Madison Medical Center

All Charges

Charge

Type

Setting

Price

NEBULIZER FIRST TREATMENT

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	3994664
Hospital Revenue Code	412
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

NEBULIZER FIRST TREATMENT

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	9794664
Hospital Revenue Code	521
Min. Negotiated Rate	$41.44
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$177.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NEBULIZER FIRST TREATMENT

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	3994664
Hospital Revenue Code	412
Rate for Payer: Cash Price	$63.00

NEBULIZER FIRST TREATMENT

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	9794664
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

NEBULIZER FIRST TX

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	9294664
Hospital Revenue Code	412
Rate for Payer: Cash Price	$63.00

NEBULIZER FIRST TX

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	9294664
Hospital Revenue Code	412
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

NEBULIZER FIRST TX

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	9494664
Hospital Revenue Code	412
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

NEBULIZER FIRST TX

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	9494664
Hospital Revenue Code	412
Rate for Payer: Cash Price	$63.00

NEBULIZER-SUBSEQUENT

Facility

$50.00

Service Code	CPT 94665
Hospital Charge Code	4494665
Hospital Revenue Code	412
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$35.70
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

NEBULIZER-SUBSEQUENT

Facility

$50.00

Service Code	CPT 94665
Hospital Charge Code	4494665
Hospital Revenue Code	412
Rate for Payer: Cash Price	$45.00

NEBULIZER TREATMENT

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	4294664
Hospital Revenue Code	412
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

NEBULIZER TREATMENT

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	4294664
Hospital Revenue Code	412
Rate for Payer: Cash Price	$63.00

NEBULIZER TREATMENT FIRST

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	9694664
Hospital Revenue Code	412
Rate for Payer: Cash Price	$63.00

NEBULIZER TREATMENT FIRST

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	9694664
Hospital Revenue Code	412
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

NEBULIZER TREATMENT FIRST

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	9894664
Hospital Revenue Code	412
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

NEBULIZER TREATMENT FIRST

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	9594664
Hospital Revenue Code	412
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

NEBULIZER TREATMENT FIRST

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	9894664
Hospital Revenue Code	412
Rate for Payer: Cash Price	$63.00

NEBULIZER TREATMENT FIRST

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	5294664
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

NEBULIZER TREATMENT FIRST

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	4194664
Hospital Revenue Code	412
Rate for Payer: Cash Price	$63.00

NEBULIZER TREATMENT FIRST

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	5294664
Hospital Revenue Code	521
Min. Negotiated Rate	$41.44
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$177.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NEBULIZER TREATMENT FIRST

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	9594664
Hospital Revenue Code	412
Rate for Payer: Cash Price	$63.00

NEBULIZER TREATMENT FIRST

Facility

$70.00

Service Code	CPT 94664
Hospital Charge Code	4194664
Hospital Revenue Code	412
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$447.44
Rate for Payer: Aetna Better Health Medicaid/QHP	$197.40
Rate for Payer: Aetna Medicare Advantage	$223.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$223.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$197.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$211.22
Rate for Payer: Home State Health Plan Medicare Advantage	$223.72
Rate for Payer: Humana Commercial	$447.44
Rate for Payer: Humana Medicare Advantage	$223.72
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$197.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

NEBULIZER TREATMENT SUBSEQ

Facility

$50.00

Service Code	CPT 94665
Hospital Charge Code	9694665
Hospital Revenue Code	412
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$35.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

NEBULIZER TREATMENT SUBSEQ

Facility

$50.00

Service Code	CPT 94664
Hospital Charge Code	9894665
Hospital Revenue Code	412
Rate for Payer: Cash Price	$45.00

NEBULIZER TREATMENT SUBSEQ

Facility

$50.00

Service Code	CPT 94665
Hospital Charge Code	9694665
Hospital Revenue Code	412
Rate for Payer: Cash Price	$45.00

Know your out-of-pocket cost for care.

All Charges