Madison Medical Center

All Charges

Charge

Type

Setting

Price

PSA SCREEN (LABCORP)

Facility

$299.00

Service Code	CPT 84153
Hospital Charge Code	2200105
Hospital Revenue Code	301
Min. Negotiated Rate	$16.55
Max. Negotiated Rate	$213.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.55
Rate for Payer: Aetna Medicare Advantage	$18.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$213.49
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cash Price	$269.10
Rate for Payer: Cigna Commercial HMO & PPO	$18.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.71
Rate for Payer: Home State Health Plan Medicare Advantage	$18.39
Rate for Payer: Humana Commercial	$36.78
Rate for Payer: Humana Medicare Advantage	$18.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$107.64

PSA SCREEN (LABCORP)

Facility

$299.00

Service Code	CPT 84153
Hospital Charge Code	2200105
Hospital Revenue Code	301
Rate for Payer: Cash Price	$269.10

PSEUDOCHOLINESTERASE

Facility

$149.00

Service Code	CPT 82480
Hospital Charge Code	2216141
Hospital Revenue Code	301
Rate for Payer: Cash Price	$134.10

PSEUDOCHOLINESTERASE

Facility

$149.00

Service Code	CPT 82480
Hospital Charge Code	2216141
Hospital Revenue Code	301
Min. Negotiated Rate	$7.08
Max. Negotiated Rate	$106.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.08
Rate for Payer: Aetna Medicare Advantage	$7.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$106.39
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cigna Commercial HMO & PPO	$7.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.58
Rate for Payer: Home State Health Plan Medicare Advantage	$7.87
Rate for Payer: Humana Commercial	$15.74
Rate for Payer: Humana Medicare Advantage	$7.87
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

PSEUDOEPHEDRINE 30MG TAB EMP

Facility

$7.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2623157
Hospital Revenue Code	250
Min. Negotiated Rate	$2.52
Max. Negotiated Rate	$5.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.00
Rate for Payer: Cash Price	$6.30
Rate for Payer: UnitedHealthcare Commercial	$4.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.52

PSEUDOEPHEDRINE 30MG TAB EMP

Facility

$7.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2623157
Hospital Revenue Code	250
Rate for Payer: Cash Price	$6.30

PSILOCIN URINE (LC 791012)

Facility

$287.00

Service Code	CPT 80307
Hospital Charge Code	22791012
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$204.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$55.93
Rate for Payer: Aetna Medicare Advantage	$62.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$169.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$204.92
Rate for Payer: Cash Price	$258.30
Rate for Payer: Cash Price	$258.30
Rate for Payer: Cash Price	$258.30
Rate for Payer: Cigna Commercial HMO & PPO	$62.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$59.85
Rate for Payer: Home State Health Plan Medicare Advantage	$62.14
Rate for Payer: Humana Commercial	$124.28
Rate for Payer: Humana Medicare Advantage	$62.14
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.32

PSILOCIN URINE (LC 791012)

Facility

$287.00

Service Code	CPT 80307
Hospital Charge Code	22791012
Hospital Revenue Code	305
Rate for Payer: Cash Price	$258.30

PS NH PRIVATE SUITE P

Facility

$215.00

Hospital Charge Code	30500080
Hospital Revenue Code	110
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$1,754.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$185.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: UnitedHealthcare Commercial	$1,519.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,754.00

PS NH PRIVATE SUITE P

Facility

$215.00

Hospital Charge Code	30500080
Hospital Revenue Code	120
Min. Negotiated Rate	$742.00
Max. Negotiated Rate	$1,754.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$742.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$742.00
Rate for Payer: Cash Price	$193.50
Rate for Payer: UnitedHealthcare Commercial	$1,519.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,754.00

PSYCHOSES

Facility

$25,505.30

Service Code	MSDRG 885
Min. Negotiated Rate	$12,752.65
Max. Negotiated Rate	$25,505.30
Rate for Payer: Aetna Medicare Advantage	$12,752.65
Rate for Payer: Cigna Commercial HMO & PPO	$12,752.65
Rate for Payer: Home State Health Plan Medicare Advantage	$12,752.65
Rate for Payer: Humana Commercial	$25,505.30
Rate for Payer: Humana Medicare Advantage	$12,752.65

PT AIR MEDIC PILLOW

Facility

$124.00

Hospital Charge Code	4618012
Hospital Revenue Code	271
Min. Negotiated Rate	$44.64
Max. Negotiated Rate	$88.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: UnitedHealthcare Commercial	$82.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

PT AIR MEDIC PILLOW

Facility

$124.00

Hospital Charge Code	4618012
Hospital Revenue Code	271
Rate for Payer: Cash Price	$111.60

PT ANKLE BRACE WITH STRAPS

Facility

$247.00

Hospital Charge Code	4620617
Hospital Revenue Code	271
Rate for Payer: Cash Price	$222.30

PT ANKLE BRACE WITH STRAPS

Facility

$247.00

Hospital Charge Code	4620617
Hospital Revenue Code	271
Min. Negotiated Rate	$88.92
Max. Negotiated Rate	$176.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$146.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$176.36
Rate for Payer: Cash Price	$222.30
Rate for Payer: UnitedHealthcare Commercial	$164.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$88.92

pTau-217

Facility

$454.00

Service Code	CPT 84393
Hospital Charge Code	2284393
Hospital Revenue Code	301
Rate for Payer: Cash Price	$408.60

pTau-217

Facility

$454.00

Service Code	CPT 84393
Hospital Charge Code	2284393
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$324.16
Rate for Payer: Aetna Better Health Medicaid/QHP	$116.03
Rate for Payer: Aetna Medicare Advantage	$128.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$268.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$324.16
Rate for Payer: Cash Price	$408.60
Rate for Payer: Cash Price	$408.60
Rate for Payer: Cash Price	$408.60
Rate for Payer: Cigna Commercial HMO & PPO	$128.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$116.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$124.15
Rate for Payer: Home State Health Plan Medicare Advantage	$128.92
Rate for Payer: Humana Commercial	$257.84
Rate for Payer: Humana Medicare Advantage	$128.92
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$116.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$163.44

PT BACK SUPPORT

Facility

$102.00

Hospital Charge Code	4648002
Hospital Revenue Code	271
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$72.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$60.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.83
Rate for Payer: Cash Price	$91.80
Rate for Payer: UnitedHealthcare Commercial	$68.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.72

PT BACK SUPPORT

Facility

$102.00

Hospital Charge Code	4648002
Hospital Revenue Code	271
Rate for Payer: Cash Price	$91.80

PTBIOFEEDBACK PERIURO

Facility

$107.00

Service Code	CPT 90911
Hospital Charge Code	4690911
Hospital Revenue Code	421
Min. Negotiated Rate	$38.52
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	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

PTBIOFEEDBACK PERIURO

Facility

$107.00

Service Code	CPT 90911
Hospital Charge Code	4690911
Hospital Revenue Code	421
Rate for Payer: Cash Price	$96.30

PT BIOFEEDBACK TRAINING BY ANY MODALITY

Facility

$107.00

Service Code	CPT 90901
Hospital Charge Code	4690901
Hospital Revenue Code	421
Min. Negotiated Rate	$38.52
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	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

PT BIOFEEDBACK TRAINING BY ANY MODALITY

Facility

$107.00

Service Code	CPT 90901
Hospital Charge Code	4690901
Hospital Revenue Code	421
Rate for Payer: Cash Price	$96.30

PT BODY POSITION DISCHARGE FUNC LIMIT

Facility

$4.00

Hospital Charge Code	468983
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT BODY POSITION DISCHARGE FUNC LIMIT

Facility

$4.00

Hospital Charge Code	468983
Hospital Revenue Code	421
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

Know your out-of-pocket cost for care.

All Charges