Madison Medical Center

All Charges

Charge

Type

Setting

Price

MR CERVICAL W CONTRAST

Facility

$3,892.00

Service Code	CPT 72142
Hospital Charge Code	3372142
Hospital Revenue Code	612
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$2,778.89
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	$2,778.89
Rate for Payer: Cash Price	$3,502.80
Rate for Payer: Cash Price	$3,502.80
Rate for Payer: Cash Price	$3,502.80
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	$2,595.96
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,401.12

MR CERVICAL WO

Facility

$3,706.00

Service Code	CPT 72141
Hospital Charge Code	3372141
Hospital Revenue Code	612
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$2,646.08
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	$2,646.08
Rate for Payer: Cash Price	$3,335.40
Rate for Payer: Cash Price	$3,335.40
Rate for Payer: Cash Price	$3,335.40
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	$2,471.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,334.16

MR CERVICAL WO

Facility

$3,706.00

Service Code	CPT 72141
Hospital Charge Code	3372141
Hospital Revenue Code	612
Rate for Payer: Cash Price	$3,335.40

MR CERVICAL WWO CONTRAST

Facility

$4,454.00

Service Code	CPT 72156
Hospital Charge Code	3372156
Hospital Revenue Code	612
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$3,180.16
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	$3,180.16
Rate for Payer: Cash Price	$4,008.60
Rate for Payer: Cash Price	$4,008.60
Rate for Payer: Cash Price	$4,008.60
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	$2,970.82
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,603.44

MR CERVICAL WWO CONTRAST

Facility

$4,454.00

Service Code	CPT 72156
Hospital Charge Code	3372156
Hospital Revenue Code	612
Rate for Payer: Cash Price	$4,008.60

MR CHEST

Facility

$3,001.00

Service Code	CPT 71550
Hospital Charge Code	3371550
Hospital Revenue Code	610
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$2,142.71
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	$2,142.71
Rate for Payer: Cash Price	$2,700.90
Rate for Payer: Cash Price	$2,700.90
Rate for Payer: Cash Price	$2,700.90
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	$2,001.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,080.36

MR CHEST

Facility

$3,001.00

Service Code	CPT 71550
Hospital Charge Code	3371550
Hospital Revenue Code	610
Rate for Payer: Cash Price	$2,700.90

MR CHEST WWO

Facility

$4,072.00

Service Code	CPT 71552
Hospital Charge Code	3371552
Hospital Revenue Code	610
Rate for Payer: Cash Price	$3,664.80

MR CHEST WWO

Facility

$4,072.00

Service Code	CPT 71552
Hospital Charge Code	3371552
Hospital Revenue Code	610
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$2,907.41
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	$2,907.41
Rate for Payer: Cash Price	$3,664.80
Rate for Payer: Cash Price	$3,664.80
Rate for Payer: Cash Price	$3,664.80
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	$2,716.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,465.92

MRI RT UPPER JOINT W/WO CONTRAST

Facility

$5,198.00

Service Code	CPT 73223
Hospital Charge Code	3373223
Hospital Revenue Code	610
Rate for Payer: Cash Price	$4,678.20

MRI RT UPPER JOINT W/WO CONTRAST

Facility

$5,198.00

Service Code	CPT 73223
Hospital Charge Code	3373223
Hospital Revenue Code	610
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$3,711.37
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	$3,711.37
Rate for Payer: Cash Price	$4,678.20
Rate for Payer: Cash Price	$4,678.20
Rate for Payer: Cash Price	$4,678.20
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	$3,467.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,871.28

MR LT LOWER EXTREMITY JOINT W CONTRAST

Facility

$4,840.00

Service Code	CPT 73722
Hospital Charge Code	3373728
Hospital Revenue Code	610
Min. Negotiated Rate	$706.66
Max. Negotiated Rate	$3,455.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$706.66
Rate for Payer: Aetna Medicare Advantage	$800.90
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	$3,455.76
Rate for Payer: Cash Price	$4,356.00
Rate for Payer: Cash Price	$4,356.00
Rate for Payer: Cash Price	$4,356.00
Rate for Payer: Cigna Commercial HMO & PPO	$800.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$706.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$756.13
Rate for Payer: Home State Health Plan Medicare Advantage	$800.90
Rate for Payer: Humana Commercial	$1,601.80
Rate for Payer: Humana Medicare Advantage	$800.90
Rate for Payer: UnitedHealthcare Commercial	$3,228.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$706.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,742.40

MR LT LOWER EXTREMITY JOINT W CONTRAST

Facility

$4,840.00

Service Code	CPT 73722
Hospital Charge Code	3373728
Hospital Revenue Code	610
Rate for Payer: Cash Price	$4,356.00

MR LT LOWER EXT W/WO

Facility

$4,189.00

Service Code	CPT 73720
Hospital Charge Code	3373719
Hospital Revenue Code	610
Rate for Payer: Cash Price	$3,770.10

MR LT LOWER EXT W/WO

Facility

$4,189.00

Service Code	CPT 73720
Hospital Charge Code	3373719
Hospital Revenue Code	610
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$2,990.95
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	$2,990.95
Rate for Payer: Cash Price	$3,770.10
Rate for Payer: Cash Price	$3,770.10
Rate for Payer: Cash Price	$3,770.10
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	$2,794.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,508.04

MR LT LOWER JOINT WO

Facility

$4,546.00

Service Code	CPT 73721
Hospital Charge Code	3373722
Hospital Revenue Code	610
Rate for Payer: Cash Price	$4,091.40

MR LT LOWER JOINT WO

Facility

$4,546.00

Service Code	CPT 73721
Hospital Charge Code	3373722
Hospital Revenue Code	610
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$3,245.84
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	$3,245.84
Rate for Payer: Cash Price	$4,091.40
Rate for Payer: Cash Price	$4,091.40
Rate for Payer: Cash Price	$4,091.40
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	$3,032.18
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,636.56

MR LT LOWER JOINT W/WO

Facility

$5,088.00

Service Code	CPT 73723
Hospital Charge Code	3373724
Hospital Revenue Code	610
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$3,632.83
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	$3,632.83
Rate for Payer: Cash Price	$4,579.20
Rate for Payer: Cash Price	$4,579.20
Rate for Payer: Cash Price	$4,579.20
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	$3,393.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,831.68

MR LT LOWER JOINT W/WO

Facility

$5,088.00

Service Code	CPT 73723
Hospital Charge Code	3373724
Hospital Revenue Code	610
Rate for Payer: Cash Price	$4,579.20

MR LT LOWER WO

Facility

$3,514.00

Service Code	CPT 73718
Hospital Charge Code	3373717
Hospital Revenue Code	610
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$2,509.00
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	$2,509.00
Rate for Payer: Cash Price	$3,162.60
Rate for Payer: Cash Price	$3,162.60
Rate for Payer: Cash Price	$3,162.60
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	$2,343.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,265.04

MR LT LOWER WO

Facility

$3,514.00

Service Code	CPT 73718
Hospital Charge Code	3373717
Hospital Revenue Code	610
Rate for Payer: Cash Price	$3,162.60

MR LT UPPER EXT W/O

Facility

$2,493.00

Service Code	CPT 73218
Hospital Charge Code	3373219
Hospital Revenue Code	610
Rate for Payer: Cash Price	$2,243.70

MR LT UPPER EXT W/O

Facility

$2,493.00

Service Code	CPT 73218
Hospital Charge Code	3373219
Hospital Revenue Code	610
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$1,780.00
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	$1,780.00
Rate for Payer: Cash Price	$2,243.70
Rate for Payer: Cash Price	$2,243.70
Rate for Payer: Cash Price	$2,243.70
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	$1,662.83
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$897.48

MR LT UPPER EXT W/WO

Facility

$3,091.00

Service Code	CPT 73220
Hospital Charge Code	3373225
Hospital Revenue Code	610
Rate for Payer: Cash Price	$2,781.90

MR LT UPPER EXT W/WO

Facility

$3,091.00

Service Code	CPT 73220
Hospital Charge Code	3373225
Hospital Revenue Code	610
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$2,206.97
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	$2,206.97
Rate for Payer: Cash Price	$2,781.90
Rate for Payer: Cash Price	$2,781.90
Rate for Payer: Cash Price	$2,781.90
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	$2,061.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,112.76

Know your out-of-pocket cost for care.

All Charges