Madison Medical Center

All Charges

Charge

Type

Setting

Price

OT THERAPUTTY 3OZ

Facility

$40.00

Hospital Charge Code	5349026
Hospital Revenue Code	271
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

OT THERAPUTTY 3OZ

Facility

$40.00

Hospital Charge Code	5349026
Hospital Revenue Code	271
Rate for Payer: Cash Price	$36.00

OT THERAPUTTY 4 OZ.

Facility

$43.00

Hospital Charge Code	5349027
Hospital Revenue Code	271
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

OT THERAPUTTY 4 OZ.

Facility

$43.00

Hospital Charge Code	5349027
Hospital Revenue Code	271
Rate for Payer: Cash Price	$38.70

OT ULTRASOUND

Facility

$111.00

Service Code	CPT 97035
Hospital Charge Code	5397035
Hospital Revenue Code	431
Min. Negotiated Rate	$12.63
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.63
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	$12.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.51
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.96

OT ULTRASOUND

Facility

$111.00

Service Code	CPT 97035
Hospital Charge Code	5397035
Hospital Revenue Code	431
Rate for Payer: Cash Price	$99.90

OT WHEELCHAIR MGT-15MIN

Facility

$87.00

Service Code	CPT 97542
Hospital Charge Code	5397542
Hospital Revenue Code	431
Min. Negotiated Rate	$27.32
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$27.32
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	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29.23
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.32

OT WHEELCHAIR MGT-15MIN

Facility

$87.00

Service Code	CPT 97542
Hospital Charge Code	5397542
Hospital Revenue Code	431
Rate for Payer: Cash Price	$78.30

OUT PATIENT PREPERATION TIME

Facility

$931.00

Hospital Charge Code	123109
Hospital Revenue Code	360
Min. Negotiated Rate	$335.16
Max. Negotiated Rate	$620.98
Rate for Payer: Cash Price	$837.90
Rate for Payer: UnitedHealthcare Commercial	$620.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$335.16

OUT PATIENT PREPERATION TIME

Facility

$931.00

Hospital Charge Code	123109
Hospital Revenue Code	360
Rate for Payer: Cash Price	$837.90

OUTPUT COMMODE

Facility

$39.00

Hospital Charge Code	2815359
Hospital Revenue Code	271
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

OUTPUT COMMODE

Facility

$39.00

Hospital Charge Code	2815359
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

OUTREACH-BETA HCG QUANT

Facility

$45.00

Service Code	CPT 84702
Hospital Charge Code	2484702
Hospital Revenue Code	301
Min. Negotiated Rate	$13.55
Max. Negotiated Rate	$32.13
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.55
Rate for Payer: Aetna Medicare Advantage	$15.05
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: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna Commercial HMO & PPO	$15.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.50
Rate for Payer: Home State Health Plan Medicare Advantage	$15.05
Rate for Payer: Humana Commercial	$30.10
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

OUTREACH-BETA HCG QUANT

Facility

$45.00

Service Code	CPT 84702
Hospital Charge Code	2484702
Hospital Revenue Code	301
Rate for Payer: Cash Price	$40.50

OUTREACH-BLOOD TYPING

Facility

$22.00

Service Code	CPT 86900
Hospital Charge Code	2486900
Hospital Revenue Code	301
Min. Negotiated Rate	$2.99
Max. Negotiated Rate	$128.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$2.99
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: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cigna Commercial HMO & PPO	$2.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$119.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$2.99
Rate for Payer: Humana Commercial	$5.98
Rate for Payer: Humana Medicare Advantage	$2.99
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

OUTREACH-BLOOD TYPING

Facility

$22.00

Service Code	CPT 86900
Hospital Charge Code	2486900
Hospital Revenue Code	301
Rate for Payer: Cash Price	$19.80

OUTREACH-BUN

Facility

$21.00

Service Code	CPT 84520
Hospital Charge Code	2484520
Hospital Revenue Code	301
Min. Negotiated Rate	$3.56
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.56
Rate for Payer: Aetna Medicare Advantage	$3.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cigna Commercial HMO & PPO	$3.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.81
Rate for Payer: Home State Health Plan Medicare Advantage	$3.95
Rate for Payer: Humana Commercial	$7.90
Rate for Payer: Humana Medicare Advantage	$3.95
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

OUTREACH-BUN

Facility

$21.00

Service Code	CPT 84520
Hospital Charge Code	2484520
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

OUTREACH-CALCIUM

Facility

$21.00

Service Code	CPT 82310
Hospital Charge Code	2482310
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

OUTREACH-CALCIUM

Facility

$21.00

Service Code	CPT 82310
Hospital Charge Code	2482310
Hospital Revenue Code	301
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.64
Rate for Payer: Aetna Medicare Advantage	$5.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cigna Commercial HMO & PPO	$5.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.96
Rate for Payer: Home State Health Plan Medicare Advantage	$5.16
Rate for Payer: Humana Commercial	$10.32
Rate for Payer: Humana Medicare Advantage	$5.16
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

OUTREACH-CBC WO DIFF

Facility

$16.00

Service Code	CPT 85027
Hospital Charge Code	2485027
Hospital Revenue Code	301
Rate for Payer: Cash Price	$14.40

OUTREACH-CBC WO DIFF

Facility

$16.00

Service Code	CPT 85027
Hospital Charge Code	2485027
Hospital Revenue Code	301
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.82
Rate for Payer: Aetna Medicare Advantage	$6.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna Commercial HMO & PPO	$6.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.23
Rate for Payer: Home State Health Plan Medicare Advantage	$6.47
Rate for Payer: Humana Commercial	$12.94
Rate for Payer: Humana Medicare Advantage	$6.47
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

OUTREACH-CHLORIDE

Facility

$21.00

Service Code	CPT 82435
Hospital Charge Code	2482435
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.14
Rate for Payer: Aetna Medicare Advantage	$4.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cigna Commercial HMO & PPO	$4.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.43
Rate for Payer: Home State Health Plan Medicare Advantage	$4.60
Rate for Payer: Humana Commercial	$9.20
Rate for Payer: Humana Medicare Advantage	$4.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

OUTREACH-CHLORIDE

Facility

$21.00

Service Code	CPT 82435
Hospital Charge Code	2482435
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

OUTREACH-CHOLESTEROL

Facility

$21.00

Service Code	CPT 82465
Hospital Charge Code	2482465
Hospital Revenue Code	301
Rate for Payer: Cash Price	$18.90

Know your out-of-pocket cost for care.

All Charges