Madison Medical Center

All Charges

Charge

Type

Setting

Price

PT RE EVALUATION

Facility

$166.00

Service Code	CPT 97002
Hospital Charge Code	4697002
Hospital Revenue Code	424
Rate for Payer: Cash Price	$149.40

PT RE EVALUATION

Facility

$166.00

Service Code	CPT 97164
Hospital Charge Code	4697164
Hospital Revenue Code	424
Min. Negotiated Rate	$59.21
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$59.21
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: Cash Price	$149.40
Rate for Payer: Cash Price	$149.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$59.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$63.35
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$59.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

PT SELF CARE 15 MIN

Facility

$76.00

Service Code	CPT 97535
Hospital Charge Code	4697535
Hospital Revenue Code	421
Rate for Payer: Cash Price	$68.40

PT SELF CARE 15 MIN

Facility

$76.00

Service Code	CPT 97535
Hospital Charge Code	4697535
Hospital Revenue Code	421
Min. Negotiated Rate	$27.36
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$28.42
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	$68.40
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$68.40
Rate for Payer: Cash Price	$68.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$28.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$30.41
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$28.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.36

PT SELF CARE DISCHARGE FUNCTIONAL LIMIT

Facility

$4.00

Hospital Charge Code	468989
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 SELF CARE DISCHARGE FUNCTIONAL LIMIT

Facility

$4.00

Hospital Charge Code	468989
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT SELF CARE GOAL FUNCTIONAL LIMITATION

Facility

$4.00

Hospital Charge Code	468988
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 SELF CARE GOAL FUNCTIONAL LIMITATION

Facility

$4.00

Hospital Charge Code	468988
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT SELF CARE ONSET FUNCTIONAL LIMITS

Facility

$4.00

Hospital Charge Code	468987
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT SELF CARE ONSET FUNCTIONAL LIMITS

Facility

$4.00

Hospital Charge Code	468987
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 SHOULDER PULLEY HOME UNIT

Facility

$87.00

Hospital Charge Code	4618006
Hospital Revenue Code	271
Min. Negotiated Rate	$31.32
Max. Negotiated Rate	$62.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$51.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.12
Rate for Payer: Cash Price	$78.30
Rate for Payer: UnitedHealthcare Commercial	$58.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.32

PT SHOULDER PULLEY HOME UNIT

Facility

$87.00

Hospital Charge Code	4618006
Hospital Revenue Code	271
Rate for Payer: Cash Price	$78.30

PT STIM ELECTRODES PADS

Facility

$67.00

Hospital Charge Code	4634008
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 STIM ELECTRODES PADS

Facility

$67.00

Hospital Charge Code	4634008
Hospital Revenue Code	271
Rate for Payer: Cash Price	$60.30

PT SUBSEQ DISCHARGE FUNCT LIMITATION

Facility

$4.00

Hospital Charge Code	468995
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 SUBSEQ DISCHARGE FUNCT LIMITATION

Facility

$4.00

Hospital Charge Code	468995
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT SUBUSEQUENT GOAL FUNC LIMITATION

Facility

$4.00

Hospital Charge Code	468994
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 SUBUSEQUENT GOAL FUNC LIMITATION

Facility

$4.00

Hospital Charge Code	468994
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT SUBUSEQUENT ONSET FUNC LIMIT

Facility

$4.00

Hospital Charge Code	468993
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 SUBUSEQUENT ONSET FUNC LIMIT

Facility

$4.00

Hospital Charge Code	468993
Hospital Revenue Code	421
Rate for Payer: Cash Price	$3.60

PT TENS UNIT ELECTRODES

Facility

$87.00

Hospital Charge Code	4618008
Hospital Revenue Code	271
Min. Negotiated Rate	$31.32
Max. Negotiated Rate	$62.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$51.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.12
Rate for Payer: Cash Price	$78.30
Rate for Payer: UnitedHealthcare Commercial	$58.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.32

PT TENS UNIT ELECTRODES

Facility

$87.00

Hospital Charge Code	4618008
Hospital Revenue Code	271
Rate for Payer: Cash Price	$78.30

PT THERA BAND

Facility

$18.00

Hospital Charge Code	4638028
Hospital Revenue Code	271
Rate for Payer: Cash Price	$16.20

PT THERA BAND

Facility

$18.00

Hospital Charge Code	4638028
Hospital Revenue Code	271
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

PT THERAPUTIC ACT15 MIN

Facility

$125.00

Service Code	CPT 97530
Hospital Charge Code	4697530
Hospital Revenue Code	421
Rate for Payer: Cash Price	$112.50

Know your out-of-pocket cost for care.

All Charges