Madison Medical Center

All Charges

Charge

Type

Setting

Price

MRA CHEST

Facility

$3,948.00

Service Code	CPT 71555
Hospital Charge Code	3371555
Hospital Revenue Code	618
Min. Negotiated Rate	$1,421.28
Max. Negotiated Rate	$2,818.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,555.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,818.87
Rate for Payer: Cash Price	$3,553.20
Rate for Payer: Cash Price	$3,553.20
Rate for Payer: UnitedHealthcare Commercial	$2,633.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.28

MRA CHEST

Facility

$3,948.00

Service Code	CPT 71555
Hospital Charge Code	3371555
Hospital Revenue Code	618
Rate for Payer: Cash Price	$3,553.20

MRA LOW EXTREMITY LT

Facility

$3,068.00

Service Code	CPT 73725
Hospital Charge Code	3373726
Hospital Revenue Code	616
Rate for Payer: Cash Price	$2,761.20

MRA LOW EXTREMITY LT

Facility

$3,068.00

Service Code	CPT 73725
Hospital Charge Code	3373726
Hospital Revenue Code	616
Min. Negotiated Rate	$1,104.48
Max. Negotiated Rate	$2,190.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,555.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,190.55
Rate for Payer: Cash Price	$2,761.20
Rate for Payer: Cash Price	$2,761.20
Rate for Payer: UnitedHealthcare Commercial	$2,046.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.48

MRA LOW EXTREMITY RT

Facility

$3,068.00

Service Code	CPT 73725
Hospital Charge Code	3373725
Hospital Revenue Code	616
Rate for Payer: Cash Price	$2,761.20

MRA LOW EXTREMITY RT

Facility

$3,068.00

Service Code	CPT 73725
Hospital Charge Code	3373725
Hospital Revenue Code	616
Min. Negotiated Rate	$1,104.48
Max. Negotiated Rate	$2,190.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,555.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,190.55
Rate for Payer: Cash Price	$2,761.20
Rate for Payer: Cash Price	$2,761.20
Rate for Payer: UnitedHealthcare Commercial	$2,046.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.48

MRA NECK

Facility

$3,886.00

Service Code	CPT 70547
Hospital Charge Code	3370541
Hospital Revenue Code	614
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$2,774.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,555.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,774.60
Rate for Payer: Cash Price	$3,497.40
Rate for Payer: Cash Price	$3,497.40
Rate for Payer: Cash Price	$3,497.40
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$2,591.96
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,398.96

MRA NECK

Facility

$3,886.00

Service Code	CPT 70547
Hospital Charge Code	3370541
Hospital Revenue Code	614
Rate for Payer: Cash Price	$3,497.40

MRA PELVIS

Facility

$3,821.00

Service Code	CPT 72198
Hospital Charge Code	3372198
Hospital Revenue Code	618
Min. Negotiated Rate	$1,375.56
Max. Negotiated Rate	$2,728.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,555.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,728.19
Rate for Payer: Cash Price	$3,438.90
Rate for Payer: Cash Price	$3,438.90
Rate for Payer: UnitedHealthcare Commercial	$2,548.61
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,375.56

MRA PELVIS

Facility

$3,821.00

Service Code	CPT 72198
Hospital Charge Code	3372198
Hospital Revenue Code	618
Rate for Payer: Cash Price	$3,438.90

MRA SPINAL CANAL

Facility

$3,489.00

Service Code	CPT 72159
Hospital Charge Code	3372159
Hospital Revenue Code	618
Min. Negotiated Rate	$1,256.04
Max. Negotiated Rate	$2,491.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,555.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,491.15
Rate for Payer: Cash Price	$3,140.10
Rate for Payer: Cash Price	$3,140.10
Rate for Payer: UnitedHealthcare Commercial	$2,327.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,256.04

MRA SPINAL CANAL

Facility

$3,489.00

Service Code	CPT 72159
Hospital Charge Code	3372159
Hospital Revenue Code	618
Rate for Payer: Cash Price	$3,140.10

MRA UPPER EXTREMITY LT

Facility

$3,205.00

Service Code	CPT 73225
Hospital Charge Code	3373226
Hospital Revenue Code	618
Rate for Payer: Cash Price	$2,884.50

MRA UPPER EXTREMITY LT

Facility

$3,205.00

Service Code	CPT 73225
Hospital Charge Code	3373226
Hospital Revenue Code	618
Min. Negotiated Rate	$1,153.80
Max. Negotiated Rate	$2,288.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,555.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,288.37
Rate for Payer: Cash Price	$2,884.50
Rate for Payer: Cash Price	$2,884.50
Rate for Payer: UnitedHealthcare Commercial	$2,137.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,153.80

MR BRAIN W CONTRAST

Facility

$3,625.00

Service Code	CPT 70552
Hospital Charge Code	3370552
Hospital Revenue Code	611
Rate for Payer: Cash Price	$3,262.50

MR BRAIN W CONTRAST

Facility

$3,625.00

Service Code	CPT 70552
Hospital Charge Code	3370552
Hospital Revenue Code	611
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$2,588.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$314.49
Rate for Payer: Aetna Medicare Advantage	$356.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,555.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,588.25
Rate for Payer: Cash Price	$3,262.50
Rate for Payer: Cash Price	$3,262.50
Rate for Payer: Cash Price	$3,262.50
Rate for Payer: Cigna Commercial HMO & PPO	$356.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$314.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$336.50
Rate for Payer: Home State Health Plan Medicare Advantage	$356.43
Rate for Payer: Humana Commercial	$712.86
Rate for Payer: Humana Medicare Advantage	$356.43
Rate for Payer: UnitedHealthcare Commercial	$2,417.88
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,305.00

MR BRAIN WO CONTRAST

Facility

$3,456.00

Service Code	CPT 70551
Hospital Charge Code	3370551
Hospital Revenue Code	611
Rate for Payer: Cash Price	$3,110.40

MR BRAIN WO CONTRAST

Facility

$3,456.00

Service Code	CPT 70551
Hospital Charge Code	3370551
Hospital Revenue Code	611
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$2,467.58
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,555.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,467.58
Rate for Payer: Cash Price	$3,110.40
Rate for Payer: Cash Price	$3,110.40
Rate for Payer: Cash Price	$3,110.40
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$2,305.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,244.16

MR BRAIN W WO CONTRAST

Facility

$4,375.00

Service Code	CPT 70553
Hospital Charge Code	3370553
Hospital Revenue Code	611
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$3,123.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$314.49
Rate for Payer: Aetna Medicare Advantage	$356.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,555.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3,123.75
Rate for Payer: Cash Price	$3,937.50
Rate for Payer: Cash Price	$3,937.50
Rate for Payer: Cash Price	$3,937.50
Rate for Payer: Cigna Commercial HMO & PPO	$356.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$314.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$336.50
Rate for Payer: Home State Health Plan Medicare Advantage	$356.43
Rate for Payer: Humana Commercial	$712.86
Rate for Payer: Humana Medicare Advantage	$356.43
Rate for Payer: UnitedHealthcare Commercial	$2,918.12
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,575.00

MR BRAIN W WO CONTRAST

Facility

$4,375.00

Service Code	CPT 70553
Hospital Charge Code	3370553
Hospital Revenue Code	611
Rate for Payer: Cash Price	$3,937.50

MR BREAST BILATERAL W OR WO CONTRAST

Facility

$3,948.00

Service Code	CPT 76094
Hospital Charge Code	3376094
Hospital Revenue Code	610
Min. Negotiated Rate	$1,421.28
Max. Negotiated Rate	$2,818.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,555.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,818.87
Rate for Payer: Cash Price	$3,553.20
Rate for Payer: Cash Price	$3,553.20
Rate for Payer: UnitedHealthcare Commercial	$2,633.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,421.28

MR BREAST BILATERAL W OR WO CONTRAST

Facility

$3,948.00

Service Code	CPT 76094
Hospital Charge Code	3376094
Hospital Revenue Code	610
Rate for Payer: Cash Price	$3,553.20

MR CARDIAC FUNCTION

Facility

$3,772.00

Service Code	CPT 75554
Hospital Charge Code	3375554
Hospital Revenue Code	610
Rate for Payer: Cash Price	$3,394.80

MR CARDIAC FUNCTION

Facility

$3,772.00

Service Code	CPT 75554
Hospital Charge Code	3375554
Hospital Revenue Code	610
Min. Negotiated Rate	$1,357.92
Max. Negotiated Rate	$2,693.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,555.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,693.21
Rate for Payer: Cash Price	$3,394.80
Rate for Payer: Cash Price	$3,394.80
Rate for Payer: UnitedHealthcare Commercial	$2,515.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,357.92

MR CERVICAL W CONTRAST

Facility

$3,892.00

Service Code	CPT 72142
Hospital Charge Code	3372142
Hospital Revenue Code	612
Rate for Payer: Cash Price	$3,502.80

Know your out-of-pocket cost for care.

All Charges