Madison Medical Center

All Charges

Charge

Type

Setting

Price

INJECTION,INTRALESIONAL; UP TO 7 LESIONS

Facility

$158.00

Service Code	CPT 11900
Hospital Charge Code	4111900
Hospital Revenue Code	521
Rate for Payer: Cash Price	$142.20

INJECTION,INTRALESIONAL; UP TO 7 LESIONS

Facility

$158.00

Service Code	CPT 11900
Hospital Charge Code	4111900
Hospital Revenue Code	521
Min. Negotiated Rate	$93.54
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$93.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$112.81
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$105.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION LUMBAR OR SACRAL, SECOND LEVEL

Professional

Both

$1,300.00

Service Code	CPT 64483
Hospital Charge Code	4164483
Hospital Revenue Code	975
Min. Negotiated Rate	$94.96
Max. Negotiated Rate	$455.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$94.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$189.23
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Cash Price	$1,170.00
Rate for Payer: Cigna Commercial HMO & PPO	$94.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$189.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$208.15
Rate for Payer: Home State Health Plan Medicare Advantage	$94.96
Rate for Payer: Optum Medicare Advantage	$455.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$189.23

INJECTION LUMBAR/THORACIC PARAVERT SYMP

Facility

$1,000.00

Service Code	CPT 64520
Hospital Charge Code	4164520
Hospital Revenue Code	521
Rate for Payer: Cash Price	$900.00

INJECTION LUMBAR/THORACIC PARAVERT SYMP

Facility

$1,000.00

Service Code	CPT 64520
Hospital Charge Code	4164520
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,807.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$797.31
Rate for Payer: Aetna Medicare Advantage	$903.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$592.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$714.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cigna Commercial HMO & PPO	$903.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$717.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$853.12
Rate for Payer: Home State Health Plan Medicare Advantage	$903.63
Rate for Payer: Humana Commercial	$1,807.26
Rate for Payer: Humana Medicare Advantage	$903.63
Rate for Payer: UnitedHealthcare Commercial	$667.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$797.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	4220610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	3920610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	9420610
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
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	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
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	$190.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	9620610
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
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	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
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	$190.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	9120610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	9120610
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
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	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
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	$190.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	4120610
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
Max. Negotiated Rate	$627.20
Rate for Payer: Cash Price	$256.50
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	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
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	$190.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	5220610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	5220610
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
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	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
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	$190.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	4120610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	9820610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	9820610
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
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	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
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	$190.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	9620610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	9220610
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
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	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
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	$190.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	9520610
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
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	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
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	$190.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	9220610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	9520610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	4220610
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
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	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
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	$190.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	3920610
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
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	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
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	$190.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION MAJOR JOINT

Facility

$285.00

Service Code	CPT 20610
Hospital Charge Code	9420610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

Know your out-of-pocket cost for care.

All Charges