Madison Medical Center

All Charges

Charge

Type

Setting

Price

INJ SINGLE OR MULTI TRIGGER POINTS

Facility

$220.00

Service Code	CPT 20552
Hospital Charge Code	9320552
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.00

INJ SINGLE OR MULTI TRIGGER POINTS

Facility

$220.00

Service Code	CPT 20552
Hospital Charge Code	9320552
Hospital Revenue Code	521
Min. Negotiated Rate	$130.24
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	$130.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.08
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
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	$146.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJ SINGLE TENDON SHEATH,LIGAMENT

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	9120550
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

INJ SINGLE TENDON SHEATH,LIGAMENT

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	9120550
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

INJ SING/MULT TRIGGER POINTS >3

Facility

$280.00

Service Code	CPT 20553
Hospital Charge Code	9820553
Hospital Revenue Code	521
Min. Negotiated Rate	$165.76
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	$165.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$199.92
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
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	$186.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJ SING/MULT TRIGGER POINTS >3

Facility

$280.00

Service Code	CPT 20553
Hospital Charge Code	9820553
Hospital Revenue Code	521
Rate for Payer: Cash Price	$252.00

INJ SING/MULT TRIGGER POINTS 3 OR MORE M

Facility

$220.00

Service Code	CPT 20552
Hospital Charge Code	9820552
Hospital Revenue Code	521
Min. Negotiated Rate	$130.24
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	$130.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.08
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
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	$146.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INJ SING/MULT TRIGGER POINTS 3 OR MORE M

Facility

$220.00

Service Code	CPT 20552
Hospital Charge Code	9820552
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.00

INJ TO TRIGGER POINT, MUSCLES

Professional

Both

$431.00

Service Code	CPT 20552
Hospital Charge Code	1820552
Hospital Revenue Code	981
Min. Negotiated Rate	$34.02
Max. Negotiated Rate	$150.85
Rate for Payer: Aetna Commercial/Medicare Advantage	$34.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$40.49
Rate for Payer: Cash Price	$387.90
Rate for Payer: Cash Price	$387.90
Rate for Payer: Cigna Commercial HMO & PPO	$34.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$40.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$44.54
Rate for Payer: Home State Health Plan Medicare Advantage	$34.02
Rate for Payer: Optum Medicare Advantage	$150.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$40.49

INNOVAR

Facility

$81.00

Hospital Charge Code	209006
Hospital Revenue Code	370
Rate for Payer: Cash Price	$72.90

INNOVAR

Facility

$81.00

Hospital Charge Code	209006
Hospital Revenue Code	370
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$57.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

INPATIENT INTERMEDIATE CONSULTATION

Facility

$255.00

Service Code	CPT 99252
Hospital Charge Code	9199252
Hospital Revenue Code	521
Rate for Payer: Cash Price	$229.50

INPATIENT INTERMEDIATE CONSULTATION

Facility

$255.00

Service Code	CPT 99252
Hospital Charge Code	9199252
Hospital Revenue Code	521
Min. Negotiated Rate	$150.96
Max. Negotiated Rate	$182.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.07
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: UnitedHealthcare Commercial	$170.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INPATIENT SURGERY 1ST HOUR

Facility

$3,719.00

Hospital Charge Code	1219101
Hospital Revenue Code	360
Min. Negotiated Rate	$1,338.84
Max. Negotiated Rate	$2,480.57
Rate for Payer: Cash Price	$3,347.10
Rate for Payer: UnitedHealthcare Commercial	$2,480.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,338.84

INPATIENT SURGERY 1ST HOUR

Facility

$3,719.00

Hospital Charge Code	1219101
Hospital Revenue Code	360
Rate for Payer: Cash Price	$3,347.10

INPATIENT SURGERY ADDITIONAL 1/2 HR

Facility

$1,675.00

Hospital Charge Code	1219103
Hospital Revenue Code	360
Min. Negotiated Rate	$603.00
Max. Negotiated Rate	$1,117.22
Rate for Payer: Cash Price	$1,507.50
Rate for Payer: UnitedHealthcare Commercial	$1,117.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$603.00

INPATIENT SURGERY ADDITIONAL 1/2 HR

Facility

$1,675.00

Hospital Charge Code	1219103
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,507.50

INPT HOSP DISCHARGE UNDER 30 MIN

Facility

$202.00

Service Code	CPT 99238
Hospital Charge Code	5499238
Rate for Payer: Cash Price	$181.80

INSERTION CENTRAL VENOUS CATHETER

Professional

Both

$1,317.00

Service Code	CPT 36556
Hospital Charge Code	1836556
Hospital Revenue Code	975
Min. Negotiated Rate	$75.54
Max. Negotiated Rate	$460.95
Rate for Payer: Aetna Commercial/Medicare Advantage	$75.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$177.44
Rate for Payer: Cash Price	$1,185.30
Rate for Payer: Cash Price	$1,185.30
Rate for Payer: Cigna Commercial HMO & PPO	$75.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$177.44
Rate for Payer: Home State Health Plan Medicaid Managed Care	$195.18
Rate for Payer: Home State Health Plan Medicare Advantage	$75.54
Rate for Payer: Optum Medicare Advantage	$460.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$177.44

INSERTION FOLEY CATHETER

Facility

$370.00

Service Code	CPT 51702
Hospital Charge Code	5251702
Hospital Revenue Code	521
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$219.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$264.18
Rate for Payer: Cash Price	$333.00
Rate for Payer: Cash Price	$333.00
Rate for Payer: Cash Price	$333.00
Rate for Payer: Cash Price	$333.00
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$246.79
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INSERTION FOLEY CATHETER

Facility

$370.00

Service Code	CPT 51702
Hospital Charge Code	5251702
Hospital Revenue Code	521
Rate for Payer: Cash Price	$333.00

INSERTION FOLEY CATHETER

Facility

$370.00

Service Code	CPT 51702
Hospital Charge Code	4151702
Hospital Revenue Code	521
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$219.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$264.18
Rate for Payer: Cash Price	$333.00
Rate for Payer: Cash Price	$333.00
Rate for Payer: Cash Price	$333.00
Rate for Payer: Cash Price	$333.00
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$246.79
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INSERTION FOLEY CATHETER

Facility

$370.00

Service Code	CPT 51702
Hospital Charge Code	4151702
Hospital Revenue Code	521
Rate for Payer: Cash Price	$333.00

INSERTION OF IUD

Facility

$360.00

Service Code	CPT 58300
Hospital Charge Code	9258300
Hospital Revenue Code	521
Rate for Payer: Cash Price	$324.00

INSERTION OF IUD

Facility

$360.00

Service Code	CPT 58300
Hospital Charge Code	9258300
Hospital Revenue Code	521
Min. Negotiated Rate	$150.07
Max. Negotiated Rate	$257.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$166.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$213.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$257.04
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$150.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$178.42
Rate for Payer: UnitedHealthcare Commercial	$240.12
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$166.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges