Madison Medical Center

All Charges

Charge

Type

Setting

Price

PTH INTACT LABCORP

Facility

$223.00

Service Code	CPT 83970
Hospital Charge Code	2216500
Hospital Revenue Code	301
Rate for Payer: Cash Price	$200.70

PTH INTACT LABCORP

Facility

$223.00

Service Code	CPT 83970
Hospital Charge Code	2216500
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 W/CALCIUM LABCORP

Facility

$223.00

Service Code	CPT 83970
Hospital Charge Code	2216502
Hospital Revenue Code	301
Rate for Payer: Cash Price	$200.70

..PTH INTACT W/CALCIUM LABCORP

Facility

$223.00

Service Code	CPT 83970
Hospital Charge Code	2216502
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

PT HOME CERVICAL TRACTION UNIT

Facility

$76.00

Hospital Charge Code	4618005
Hospital Revenue Code	271
Rate for Payer: Cash Price	$68.40

PT HOME CERVICAL TRACTION UNIT

Facility

$76.00

Hospital Charge Code	4618005
Hospital Revenue Code	271
Min. Negotiated Rate	$27.36
Max. Negotiated Rate	$54.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.26
Rate for Payer: Cash Price	$68.40
Rate for Payer: UnitedHealthcare Commercial	$50.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.36

PT HOT COLD PACKS

Facility

$55.00

Hospital Charge Code	4697010
Hospital Revenue Code	271
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

PT HOT COLD PACKS

Facility

$55.00

Hospital Charge Code	4697010
Hospital Revenue Code	271
Rate for Payer: Cash Price	$49.50

PTH-RELATED PEPTDE

Facility

$155.00

Service Code	CPT 82397
Hospital Charge Code	2283509
Hospital Revenue Code	301
Rate for Payer: Cash Price	$139.50

PTH-RELATED PEPTDE

Facility

$155.00

Service Code	CPT 82397
Hospital Charge Code	2283509
Hospital Revenue Code	301
Min. Negotiated Rate	$12.71
Max. Negotiated Rate	$110.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.71
Rate for Payer: Aetna Medicare Advantage	$14.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$91.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$110.67
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cigna Commercial HMO & PPO	$14.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.60
Rate for Payer: Home State Health Plan Medicare Advantage	$14.12
Rate for Payer: Humana Commercial	$28.24
Rate for Payer: Humana Medicare Advantage	$14.12
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.80

PT INFRARED

Facility

$89.00

Service Code	CPT 97026
Hospital Charge Code	4697026
Hospital Revenue Code	421
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.82
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	$5.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.23
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

PT INFRARED

Facility

$89.00

Service Code	CPT 97026
Hospital Charge Code	4697026
Hospital Revenue Code	421
Rate for Payer: Cash Price	$80.10

PT IONTOPHORESIS

Facility

$149.00

Service Code	CPT 97033
Hospital Charge Code	4697033
Hospital Revenue Code	421
Min. Negotiated Rate	$16.70
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.70
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	$16.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.87
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

PT IONTOPHORESIS

Facility

$149.00

Service Code	CPT 97033
Hospital Charge Code	4697033
Hospital Revenue Code	421
Rate for Payer: Cash Price	$134.10

PT KNEE BRACE BLEDSOE TYPE HINGED

Facility

$701.00

Hospital Charge Code	461900
Hospital Revenue Code	274
Min. Negotiated Rate	$467.57
Max. Negotiated Rate	$569.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$475.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$569.21
Rate for Payer: Cash Price	$630.90
Rate for Payer: UnitedHealthcare Commercial	$467.57

PT KNEE BRACE BLEDSOE TYPE HINGED

Facility

$701.00

Hospital Charge Code	461900
Hospital Revenue Code	274
Min. Negotiated Rate	$252.36
Max. Negotiated Rate	$569.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$475.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$569.21
Rate for Payer: Cash Price	$630.90
Rate for Payer: UnitedHealthcare Commercial	$467.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$252.36

PT LUMBAR CERVICAL ROLL

Facility

$79.00

Hospital Charge Code	4634010
Hospital Revenue Code	271
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$56.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$46.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$56.41
Rate for Payer: Cash Price	$71.10
Rate for Payer: UnitedHealthcare Commercial	$52.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.44

PT LUMBAR CERVICAL ROLL

Facility

$79.00

Hospital Charge Code	4634010
Hospital Revenue Code	271
Rate for Payer: Cash Price	$71.10

PT MANUAL THERAPY MYOFACIAL MOBIL MANIP

Facility

$147.00

Service Code	CPT 97140
Hospital Charge Code	4697250
Hospital Revenue Code	421
Min. Negotiated Rate	$24.39
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$24.39
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	$24.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.10
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$52.92

PT MANUAL THERAPY MYOFACIAL MOBIL MANIP

Facility

$147.00

Service Code	CPT 97140
Hospital Charge Code	4697250
Hospital Revenue Code	421
Rate for Payer: Cash Price	$132.30

PT MASSAGE

Facility

$70.00

Service Code	CPT 97124
Hospital Charge Code	4697124
Hospital Revenue Code	421
Rate for Payer: Cash Price	$63.00

PT MASSAGE

Facility

$70.00

Service Code	CPT 97124
Hospital Charge Code	4697124
Hospital Revenue Code	421
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$25.99
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	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$25.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27.81
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

PT MOBILITY DISCHARGE FUNCTIONAL LIMIT

Facility

$4.00

Hospital Charge Code	468980
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT MOBILITY DISCHARGE FUNCTIONAL LIMIT

Facility

$4.00

Hospital Charge Code	468980
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 MOBILITY GOAL FUNCTIONAL LIMITATION

Facility

$4.00

Hospital Charge Code	468979
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