Madison Medical Center

All Charges

Charge

Type

Setting

Price

MR LT UPPER JOINT WO CONTRAST

Facility

$4,546.00

Service Code	CPT 73221
Hospital Charge Code	3373222
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 UPPER JOINT WO CONTRAST

Facility

$4,546.00

Service Code	CPT 73221
Hospital Charge Code	3373222
Hospital Revenue Code	610
Rate for Payer: Cash Price	$4,091.40

MR LT UPPER JOINT W/WO

Facility

$5,198.00

Service Code	CPT 73223
Hospital Charge Code	3373224
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 UPPER JOINT W/WO

Facility

$5,198.00

Service Code	CPT 73223
Hospital Charge Code	3373224
Hospital Revenue Code	610
Rate for Payer: Cash Price	$4,678.20

MR LUMBAR W CONTRAST

Facility

$3,711.00

Service Code	CPT 72149
Hospital Charge Code	3372149
Hospital Revenue Code	612
Rate for Payer: Cash Price	$3,339.90

MR LUMBAR W CONTRAST

Facility

$3,711.00

Service Code	CPT 72149
Hospital Charge Code	3372149
Hospital Revenue Code	612
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$2,649.65
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	$2,649.65
Rate for Payer: Cash Price	$3,339.90
Rate for Payer: Cash Price	$3,339.90
Rate for Payer: Cash Price	$3,339.90
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	$2,475.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,335.96

MR LUMBAR WO

Facility

$3,640.00

Service Code	CPT 72148
Hospital Charge Code	3372148
Hospital Revenue Code	612
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$2,598.96
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	$2,598.96
Rate for Payer: Cash Price	$3,276.00
Rate for Payer: Cash Price	$3,276.00
Rate for Payer: Cash Price	$3,276.00
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	$2,427.88
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,310.40

MR LUMBAR WO

Facility

$3,640.00

Service Code	CPT 72148
Hospital Charge Code	3372148
Hospital Revenue Code	612
Rate for Payer: Cash Price	$3,276.00

MR LUMBAR WWO CONTRAST

Facility

$4,325.00

Service Code	CPT 72158
Hospital Charge Code	3372158
Hospital Revenue Code	612
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$3,088.05
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	$3,088.05
Rate for Payer: Cash Price	$3,892.50
Rate for Payer: Cash Price	$3,892.50
Rate for Payer: Cash Price	$3,892.50
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	$2,884.78
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,557.00

MR LUMBAR WWO CONTRAST

Facility

$4,325.00

Service Code	CPT 72158
Hospital Charge Code	3372158
Hospital Revenue Code	612
Rate for Payer: Cash Price	$3,892.50

MR ORBIT, FACE AND NECK

Facility

$3,625.00

Service Code	CPT 70540
Hospital Charge Code	3370540
Hospital Revenue Code	610
Rate for Payer: Cash Price	$3,262.50

MR ORBIT, FACE AND NECK

Facility

$3,625.00

Service Code	CPT 70540
Hospital Charge Code	3370540
Hospital Revenue Code	610
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$2,588.25
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	$2,588.25
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	$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	$2,417.88
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,305.00

MR ORBIT FACE NECK W/WO

Facility

$3,568.00

Service Code	CPT 70543
Hospital Charge Code	3370543
Hospital Revenue Code	610
Rate for Payer: Cash Price	$3,211.20

MR ORBIT FACE NECK W/WO

Facility

$3,568.00

Service Code	CPT 70543
Hospital Charge Code	3370543
Hospital Revenue Code	610
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$2,547.55
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	$2,547.55
Rate for Payer: Cash Price	$3,211.20
Rate for Payer: Cash Price	$3,211.20
Rate for Payer: Cash Price	$3,211.20
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	$2,379.86
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,284.48

MR PELVIS W CONTRAST

Facility

$3,068.00

Service Code	CPT 72196
Hospital Charge Code	3372196
Hospital Revenue Code	610
Rate for Payer: Cash Price	$2,761.20

MR PELVIS W CONTRAST

Facility

$3,068.00

Service Code	CPT 72196
Hospital Charge Code	3372196
Hospital Revenue Code	610
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$2,190.55
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	$2,190.55
Rate for Payer: Cash Price	$2,761.20
Rate for Payer: Cash Price	$2,761.20
Rate for Payer: Cash Price	$2,761.20
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	$2,046.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.48

MR PELVIS WO CONTRAST

Facility

$3,068.00

Service Code	CPT 72195
Hospital Charge Code	3372195
Hospital Revenue Code	610
Rate for Payer: Cash Price	$2,761.20

MR PELVIS WO CONTRAST

Facility

$3,068.00

Service Code	CPT 72195
Hospital Charge Code	3372195
Hospital Revenue Code	610
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$2,190.55
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	$2,190.55
Rate for Payer: Cash Price	$2,761.20
Rate for Payer: Cash Price	$2,761.20
Rate for Payer: Cash Price	$2,761.20
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	$2,046.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,104.48

MR PELVIS W W/O CONTRAST

Facility

$3,474.00

Service Code	CPT 72197
Hospital Charge Code	3372197
Hospital Revenue Code	610
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$2,480.44
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	$2,480.44
Rate for Payer: Cash Price	$3,126.60
Rate for Payer: Cash Price	$3,126.60
Rate for Payer: Cash Price	$3,126.60
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	$2,317.16
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,250.64

MR PELVIS W W/O CONTRAST

Facility

$3,474.00

Service Code	CPT 72197
Hospital Charge Code	3372197
Hospital Revenue Code	610
Rate for Payer: Cash Price	$3,126.60

MR RT LOWER EXTREMITY JOINT W CONTRAST

Facility

$4,920.00

Service Code	CPT 73722
Hospital Charge Code	3373727
Hospital Revenue Code	610
Rate for Payer: Cash Price	$4,428.00

MR RT LOWER EXTREMITY JOINT W CONTRAST

Facility

$4,920.00

Service Code	CPT 73722
Hospital Charge Code	3373727
Hospital Revenue Code	610
Min. Negotiated Rate	$706.66
Max. Negotiated Rate	$3,512.88
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	$3,512.88
Rate for Payer: Cash Price	$4,428.00
Rate for Payer: Cash Price	$4,428.00
Rate for Payer: Cash Price	$4,428.00
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	$3,281.64
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$706.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,771.20

MR RT LOWER EXT WO

Facility

$3,594.00

Service Code	CPT 73718
Hospital Charge Code	3373718
Hospital Revenue Code	610
Rate for Payer: Cash Price	$3,234.60

MR RT LOWER EXT WO

Facility

$3,594.00

Service Code	CPT 73718
Hospital Charge Code	3373718
Hospital Revenue Code	610
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$2,566.12
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	$2,566.12
Rate for Payer: Cash Price	$3,234.60
Rate for Payer: Cash Price	$3,234.60
Rate for Payer: Cash Price	$3,234.60
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	$2,397.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,293.84

MR RT LOWER EXT W/WO

Facility

$4,267.00

Service Code	CPT 73720
Hospital Charge Code	3373720
Hospital Revenue Code	610
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$3,046.64
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	$3,046.64
Rate for Payer: Cash Price	$3,840.30
Rate for Payer: Cash Price	$3,840.30
Rate for Payer: Cash Price	$3,840.30
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	$2,846.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,536.12

Know your out-of-pocket cost for care.

All Charges