Madison Medical Center

All Charges

Charge

Type

Setting

Price

PT MOBILITY GOAL FUNCTIONAL LIMITATION

Facility

$4.00

Hospital Charge Code	468979
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT MOBILITY ONSET FUNCTIONAL LIMITATION

Facility

$4.00

Hospital Charge Code	468978
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT MOBILITY ONSET FUNCTIONAL LIMITATION

Facility

$4.00

Hospital Charge Code	468978
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 NEO WRIST THUMB SUPPORT

Facility

$111.00

Hospital Charge Code	4620600
Hospital Revenue Code	271
Min. Negotiated Rate	$39.96
Max. Negotiated Rate	$79.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.25
Rate for Payer: Cash Price	$99.90
Rate for Payer: UnitedHealthcare Commercial	$74.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.96

PT NEO WRIST THUMB SUPPORT

Facility

$111.00

Hospital Charge Code	4620600
Hospital Revenue Code	271
Rate for Payer: Cash Price	$99.90

PT ORTHOTICS TRAINING FITTING

Facility

$89.00

Service Code	CPT 97504
Hospital Charge Code	4697500
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 ORTHOTICS TRAINING FITTING

Facility

$89.00

Service Code	CPT 97504
Hospital Charge Code	4697500
Hospital Revenue Code	421
Rate for Payer: Cash Price	$80.10

PT OTHER PRIM DISCHARGE FUNCTIONAL LIMIT

Facility

$4.00

Hospital Charge Code	468992
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT OTHER PRIM DISCHARGE FUNCTIONAL LIMIT

Facility

$4.00

Hospital Charge Code	468992
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 OTHER PRIM GOAL FUNCTIONAL LIMIT

Facility

$4.00

Hospital Charge Code	468991
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT OTHER PRIM GOAL FUNCTIONAL LIMIT

Facility

$4.00

Hospital Charge Code	468991
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 OTHER PRIM ONSET FUNCTIONA LIMITATION

Facility

$4.00

Hospital Charge Code	468990
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 OTHER PRIM ONSET FUNCTIONA LIMITATION

Facility

$4.00

Hospital Charge Code	468990
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT PARAFFIN BATH

Facility

$107.00

Service Code	CPT 97018
Hospital Charge Code	4697018
Hospital Revenue Code	421
Min. Negotiated Rate	$5.26
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.26
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	$5.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.63
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

PT PARAFFIN BATH

Facility

$107.00

Service Code	CPT 97018
Hospital Charge Code	4697018
Hospital Revenue Code	421
Rate for Payer: Cash Price	$96.30

PT PATELLA STABLIZER BRACE

Facility

$196.00

Hospital Charge Code	2811814
Hospital Revenue Code	271
Rate for Payer: Cash Price	$176.40

PT PATELLA STABLIZER BRACE

Facility

$196.00

Hospital Charge Code	2811814
Hospital Revenue Code	271
Min. Negotiated Rate	$70.56
Max. Negotiated Rate	$139.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$116.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.94
Rate for Payer: Cash Price	$176.40
Rate for Payer: UnitedHealthcare Commercial	$130.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$70.56

PT PHY PERFORMANCE TEST

Facility

$89.00

Service Code	CPT 97750
Hospital Charge Code	4697750
Hospital Revenue Code	421
Rate for Payer: Cash Price	$80.10

PT PHY PERFORMANCE TEST

Facility

$89.00

Service Code	CPT 97750
Hospital Charge Code	4697750
Hospital Revenue Code	421
Min. Negotiated Rate	$29.57
Max. Negotiated Rate	$136.00
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	$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	$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	$32.04

PT POST OFFER FIT FOR DUTY

Facility

$180.00

Hospital Charge Code	462000
Hospital Revenue Code	421
Rate for Payer: Cash Price	$162.00

PT POST OFFER FIT FOR DUTY

Facility

$180.00

Hospital Charge Code	462000
Hospital Revenue Code	421
Min. Negotiated Rate	$64.80
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	$162.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.80

PT/PTT

Facility

$20.00

Service Code	CPT 85610
Hospital Charge Code	4285610
Hospital Revenue Code	521
Rate for Payer: Cash Price	$18.00

PT/PTT

Facility

$20.00

Service Code	CPT 85610
Hospital Charge Code	4285610
Hospital Revenue Code	521
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.86
Rate for Payer: Aetna Medicare Advantage	$4.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cash Price	$18.00
Rate for Payer: Cigna Commercial HMO & PPO	$4.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.13
Rate for Payer: Home State Health Plan Medicare Advantage	$4.29
Rate for Payer: Humana Commercial	$8.58
Rate for Payer: Humana Medicare Advantage	$4.29
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PT RE EVALUATION

Facility

$166.00

Service Code	CPT 97164
Hospital Charge Code	4697164
Hospital Revenue Code	424
Rate for Payer: Cash Price	$149.40

PT RE EVALUATION

Facility

$166.00

Service Code	CPT 97002
Hospital Charge Code	4697002
Hospital Revenue Code	424
Min. Negotiated Rate	$59.76
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	$149.40
Rate for Payer: Cash Price	$149.40
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

Know your out-of-pocket cost for care.

All Charges