Madison Medical Center

All Charges

Charge

Type

Setting

Price

CT LUMBAR WWO CONTRAST

Facility

$3,057.00

Service Code	CPT 72133
Hospital Charge Code	3672133
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 LUMBAR WWO CONTRAST

Facility

$3,057.00

Service Code	CPT 72133
Hospital Charge Code	3672133
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,751.30

CT MAXILLA FACIAL SINUSES WO

Facility

$2,273.00

Service Code	CPT 70486
Hospital Charge Code	3670486
Hospital Revenue Code	350
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$1,622.92
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	$1,622.92
Rate for Payer: Cash Price	$2,045.70
Rate for Payer: Cash Price	$2,045.70
Rate for Payer: Cash Price	$2,045.70
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	$818.28

CT MAXILLA FACIAL SINUSES WO

Facility

$2,273.00

Service Code	CPT 70486
Hospital Charge Code	3670486
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,045.70

CT MAXILLOFACIAL AREA WO CONTRAST

Facility

$2,448.00

Service Code	CPT 70487
Hospital Charge Code	3670487
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,203.20

CT MAXILLOFACIAL AREA WO CONTRAST

Facility

$2,448.00

Service Code	CPT 70487
Hospital Charge Code	3670487
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$1,747.87
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	$1,747.87
Rate for Payer: Cash Price	$2,203.20
Rate for Payer: Cash Price	$2,203.20
Rate for Payer: Cash Price	$2,203.20
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	$881.28

CT MAXILLOFACIAL AREA WWO CONTRAST

Facility

$2,607.00

Service Code	CPT 70488
Hospital Charge Code	3670488
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$1,861.40
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	$1,861.40
Rate for Payer: Cash Price	$2,346.30
Rate for Payer: Cash Price	$2,346.30
Rate for Payer: Cash Price	$2,346.30
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	$938.52

CT MAXILLOFACIAL AREA WWO CONTRAST

Facility

$2,607.00

Service Code	CPT 70488
Hospital Charge Code	3670488
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,346.30

CT NECK WITH

Facility

$2,571.00

Service Code	CPT 70491
Hospital Charge Code	3670491
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,313.90

CT NECK WITH

Facility

$2,571.00

Service Code	CPT 70491
Hospital Charge Code	3670491
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$1,835.69
Rate for Payer: Humana Commercial	$358.40
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	$1,835.69
Rate for Payer: Cash Price	$2,313.90
Rate for Payer: Cash Price	$2,313.90
Rate for Payer: Cash Price	$2,313.90
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 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	$925.56

CT NECK WO SOFT TISSUE

Facility

$2,422.00

Service Code	CPT 70490
Hospital Charge Code	3670490
Hospital Revenue Code	350
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$1,729.31
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	$1,729.31
Rate for Payer: Cash Price	$2,179.80
Rate for Payer: Cash Price	$2,179.80
Rate for Payer: Cash Price	$2,179.80
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	$871.92

CT NECK WO SOFT TISSUE

Facility

$2,422.00

Service Code	CPT 70490
Hospital Charge Code	3670490
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,179.80

CT NEEDLE BIO GUIDANCE

Facility

$1,621.00

Service Code	CPT 77012
Hospital Charge Code	3677012
Hospital Revenue Code	350
Min. Negotiated Rate	$583.56
Max. Negotiated Rate	$1,157.39
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	$1,157.39
Rate for Payer: Cash Price	$1,458.90
Rate for Payer: Cash Price	$1,458.90
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$583.56

CT NEEDLE BIO GUIDANCE

Facility

$1,909.00

Service Code	CPT 77012
Hospital Charge Code	3600080
Hospital Revenue Code	350
Min. Negotiated Rate	$585.00
Max. Negotiated Rate	$1,363.03
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	$1,363.03
Rate for Payer: Cash Price	$1,718.10
Rate for Payer: Cash Price	$1,718.10
Rate for Payer: UnitedHealthcare Commercial	$585.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$687.24

CT NEEDLE BIO GUIDANCE

Facility

$1,621.00

Service Code	CPT 77012
Hospital Charge Code	3677012
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,458.90

CT NEEDLE BIO GUIDANCE

Facility

$1,909.00

Service Code	CPT 77012
Hospital Charge Code	3600080
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,718.10

CT ORBIT SELLA EAR MASTOID WITH

Facility

$2,788.00

Service Code	CPT 70481
Hospital Charge Code	3670481
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,509.20

CT ORBIT SELLA EAR MASTOID WITH

Facility

$2,788.00

Service Code	CPT 70481
Hospital Charge Code	3670481
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$1,990.63
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	$1,990.63
Rate for Payer: Cash Price	$2,509.20
Rate for Payer: Cash Price	$2,509.20
Rate for Payer: Cash Price	$2,509.20
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	$1,003.68

CT ORBIT SELLA EAR MASTOID WO

Facility

$2,415.00

Service Code	CPT 70480
Hospital Charge Code	3670480
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,173.50

CT ORBIT SELLA EAR MASTOID WO

Facility

$2,415.00

Service Code	CPT 70480
Hospital Charge Code	3670480
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 ORBIT SELLA EAR MASTOID WO WITH

Facility

$3,057.00

Service Code	CPT 70482
Hospital Charge Code	3670482
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 ORBIT SELLA EAR MASTOID WO WITH

Facility

$3,057.00

Service Code	CPT 70482
Hospital Charge Code	3670482
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,751.30

CT PELVIS WITH CONTRAST

Facility

$3,008.00

Service Code	CPT 72193
Hospital Charge Code	3672193
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,707.20

CT PELVIS WITH CONTRAST

Facility

$3,008.00

Service Code	CPT 72193
Hospital Charge Code	3672193
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$2,147.71
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	$2,147.71
Rate for Payer: Cash Price	$2,707.20
Rate for Payer: Cash Price	$2,707.20
Rate for Payer: Cash Price	$2,707.20
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	$1,082.88

CT PELVIS WO AND W CONTRAST

Facility

$3,178.00

Service Code	CPT 72194
Hospital Charge Code	3672194
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

Know your out-of-pocket cost for care.

All Charges