Madison Medical Center

All Charges

Charge

Type

Setting

Price

CT PELVIS WO AND W CONTRAST

Facility

$3,178.00

Service Code	CPT 72194
Hospital Charge Code	3672194
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,860.20

CT PELVIS WO CONTRAST

Facility

$2,488.00

Service Code	CPT 72192
Hospital Charge Code	3672192
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,239.20

CT PELVIS WO CONTRAST

Facility

$2,488.00

Service Code	CPT 72192
Hospital Charge Code	3672192
Hospital Revenue Code	350
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$1,776.43
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	$1,776.43
Rate for Payer: Cash Price	$2,239.20
Rate for Payer: Cash Price	$2,239.20
Rate for Payer: Cash Price	$2,239.20
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	$895.68

CT SINUSES LIMITED

Facility

$1,436.00

Service Code	CPT 76380
Hospital Charge Code	3676380
Hospital Revenue Code	350
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$1,025.30
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	$1,025.30
Rate for Payer: Cash Price	$1,292.40
Rate for Payer: Cash Price	$1,292.40
Rate for Payer: Cash Price	$1,292.40
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	$516.96

CT SINUSES LIMITED

Facility

$1,436.00

Service Code	CPT 76380
Hospital Charge Code	3676380
Hospital Revenue Code	350
Rate for Payer: Cash Price	$1,292.40

CT SOFT TISSUE NECK WWO CONTRAST

Facility

$3,057.00

Service Code	CPT 70492
Hospital Charge Code	3670492
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 SOFT TISSUE NECK WWO CONTRAST

Facility

$3,057.00

Service Code	CPT 70492
Hospital Charge Code	3670492
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,751.30

CT THORACIC SPINE WO CONTRAST

Facility

$2,415.00

Service Code	CPT 72128
Hospital Charge Code	3672128
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,173.50

CT THORACIC SPINE WO CONTRAST

Facility

$2,415.00

Service Code	CPT 72128
Hospital Charge Code	3672128
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 THORACIC WITH CONTRAST

Facility

$2,890.00

Service Code	CPT 72129
Hospital Charge Code	3672129
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,601.00

CT THORACIC WITH CONTRAST

Facility

$2,890.00

Service Code	CPT 72129
Hospital Charge Code	3672129
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$2,063.46
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	$2,063.46
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	$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	$1,040.40

CT THORACIC WO & WITH CONTRAST

Facility

$3,096.00

Service Code	CPT 72130
Hospital Charge Code	3672130
Hospital Revenue Code	350
Rate for Payer: Cash Price	$2,786.40

CT THORACIC WO & WITH CONTRAST

Facility

$3,096.00

Service Code	CPT 72130
Hospital Charge Code	3672130
Hospital Revenue Code	350
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$2,210.54
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	$2,210.54
Rate for Payer: Cash Price	$2,786.40
Rate for Payer: Cash Price	$2,786.40
Rate for Payer: Cash Price	$2,786.40
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	$1,114.56

CTY-CNTY EMO PHY. PLAN B

Facility

$61.00

Hospital Charge Code	99037
Hospital Revenue Code	310
Rate for Payer: Cash Price	$54.90

CTY-CNTY EMO PHY. PLAN B

Facility

$61.00

Hospital Charge Code	99037
Hospital Revenue Code	310
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$43.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$43.55
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cash Price	$54.90
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.96

CTY-CNTY EMP PHY. PLAN A

Facility

$110.00

Hospital Charge Code	99034
Hospital Revenue Code	310
Rate for Payer: Cash Price	$99.00

CTY-CNTY EMP PHY. PLAN A

Facility

$110.00

Hospital Charge Code	99034
Hospital Revenue Code	310
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$78.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: UnitedHealthcare Commercial	$18.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

CULDOCENTESIS

Facility

$123.00

Service Code	CPT 57020
Hospital Charge Code	4257020
Hospital Revenue Code	521
Rate for Payer: Cash Price	$110.70

CULDOCENTESIS

Facility

$123.00

Service Code	CPT 57020
Hospital Charge Code	4257020
Hospital Revenue Code	521
Min. Negotiated Rate	$72.82
Max. Negotiated Rate	$10,221.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,509.45
Rate for Payer: Aetna Medicare Advantage	$5,110.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$72.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$87.82
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$5,110.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,058.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,825.11
Rate for Payer: Home State Health Plan Medicare Advantage	$5,110.80
Rate for Payer: Humana Commercial	$10,221.60
Rate for Payer: Humana Medicare Advantage	$5,110.80
Rate for Payer: UnitedHealthcare Commercial	$82.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,509.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CULTURE AEROBIC

Facility

$221.00

Service Code	CPT 87070
Hospital Charge Code	301007
Hospital Revenue Code	306
Rate for Payer: Cash Price	$198.90

CULTURE AEROBIC

Facility

$221.00

Service Code	CPT 87070
Hospital Charge Code	301007
Hospital Revenue Code	306
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$157.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.76
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$130.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.79
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cigna Commercial HMO & PPO	$8.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.30
Rate for Payer: Home State Health Plan Medicare Advantage	$8.62
Rate for Payer: Humana Commercial	$17.24
Rate for Payer: Humana Medicare Advantage	$8.62
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$79.56

CULTURE ANAEROBIC

Facility

$126.00

Service Code	CPT 87075
Hospital Charge Code	301010
Hospital Revenue Code	306
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$89.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.52
Rate for Payer: Aetna Medicare Advantage	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
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	$9.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.12
Rate for Payer: Home State Health Plan Medicare Advantage	$9.47
Rate for Payer: Humana Commercial	$18.94
Rate for Payer: Humana Medicare Advantage	$9.47
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

CULTURE ANAEROBIC

Facility

$126.00

Service Code	CPT 87075
Hospital Charge Code	301010
Hospital Revenue Code	306
Rate for Payer: Cash Price	$113.40

CULTURE ANAEROBIC EXTENDED

Facility

$301.00

Service Code	CPT 87075
Hospital Charge Code	301012
Hospital Revenue Code	306
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$214.91
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.52
Rate for Payer: Aetna Medicare Advantage	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$178.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.91
Rate for Payer: Cash Price	$270.90
Rate for Payer: Cash Price	$270.90
Rate for Payer: Cash Price	$270.90
Rate for Payer: Cigna Commercial HMO & PPO	$9.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.12
Rate for Payer: Home State Health Plan Medicare Advantage	$9.47
Rate for Payer: Humana Commercial	$18.94
Rate for Payer: Humana Medicare Advantage	$9.47
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.36

CULTURE ANAEROBIC EXTENDED

Facility

$301.00

Service Code	CPT 87075
Hospital Charge Code	301012
Hospital Revenue Code	306
Rate for Payer: Cash Price	$270.90

Know your out-of-pocket cost for care.

All Charges