Madison Medical Center

All Charges

Charge

Type

Setting

Price

OT OCCU. THERAPY EVAL. UNIT

Facility

$149.00

Service Code	CPT 97703
Hospital Charge Code	5339001
Hospital Revenue Code	430
Min. Negotiated Rate	$53.64
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	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

OT OCCU. THERAPY EVAL. UNIT

Facility

$149.00

Service Code	CPT 97703
Hospital Charge Code	5339001
Hospital Revenue Code	430
Rate for Payer: Cash Price	$134.10

OT OCCU. THERAPY UNIT 15 MIN.

Facility

$149.00

Service Code	CPT 97535
Hospital Charge Code	5339003
Hospital Revenue Code	432
Min. Negotiated Rate	$28.42
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$28.42
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	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$30.41
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

OT OCCU. THERAPY UNIT 15 MIN.

Facility

$149.00

Service Code	CPT 97535
Hospital Charge Code	5339003
Hospital Revenue Code	432
Rate for Payer: Cash Price	$134.10

OT ONSET OCCP THERAPY BODY POSITION

Facility

$4.00

Hospital Charge Code	538981
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 ONSET OCCP THERAPY BODY POSITION

Facility

$4.00

Hospital Charge Code	538981
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT ONSET OCCP THERAPY CARRYING,MOVING

Facility

$4.00

Hospital Charge Code	538984
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT ONSET OCCP THERAPY CARRYING,MOVING

Facility

$4.00

Hospital Charge Code	538984
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 ONSET SELF CARE OCCP THERAPY FUN

Facility

$4.00

Hospital Charge Code	538987
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 ONSET SELF CARE OCCP THERAPY FUN

Facility

$4.00

Hospital Charge Code	538987
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT ORTHODICS FITTING & TRAINING 15 MIN

Facility

$101.00

Service Code	CPT 97760
Hospital Charge Code	5397504
Hospital Revenue Code	431
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$40.23
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	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$40.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$43.05
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$40.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

OT ORTHODICS FITTING & TRAINING 15 MIN

Facility

$101.00

Service Code	CPT 97760
Hospital Charge Code	5397504
Hospital Revenue Code	431
Rate for Payer: Cash Price	$90.90

OT OTHER OCCP THERAPY SUBSQT FUN

Facility

$4.00

Hospital Charge Code	538993
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT OTHER OCCP THERAPY SUBSQT FUN

Facility

$4.00

Hospital Charge Code	538993
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 OTHER OCCP THERAPY SUBSQT FUNC

Facility

$4.00

Hospital Charge Code	538994
Hospital Revenue Code	430
Rate for Payer: Cash Price	$3.60

OT OTHER OCCP THERAPY SUBSQT FUNC

Facility

$4.00

Hospital Charge Code	538994
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 PALM PROTECTOR

Facility

$60.00

Hospital Charge Code	5349045
Hospital Revenue Code	271
Rate for Payer: Cash Price	$54.00

OT PALM PROTECTOR

Facility

$60.00

Hospital Charge Code	5349045
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 PARAFFIN BATH

Facility

$111.00

Service Code	CPT 97018
Hospital Charge Code	5397018
Hospital Revenue Code	431
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.26
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	$5.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.63
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.96

OT PARAFFIN BATH

Facility

$111.00

Service Code	CPT 97018
Hospital Charge Code	5397018
Hospital Revenue Code	431
Rate for Payer: Cash Price	$99.90

OT REACHER 26

Facility

$35.00

Hospital Charge Code	5349011
Hospital Revenue Code	271
Rate for Payer: Cash Price	$31.50

OT REACHER 26

Facility

$35.00

Hospital Charge Code	5349011
Hospital Revenue Code	271
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

OT RE EVALUATION

Facility

$240.00

Service Code	CPT 97168
Hospital Charge Code	5397168
Hospital Revenue Code	434
Rate for Payer: Cash Price	$216.00

OT RE EVALUATION

Facility

$240.00

Service Code	CPT 97004
Hospital Charge Code	5397004
Hospital Revenue Code	434
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$136.00
Rate for Payer: UnitedHealthcare Commercial	$82.00
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	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$86.40

OT RE EVALUATION

Facility

$240.00

Service Code	CPT 97168
Hospital Charge Code	5397168
Hospital Revenue Code	434
Min. Negotiated Rate	$60.07
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$60.07
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	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$60.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$64.27
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$60.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$86.40

Know your out-of-pocket cost for care.

All Charges