Madison Medical Center

All Charges

Charge

Type

Setting

Price

MR RT LOWER EXT W/WO

Facility

$4,267.00

Service Code	CPT 73720
Hospital Charge Code	3373720
Hospital Revenue Code	610
Rate for Payer: Cash Price	$3,840.30

MR RT LOWER JOINTW/O

Facility

$4,546.00

Service Code	CPT 73721
Hospital Charge Code	3373721
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 RT LOWER JOINTW/O

Facility

$4,546.00

Service Code	CPT 73721
Hospital Charge Code	3373721
Hospital Revenue Code	610
Rate for Payer: Cash Price	$4,091.40

MR RT LOWER JOINT W/WO

Facility

$5,167.00

Service Code	CPT 73723
Hospital Charge Code	3373723
Hospital Revenue Code	610
Rate for Payer: Cash Price	$4,650.30

MR RT LOWER JOINT W/WO

Facility

$5,167.00

Service Code	CPT 73723
Hospital Charge Code	3373723
Hospital Revenue Code	610
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$3,689.24
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	$3,689.24
Rate for Payer: Cash Price	$4,650.30
Rate for Payer: Cash Price	$4,650.30
Rate for Payer: Cash Price	$4,650.30
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	$3,446.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,860.12

MR RT UPPER EXT W/O

Facility

$2,493.00

Service Code	CPT 73218
Hospital Charge Code	3373218
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 RT UPPER EXT W/O

Facility

$2,493.00

Service Code	CPT 73218
Hospital Charge Code	3373218
Hospital Revenue Code	610
Rate for Payer: Cash Price	$2,243.70

MR RT UPPER EXT W/WO

Facility

$3,091.00

Service Code	CPT 73220
Hospital Charge Code	3373220
Hospital Revenue Code	610
Rate for Payer: Cash Price	$2,781.90

MR RT UPPER EXT W/WO

Facility

$3,091.00

Service Code	CPT 73220
Hospital Charge Code	3373220
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

MR RT UPPER JOINT W/O

Facility

$4,546.00

Service Code	CPT 73221
Hospital Charge Code	3373221
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 RT UPPER JOINT W/O

Facility

$4,546.00

Service Code	CPT 73221
Hospital Charge Code	3373221
Hospital Revenue Code	610
Rate for Payer: Cash Price	$4,091.40

MRSA NUCLEIC ACID AMP

Facility

$334.00

Service Code	CPT 87081
Hospital Charge Code	2287790
Hospital Revenue Code	301
Rate for Payer: Cash Price	$300.60

MRSA NUCLEIC ACID AMP

Facility

$334.00

Service Code	CPT 87081
Hospital Charge Code	2287790
Hospital Revenue Code	301
Min. Negotiated Rate	$5.97
Max. Negotiated Rate	$238.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.97
Rate for Payer: Aetna Medicare Advantage	$6.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$197.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$238.48
Rate for Payer: Cash Price	$300.60
Rate for Payer: Cash Price	$300.60
Rate for Payer: Cash Price	$300.60
Rate for Payer: Cigna Commercial HMO & PPO	$6.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.39
Rate for Payer: Home State Health Plan Medicare Advantage	$6.63
Rate for Payer: Humana Commercial	$13.26
Rate for Payer: Humana Medicare Advantage	$6.63
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$120.24

MRSA SCREENING CULTURE

Facility

$60.00

Service Code	CPT 87081
Hospital Charge Code	2287090
Hospital Revenue Code	301
Min. Negotiated Rate	$5.97
Max. Negotiated Rate	$42.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.97
Rate for Payer: Aetna Medicare Advantage	$6.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cigna Commercial HMO & PPO	$6.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.39
Rate for Payer: Home State Health Plan Medicare Advantage	$6.63
Rate for Payer: Humana Commercial	$13.26
Rate for Payer: Humana Medicare Advantage	$6.63
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

MRSA SCREENING CULTURE

Facility

$60.00

Service Code	CPT 87081
Hospital Charge Code	2287090
Hospital Revenue Code	301
Rate for Payer: Cash Price	$54.00

MR THORACIC W CONTRAST

Facility

$3,205.00

Service Code	CPT 72147
Hospital Charge Code	3372147
Hospital Revenue Code	612
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$2,288.37
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	$2,288.37
Rate for Payer: Cash Price	$2,884.50
Rate for Payer: Cash Price	$2,884.50
Rate for Payer: Cash Price	$2,884.50
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	$2,137.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,153.80

MR THORACIC W CONTRAST

Facility

$3,205.00

Service Code	CPT 72147
Hospital Charge Code	3372147
Hospital Revenue Code	612
Rate for Payer: Cash Price	$2,884.50

MR THORACIC WO

Facility

$3,347.00

Service Code	CPT 72146
Hospital Charge Code	3372146
Hospital Revenue Code	612
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$2,389.76
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	$2,389.76
Rate for Payer: Cash Price	$3,012.30
Rate for Payer: Cash Price	$3,012.30
Rate for Payer: Cash Price	$3,012.30
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	$2,232.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,204.92

MR THORACIC WO

Facility

$3,347.00

Service Code	CPT 72146
Hospital Charge Code	3372146
Hospital Revenue Code	612
Rate for Payer: Cash Price	$3,012.30

MR THORACIC WWO CONTRAST

Facility

$3,489.00

Service Code	CPT 72157
Hospital Charge Code	3372157
Hospital Revenue Code	612
Min. Negotiated Rate	$314.49
Max. Negotiated Rate	$2,491.15
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	$2,491.15
Rate for Payer: Cash Price	$3,140.10
Rate for Payer: Cash Price	$3,140.10
Rate for Payer: Cash Price	$3,140.10
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	$2,327.16
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$314.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,256.04

MR THORACIC WWO CONTRAST

Facility

$3,489.00

Service Code	CPT 72157
Hospital Charge Code	3372157
Hospital Revenue Code	612
Rate for Payer: Cash Price	$3,140.10

MR TMJ

Facility

$2,780.00

Service Code	CPT 70336
Hospital Charge Code	3370336
Hospital Revenue Code	610
Rate for Payer: Cash Price	$2,502.00

MR TMJ

Facility

$2,780.00

Service Code	CPT 70336
Hospital Charge Code	3370336
Hospital Revenue Code	610
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$1,984.92
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	$1,984.92
Rate for Payer: Cash Price	$2,502.00
Rate for Payer: Cash Price	$2,502.00
Rate for Payer: Cash Price	$2,502.00
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	$1,854.26
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,000.80

MSAFP

Facility

$61.00

Service Code	CPT 82105
Hospital Charge Code	4282105
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.90

MSAFP

Facility

$61.00

Service Code	CPT 82105
Hospital Charge Code	4282105
Hospital Revenue Code	521
Min. Negotiated Rate	$13.58
Max. Negotiated Rate	$173.53
Rate for Payer: Humana Commercial	$33.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.09
Rate for Payer: Aetna Medicare Advantage	$16.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$43.55
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.15
Rate for Payer: Home State Health Plan Medicare Advantage	$16.77
Rate for Payer: Humana Medicare Advantage	$16.77
Rate for Payer: UnitedHealthcare Commercial	$40.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges