Madison Medical Center

All Charges

Charge

Type

Setting

Price

INJECTION CARPAL TUNNEL

Facility

$250.00

Service Code	CPT 20526
Hospital Charge Code	9820526
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

INJECTION CARPAL TUNNEL

Facility

$250.00

Service Code	CPT 20526
Hospital Charge Code	9820526
Hospital Revenue Code	521
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION CORPORA CAVERNOSA

Facility

$295.00

Service Code	CPT 54235
Hospital Charge Code	9854235
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$510.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$225.22
Rate for Payer: Aetna Medicare Advantage	$255.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$174.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$210.63
Rate for Payer: Cash Price	$265.50
Rate for Payer: Cash Price	$265.50
Rate for Payer: Cash Price	$265.50
Rate for Payer: Cash Price	$265.50
Rate for Payer: Cigna Commercial HMO & PPO	$255.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$202.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$240.99
Rate for Payer: Home State Health Plan Medicare Advantage	$255.26
Rate for Payer: Humana Commercial	$510.52
Rate for Payer: Humana Medicare Advantage	$255.26
Rate for Payer: UnitedHealthcare Commercial	$196.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$225.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION CORPORA CAVERNOSA

Facility

$295.00

Service Code	CPT 54235
Hospital Charge Code	9854235
Hospital Revenue Code	521
Rate for Payer: Cash Price	$265.50

INJECTION DIPENHYDRAMINE HCI

Facility

$3.00

Service Code	CPT G0010
Hospital Charge Code	4400010
Hospital Revenue Code	636
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$95.68
Rate for Payer: Aetna Medicare Advantage	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2.14
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cash Price	$2.70
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$47.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.84

INJECTION DIPENHYDRAMINE HCI

Facility

$3.00

Service Code	CPT G0010
Hospital Charge Code	4400010
Hospital Revenue Code	636
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$2.00
Rate for Payer: Cash Price	$2.70
Rate for Payer: UnitedHealthcare Commercial	$2.00

INJECTION/EPIDURAL/LUMBAR

Professional

Both

$1,820.00

Service Code	CPT 62311
Hospital Charge Code	1262311
Hospital Revenue Code	975
Min. Negotiated Rate	$637.00
Max. Negotiated Rate	$637.00
Rate for Payer: Cash Price	$1,638.00
Rate for Payer: Optum Medicare Advantage	$637.00

INJECTION FEMORAL NERVE

Professional

Both

$700.00

Service Code	CPT 64447
Hospital Charge Code	4164447
Hospital Revenue Code	975
Min. Negotiated Rate	$58.89
Max. Negotiated Rate	$245.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$58.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$67.10
Rate for Payer: Cash Price	$630.00
Rate for Payer: Cash Price	$630.00
Rate for Payer: Cigna Commercial HMO & PPO	$58.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$67.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$73.81
Rate for Payer: Home State Health Plan Medicare Advantage	$58.89
Rate for Payer: Optum Medicare Advantage	$245.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$67.10

INJECTION FOR HSG

Facility

$198.00

Service Code	CPT 58340
Hospital Charge Code	4258340
Rate for Payer: Cash Price	$178.20

INJECTION GLUCAGON HYDROCHLORIDE 1 MG.

Facility

$41.00

Hospital Charge Code	4401610
Hospital Revenue Code	636
Min. Negotiated Rate	$27.35
Max. Negotiated Rate	$27.35
Rate for Payer: Cash Price	$36.90
Rate for Payer: UnitedHealthcare Commercial	$27.35

INJECTION GLUCAGON HYDROCHLORIDE 1 MG.

Facility

$41.00

Hospital Charge Code	4401610
Hospital Revenue Code	636
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$29.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.27
Rate for Payer: Cash Price	$36.90
Rate for Payer: UnitedHealthcare Commercial	$27.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.76

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	9420605
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	5420605
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	9220605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	4220605
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	9520605
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	9420605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	9820605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	9820605
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	9520605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	4220605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	5420605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	9220605
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	3920605
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION INTERMEDIATE JOINT

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	3920605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

Know your out-of-pocket cost for care.

All Charges