Madison Medical Center

All Charges

Charge

Type

Setting

Price

PT BODY POSITION FUNC LIMIT STATUS

Facility

$4.00

Hospital Charge Code	468981
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT BODY POSITION FUNC LIMIT STATUS

Facility

$4.00

Hospital Charge Code	468981
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

PT BODY POSITION GOAL FUNC LIMIT

Facility

$4.00

Hospital Charge Code	468982
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT BODY POSITION GOAL FUNC LIMIT

Facility

$4.00

Hospital Charge Code	468982
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

PT BOOK BACK NECK CARE

Facility

$28.00

Hospital Charge Code	4638040
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

PT BOOK BACK NECK CARE

Facility

$28.00

Hospital Charge Code	4638040
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

PT BUCKS TRACTION BOOT

Facility

$105.00

Hospital Charge Code	464625
Hospital Revenue Code	271
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$74.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: UnitedHealthcare Commercial	$70.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.80

PT BUCKS TRACTION BOOT

Facility

$105.00

Hospital Charge Code	464625
Hospital Revenue Code	271
Rate for Payer: Cash Price	$94.50

PT CARRYING DISCHARGE FUNCTIONAL LIMIT

Facility

$4.00

Hospital Charge Code	468986
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT CARRYING DISCHARGE FUNCTIONAL LIMIT

Facility

$4.00

Hospital Charge Code	468986
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

PT CARRYING FINCTIONAL LIMITATION STATUS

Facility

$4.00

Hospital Charge Code	468984
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT CARRYING FINCTIONAL LIMITATION STATUS

Facility

$4.00

Hospital Charge Code	468984
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

PT CARRYING FUNCTIONAL GOAL LIMITATIONS

Facility

$4.00

Hospital Charge Code	468985
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT CARRYING FUNCTIONAL GOAL LIMITATIONS

Facility

$4.00

Hospital Charge Code	468985
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

PT CERVICAL PELVIC TRACTION

Facility

$112.00

Service Code	CPT 97012
Hospital Charge Code	4697012
Hospital Revenue Code	421
Rate for Payer: Cash Price	$100.80

PT CERVICAL PELVIC TRACTION

Facility

$112.00

Service Code	CPT 97012
Hospital Charge Code	4697012
Hospital Revenue Code	421
Min. Negotiated Rate	$12.66
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.66
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	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

PT COLD PACKS HOME USE

Facility

$67.00

Hospital Charge Code	4618003
Hospital Revenue Code	271
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

PT COLD PACKS HOME USE

Facility

$67.00

Hospital Charge Code	4618003
Hospital Revenue Code	271
Rate for Payer: Cash Price	$60.30

PT CONTRAST BATH

Facility

$48.00

Service Code	CPT 97034
Hospital Charge Code	4697034
Hospital Revenue Code	421
Rate for Payer: Cash Price	$43.20

PT CONTRAST BATH

Facility

$48.00

Service Code	CPT 97034
Hospital Charge Code	4697034
Hospital Revenue Code	421
Min. Negotiated Rate	$12.34
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.34
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	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.20
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

PT CRUTCHES

Facility

$129.00

Hospital Charge Code	4618014
Hospital Revenue Code	271
Rate for Payer: Cash Price	$116.10

PT CRUTCHES

Facility

$129.00

Hospital Charge Code	4618014
Hospital Revenue Code	271
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

PT DEVEL COGNITIVE SKILLS

Facility

$89.00

Service Code	CPT 97770
Hospital Charge Code	4697770
Hospital Revenue Code	421
Rate for Payer: Cash Price	$80.10

PT DEVEL COGNITIVE SKILLS

Facility

$89.00

Service Code	CPT 97770
Hospital Charge Code	4697770
Hospital Revenue Code	421
Min. Negotiated Rate	$32.04
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	$80.10
Rate for Payer: Cash Price	$80.10
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

PT DIATHERMY

Facility

$89.00

Service Code	CPT 97024
Hospital Charge Code	4697024
Hospital Revenue Code	421
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.40
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	$80.10
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cash Price	$80.10
Rate for Payer: Cash Price	$80.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.85
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

Know your out-of-pocket cost for care.

All Charges