Revenue Code	975
Min. Negotiated Rate	$70.79
Max. Negotiated Rate	$266.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$70.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$123.51
Rate for Payer: Cash Price	$684.00
Rate for Payer: Cash Price	$684.00
Rate for Payer: Cigna Commercial HMO & PPO	$70.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$123.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$135.86
Rate for Payer: Home State Health Plan Medicare Advantage	$70.79
Rate for Payer: Optum Medicare Advantage	$266.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$123.51

CT GUIDE FOR DRAINAGE ABCESS

Facility

$1,907.00

Service Code	CPT 75989
Hospital Charge Code	3675989
Hospital Revenue Code	350
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$1,361.60
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	$1,361.60
Rate for Payer: Cash Price	$1,716.30
Rate for Payer: Cash Price	$1,716.30
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$686.52

CT GUIDE FOR DRAINAGE ABCESS

Facility

$1,907.00

Service Code	CPT 75989
Hospital Charge Code	3675989
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,716.30

CT HEAD W CONTRAST

Facility

$2,755.00

Service Code	CPT 70460
Hospital Charge Code	3670460
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$1,967.07
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	$1,967.07
Rate for Payer: Cash Price	$2,479.50
Rate for Payer: Cash Price	$2,479.50
Rate for Payer: Cash Price	$2,479.50
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	$991.80

CT HEAD W CONTRAST

Facility

$2,755.00

Service Code	CPT 70460
Hospital Charge Code	3670460
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,479.50

CT HEAD WO CONTRAST

Facility

$2,518.00

Service Code	CPT 70450
Hospital Charge Code	3670450
Hospital Revenue Code	350
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$1,797.85
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	$1,797.85
Rate for Payer: Cash Price	$2,266.20
Rate for Payer: Cash Price	$2,266.20
Rate for Payer: Cash Price	$2,266.20
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	$585.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$906.48

CT HEAD WO CONTRAST

Facility

$2,518.00

Service Code	CPT 70450
Hospital Charge Code	3670450
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,266.20

CT HEAD WWO CONTRAST

Facility

$3,057.00

Service Code	CPT 70470
Hospital Charge Code	3670470
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,751.30

CT HEAD WWO CONTRAST

Facility

$3,057.00

Service Code	CPT 70470
Hospital Charge Code	3670470
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$2,182.70
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	$2,182.70
Rate for Payer: Cash Price	$2,751.30
Rate for Payer: Cash Price	$2,751.30
Rate for Payer: Cash Price	$2,751.30
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	$1,100.52

CT LOWER EXTREMITY W CONTRAST

Facility

$2,219.00

Service Code	CPT 73701
Hospital Charge Code	3673701
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,997.10

CT LOWER EXTREMITY W CONTRAST

Facility

$2,219.00

Service Code	CPT 73701
Hospital Charge Code	3673701
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$1,584.37
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	$1,584.37
Rate for Payer: Cash Price	$1,997.10
Rate for Payer: Cash Price	$1,997.10
Rate for Payer: Cash Price	$1,997.10
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	$798.84

CT LUMBAR SPINE WITH CONTRAST

Facility

$2,890.00

Service Code	CPT 72131
Hospital Charge Code	3672132
Hospital Revenue Code	350
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$2,063.46
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	$2,063.46
Rate for Payer: Cash Price	$2,601.00
Rate for Payer: Cash Price	$2,601.00
Rate for Payer: Cash Price	$2,601.00
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	$1,040.40

CT LUMBAR SPINE WITH CONTRAST

Facility

$2,890.00

Service Code	CPT 72131
Hospital Charge Code	3672132
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,601.00

CT LUMBAR SPINE WO CONTRAST

Facility

$2,663.00

Service Code	CPT 72131
Hospital Charge Code	3672131
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,396.70

CT LUMBAR SPINE WO CONTRAST

Facility

$2,663.00

Service Code	CPT 72131
Hospital Charge Code	3672131
Hospital Revenue Code	350
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$1,901.38
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	$1,901.38
Rate for Payer: Cash Price	$2,396.70
Rate for Payer: Cash Price	$2,396.70
Rate for Payer: Cash Price	$2,396.70
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	$958.68

Know your out-of-pocket cost for care.

All Charges