Madison Medical Center

All Charges

Charge

Type

Setting

Price

OT DISCHARGE OCCP THERAPY SUBSQT FUN

Facility

$4.00

Hospital Charge Code	538995
Hospital Revenue Code	430
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

OT ELASTIC SHOE LACES

Facility

$22.00

Hospital Charge Code	5349019
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

OT ELASTIC SHOE LACES

Facility

$22.00

Hospital Charge Code	5349019
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

OT ELECTRICAL STIMULATION

Facility

$111.00

Service Code	CPT 97032
Hospital Charge Code	5397014
Hospital Revenue Code	431
Rate for Payer: Cash Price	$99.90

OT ELECTRICAL STIMULATION

Facility

$111.00

Service Code	CPT 97032
Hospital Charge Code	5397014
Hospital Revenue Code	431
Min. Negotiated Rate	$12.97
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cash Price	$99.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.88
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.96

OT EVALUATION

Facility

$264.00

Service Code	CPT 97003GO
Hospital Charge Code	5397003
Hospital Revenue Code	434
Rate for Payer: Cash Price	$237.60

OT EVALUATION

Facility

$264.00

Service Code	CPT 97003GO
Hospital Charge Code	5397003
Hospital Revenue Code	434
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.04

OT EZ SPONGE

Facility

$24.00

Hospital Charge Code	5349001
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

OT EZ SPONGE

Facility

$24.00

Hospital Charge Code	5349001
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

OT FINGER CONTRACTURE CU

Facility

$60.00

Hospital Charge Code	5349033
Hospital Revenue Code	271
Rate for Payer: Cash Price	$54.00

OT FINGER CONTRACTURE CU

Facility

$60.00

Hospital Charge Code	5349033
Hospital Revenue Code	271
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
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: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

OT FOAM HAND EXER

Facility

$28.00

Hospital Charge Code	5349031
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

OT FOAM HAND EXER

Facility

$28.00

Hospital Charge Code	5349031
Hospital Revenue Code	271
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

OT FUNCTIONAL SOFT SPLINT

Facility

$301.00

Hospital Charge Code	5349041
Hospital Revenue Code	271
Min. Negotiated Rate	$108.36
Max. Negotiated Rate	$214.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$178.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.91
Rate for Payer: Cash Price	$270.90
Rate for Payer: UnitedHealthcare Commercial	$200.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.36

OT FUNCTIONAL SOFT SPLINT

Facility

$301.00

Hospital Charge Code	5349041
Hospital Revenue Code	271
Rate for Payer: Cash Price	$270.90

OT GEL SHEET 1X1 INCH

Facility

$45.00

Hospital Charge Code	5349037
Hospital Revenue Code	271
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

OT GEL SHEET 1X1 INCH

Facility

$45.00

Hospital Charge Code	5349037
Hospital Revenue Code	271
Rate for Payer: Cash Price	$40.50

OT GOAL MOBILITY OCCP THERAPY FUN

Facility

$4.00

Hospital Charge Code	538979
Hospital Revenue Code	430
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

OT GOAL MOBILITY OCCP THERAPY FUN

Facility

$4.00

Hospital Charge Code	538979
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT GOAL OCCP THERAPY BODY POS

Facility

$4.00

Hospital Charge Code	538982
Hospital Revenue Code	430
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

OT GOAL OCCP THERAPY BODY POS

Facility

$4.00

Hospital Charge Code	538982
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT GOAL OCCP THERAPY CARRYING MOVING

Facility

$4.00

Hospital Charge Code	538985
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT GOAL OCCP THERAPY CARRYING MOVING

Facility

$4.00

Hospital Charge Code	538985
Hospital Revenue Code	430
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

OT GOAL OCCP THERAPY FUNCTION

Facility

$4.00

Hospital Charge Code	538991
Hospital Revenue Code	430
Min. Negotiated Rate	$1.44
Max. Negotiated Rate	$136.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$136.00
Rate for Payer: Cash Price	$3.60
Rate for Payer: Cash Price	$3.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.44

OT GOAL OCCP THERAPY FUNCTION

Facility

$4.00

Hospital Charge Code	538991
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

Know your out-of-pocket cost for care.

All Charges