Madison Medical Center

All Charges

Charge

Type

Setting

Price

PT DIATHERMY

Facility

$89.00

Service Code	CPT 97024
Hospital Charge Code	4697024
Hospital Revenue Code	421
Rate for Payer: Cash Price	$80.10

PT ELECTRICAL STIMULATION

Facility

$82.00

Service Code	CPT 97032
Hospital Charge Code	4697032
Hospital Revenue Code	421
Rate for Payer: Cash Price	$73.80

PT ELECTRICAL STIMULATION

Facility

$107.00

Service Code	CPT 97032
Hospital Charge Code	4697014
Hospital Revenue Code	421
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	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
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	$38.52

PT ELECTRICAL STIMULATION

Facility

$107.00

Service Code	CPT 97032
Hospital Charge Code	4697014
Hospital Revenue Code	421
Rate for Payer: Cash Price	$96.30

PT ELECTRICAL STIMULATION

Facility

$82.00

Service Code	CPT 97032
Hospital Charge Code	4697032
Hospital Revenue Code	421
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	$73.80
Rate for Payer: Cash Price	$73.80
Rate for Payer: Cash Price	$73.80
Rate for Payer: Cash Price	$73.80
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	$29.52

PT ELECTRICAL STIMULATION HMO

Facility

$107.00

Service Code	CPT G0283GP
Hospital Charge Code	460283
Hospital Revenue Code	421
Rate for Payer: Cash Price	$96.30

PT ELECTRICAL STIMULATION HMO

Facility

$107.00

Service Code	CPT G0283GP
Hospital Charge Code	460283
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 EVALUATION LOW

Facility

$234.00

Service Code	CPT 97161GP
Hospital Charge Code	4697161
Hospital Revenue Code	424
Rate for Payer: Cash Price	$210.60

PT EVALUATION LOW

Facility

$234.00

Service Code	CPT 97161GP
Hospital Charge Code	4697161
Hospital Revenue Code	424
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	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.24

PT EVALUATION MOD COMPLEXITY

Facility

$234.00

Service Code	CPT 97162GP
Hospital Charge Code	4697162
Hospital Revenue Code	424
Rate for Payer: Cash Price	$210.60

PT EVALUATION MOD COMPLEXITY

Facility

$234.00

Service Code	CPT 97162GP
Hospital Charge Code	4697162
Hospital Revenue Code	424
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	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.24

PT EXERCISE 15 MIN.BALANCE COORD REEDUC

Facility

$141.00

Service Code	CPT 97112
Hospital Charge Code	4697112
Hospital Revenue Code	421
Min. Negotiated Rate	$28.78
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$28.78
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	$126.90
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cash Price	$126.90
Rate for Payer: Cash Price	$126.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$30.79
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$50.76

PT EXERCISE 15 MIN.BALANCE COORD REEDUC

Facility

$141.00

Service Code	CPT 97112
Hospital Charge Code	4697112
Hospital Revenue Code	421
Rate for Payer: Cash Price	$126.90

PT EXERCISE 15 MIN ROM STRENGTH ENDUR

Facility

$147.00

Service Code	CPT 97110
Hospital Charge Code	4697110
Hospital Revenue Code	421
Rate for Payer: Cash Price	$132.30

PT EXERCISE 15 MIN ROM STRENGTH ENDUR

Facility

$147.00

Service Code	CPT 97110
Hospital Charge Code	4697110
Hospital Revenue Code	421
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$25.56
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	$132.30
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cash Price	$132.30
Rate for Payer: Cash Price	$132.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27.35
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$52.92

PT FUNCTIONAL CAPACITY EVALUATION

Facility

$1,037.00

Service Code	CPT 97750
Hospital Charge Code	461000
Hospital Revenue Code	421
Min. Negotiated Rate	$29.57
Max. Negotiated Rate	$373.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$29.57
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	$933.30
Rate for Payer: Cash Price	$933.30
Rate for Payer: Cash Price	$933.30
Rate for Payer: Cash Price	$933.30
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$31.64
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$373.32

PT FUNCTIONAL CAPACITY EVALUATION

Facility

$1,037.00

Service Code	CPT 97750
Hospital Charge Code	461000
Hospital Revenue Code	421
Rate for Payer: Cash Price	$933.30

PT GAIT TRAINING

Facility

$121.00

Service Code	CPT 97116
Hospital Charge Code	4697116
Hospital Revenue Code	421
Rate for Payer: Cash Price	$108.90

PT GAIT TRAINING

Facility

$121.00

Service Code	CPT 97116
Hospital Charge Code	4697116
Hospital Revenue Code	421
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$25.56
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	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27.35
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25.56
Rate for Payer: UnitedHealthcare Medicare Advantage	$43.56

PTH

Facility

$195.00

Service Code	CPT 84443
Hospital Charge Code	2216501
Hospital Revenue Code	301
Rate for Payer: Cash Price	$175.50

PTH

Facility

$195.00

Service Code	CPT 84443
Hospital Charge Code	2216501
Hospital Revenue Code	301
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$139.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.12
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$115.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.23
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cigna Commercial HMO & PPO	$16.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.18
Rate for Payer: Home State Health Plan Medicare Advantage	$16.80
Rate for Payer: Humana Commercial	$33.60
Rate for Payer: Humana Medicare Advantage	$16.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.20

PT HIGH EVALUATION

Facility

$234.00

Service Code	CPT 97163GP
Hospital Charge Code	4697163
Hospital Revenue Code	424
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	$210.60
Rate for Payer: Cash Price	$210.60
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.24

PT HIGH EVALUATION

Facility

$234.00

Service Code	CPT 97163GP
Hospital Charge Code	4697163
Hospital Revenue Code	424
Rate for Payer: Cash Price	$210.60

..PTH INTACT AEL

Facility

$223.00

Service Code	CPT 83970
Hospital Charge Code	2216510
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$159.22
Rate for Payer: Aetna Better Health Medicaid/QHP	$37.15
Rate for Payer: Aetna Medicare Advantage	$41.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$132.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$159.22
Rate for Payer: Cash Price	$200.70
Rate for Payer: Cash Price	$200.70
Rate for Payer: Cash Price	$200.70
Rate for Payer: Cigna Commercial HMO & PPO	$41.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$39.75
Rate for Payer: Home State Health Plan Medicare Advantage	$41.28
Rate for Payer: Humana Commercial	$82.56
Rate for Payer: Humana Medicare Advantage	$41.28
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$80.28

..PTH INTACT AEL

Facility

$223.00

Service Code	CPT 83970
Hospital Charge Code	2216510
Hospital Revenue Code	301
Rate for Payer: Cash Price	$200.70

Know your out-of-pocket cost for care.

All Charges