Madison Medical Center

All Charges

Charge

Type

Setting

Price

INJECTION SMALL JOINT

Facility

$190.00

Service Code	CPT 20600
Hospital Charge Code	9220600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$171.00

INJECTION SMALL JOINT

Facility

$190.00

Service Code	CPT 20600
Hospital Charge Code	9420600
Hospital Revenue Code	521
Min. Negotiated Rate	$112.48
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	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
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	$126.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION SMALL JOINT FINGERS TOES

Facility

$190.00

Service Code	CPT 20600
Hospital Charge Code	9120600
Hospital Revenue Code	521
Min. Negotiated Rate	$112.48
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	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
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	$126.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION SMALL JOINT FINGERS TOES

Facility

$190.00

Service Code	CPT 20600
Hospital Charge Code	9120600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$171.00

Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (i.e., fluoroscopy or CT)

Facility

$1,442.34

Service Code	CPT 62321
Hospital Revenue Code	490
Min. Negotiated Rate	$636.32
Max. Negotiated Rate	$1,442.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$636.32
Rate for Payer: Aetna Medicare Advantage	$721.17
Rate for Payer: Cigna Commercial HMO & PPO	$721.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$636.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$680.86
Rate for Payer: Home State Health Plan Medicare Advantage	$721.17
Rate for Payer: Humana Commercial	$1,442.34
Rate for Payer: Humana Medicare Advantage	$721.17
Rate for Payer: UnitedHealthcare Commercial	$947.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$636.32

Facility

$1,442.34

Service Code	CPT 62321
Hospital Revenue Code	360
Min. Negotiated Rate	$636.32
Max. Negotiated Rate	$1,442.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$636.32
Rate for Payer: Aetna Medicare Advantage	$721.17
Rate for Payer: Cigna Commercial HMO & PPO	$721.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$636.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$680.86
Rate for Payer: Home State Health Plan Medicare Advantage	$721.17
Rate for Payer: Humana Commercial	$1,442.34
Rate for Payer: Humana Medicare Advantage	$721.17
Rate for Payer: UnitedHealthcare Commercial	$947.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$636.32

Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (i.e., fluoroscopy or CT)

Facility

$1,442.34

Service Code	CPT 62323
Hospital Revenue Code	360
Min. Negotiated Rate	$636.32
Max. Negotiated Rate	$1,442.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$636.32
Rate for Payer: Aetna Medicare Advantage	$721.17
Rate for Payer: Cigna Commercial HMO & PPO	$721.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$636.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$680.86
Rate for Payer: Home State Health Plan Medicare Advantage	$721.17
Rate for Payer: Humana Commercial	$1,442.34
Rate for Payer: Humana Medicare Advantage	$721.17
Rate for Payer: UnitedHealthcare Commercial	$947.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$636.32

Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (i.e., fluoroscopy or CT)

Facility

$1,442.34

Service Code	CPT 62323
Hospital Revenue Code	490
Min. Negotiated Rate	$636.32
Max. Negotiated Rate	$1,442.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$636.32
Rate for Payer: Aetna Medicare Advantage	$721.17
Rate for Payer: Cigna Commercial HMO & PPO	$721.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$636.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$680.86
Rate for Payer: Home State Health Plan Medicare Advantage	$721.17
Rate for Payer: Humana Commercial	$1,442.34
Rate for Payer: Humana Medicare Advantage	$721.17
Rate for Payer: UnitedHealthcare Commercial	$947.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$636.32

INJECTION TENDON SHEATH

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	9520550
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

INJECTION TENDON SHEATH

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	9520550
Hospital Revenue Code	521
Min. Negotiated Rate	$142.08
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	$142.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$171.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
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	$160.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION TENDON SHEATH SINGLE/MULT 3 OR

Facility

$270.00

Service Code	CPT 20553
Hospital Charge Code	4120553
Hospital Revenue Code	521
Rate for Payer: Cash Price	$243.00

INJECTION TENDON SHEATH SINGLE/MULT 3 OR

Facility

$270.00

Service Code	CPT 20553
Hospital Charge Code	4120553
Hospital Revenue Code	521
Min. Negotiated Rate	$159.84
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	$159.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$192.78
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cash Price	$243.00
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	$180.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJECTION WRIST ELBOW ANKLE

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	9120605
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 WRIST ELBOW ANKLE

Facility

$205.00

Service Code	CPT 20605
Hospital Charge Code	9120605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

INJETAK NEEDLE 35CM

Facility

$154.00

Hospital Charge Code	1289006
Hospital Revenue Code	271
Rate for Payer: Cash Price	$138.60

INJETAK NEEDLE 35CM

Facility

$154.00

Hospital Charge Code	1289006
Hospital Revenue Code	271
Min. Negotiated Rate	$55.44
Max. Negotiated Rate	$109.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$91.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.96
Rate for Payer: Cash Price	$138.60
Rate for Payer: UnitedHealthcare Commercial	$102.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.44

INJETAK NEEDLE 70CM

Facility

$190.00

Hospital Charge Code	1289005
Hospital Revenue Code	271
Rate for Payer: Cash Price	$171.00

INJETAK NEEDLE 70CM

Facility

$190.00

Hospital Charge Code	1289005
Hospital Revenue Code	271
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$135.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: UnitedHealthcare Commercial	$126.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.40

INJ ILIOINGUINAL, ILOHYPOGASTRIC NERVE

Facility

$650.00

Service Code	CPT 20600
Hospital Charge Code	9364425
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
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	$384.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$464.10
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cash Price	$585.00
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	$433.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJ ILIOINGUINAL, ILOHYPOGASTRIC NERVE

Facility

$650.00

Service Code	CPT 20600
Hospital Charge Code	9364425
Hospital Revenue Code	521
Rate for Payer: Cash Price	$585.00

INJ MAJOR JOINT U/S GUIDED

Facility

$395.00

Service Code	CPT 20611
Hospital Charge Code	9320611
Hospital Revenue Code	521
Rate for Payer: Cash Price	$355.50

INJ MAJOR JOINT U/S GUIDED

Facility

$395.00

Service Code	CPT 20611
Hospital Charge Code	9320611
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
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	$233.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$282.03
Rate for Payer: Cash Price	$355.50
Rate for Payer: Cash Price	$355.50
Rate for Payer: Cash Price	$355.50
Rate for Payer: Cash Price	$355.50
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	$263.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJ SECOND LEVEL, LUMBAR OR SACRAL

Professional

Both

$1,200.00

Service Code	CPT 64484
Hospital Charge Code	4164484
Hospital Revenue Code	975
Min. Negotiated Rate	$42.53
Max. Negotiated Rate	$420.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$42.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$90.68
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cigna Commercial HMO & PPO	$42.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$90.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$99.75
Rate for Payer: Home State Health Plan Medicare Advantage	$42.53
Rate for Payer: Optum Medicare Advantage	$420.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$90.68

INJ SINGLE/MULT TRIGGER POINTS 1 OR 2 MU

Facility

$190.00

Service Code	CPT 20552
Hospital Charge Code	4220552
Hospital Revenue Code	521
Min. Negotiated Rate	$112.48
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	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
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	$126.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJ SINGLE/MULT TRIGGER POINTS 1 OR 2 MU

Facility

$190.00

Service Code	CPT 20552
Hospital Charge Code	4220552
Hospital Revenue Code	521
Rate for Payer: Cash Price	$171.00

Know your out-of-pocket cost for care.

All Charges