Madison Medical Center

All Charges

Charge

Type

Setting

Price

PT THERAPUTIC ACT15 MIN

Facility

$125.00

Service Code	CPT 97530
Hospital Charge Code	4697530
Hospital Revenue Code	421
Min. Negotiated Rate	$30.70
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$30.70
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	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$30.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32.85
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$30.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

PT THERA PUTTY

Facility

$28.00

Hospital Charge Code	4638030
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

PT THERA PUTTY

Facility

$28.00

Hospital Charge Code	4638030
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 THERAPY USING MANUAL TECHNIQUE

Facility

$147.00

Service Code	CPT 97140
Hospital Charge Code	4697140
Hospital Revenue Code	421
Rate for Payer: Cash Price	$132.30

PT THERAPY USING MANUAL TECHNIQUE

Facility

$147.00

Service Code	CPT 97140
Hospital Charge Code	4697140
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

.PTT MIXING STUDY

Facility

$92.00

Service Code	CPT 85732
Hospital Charge Code	2285732
Hospital Revenue Code	305
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$65.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.82
Rate for Payer: Aetna Medicare Advantage	$6.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$54.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$65.69
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cash Price	$82.80
Rate for Payer: Cigna Commercial HMO & PPO	$6.47
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: Home State Health Plan Medicare Advantage	$6.47
Rate for Payer: Humana Commercial	$12.94
Rate for Payer: Humana Medicare Advantage	$6.47
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.12

.PTT MIXING STUDY

Facility

$92.00

Service Code	CPT 85732
Hospital Charge Code	2285732
Hospital Revenue Code	305
Rate for Payer: Cash Price	$82.80

PT TUBIGRIP STOCKINET

Facility

$16.00

Hospital Charge Code	4638035
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

PT TUBIGRIP STOCKINET

Facility

$16.00

Hospital Charge Code	4638035
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

PT ULTRASOUND

Facility

$107.00

Service Code	CPT 97035
Hospital Charge Code	4697035
Hospital Revenue Code	421
Rate for Payer: Cash Price	$96.30

PT ULTRASOUND

Facility

$107.00

Service Code	CPT 97035
Hospital Charge Code	4697035
Hospital Revenue Code	421
Min. Negotiated Rate	$12.63
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.63
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	$12.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.51
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.63
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

PT UNLISTED MODALITIES

Facility

$95.00

Service Code	CPT 97039
Hospital Charge Code	4697039
Hospital Revenue Code	421
Min. Negotiated Rate	$34.20
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	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.20

PT UNLISTED MODALITIES

Facility

$95.00

Service Code	CPT 97039
Hospital Charge Code	4697039
Hospital Revenue Code	421
Rate for Payer: Cash Price	$85.50

PT UNLISTED THERAPUETIC PROCEDURE

Facility

$70.00

Service Code	CPT 97139
Hospital Charge Code	4697139
Hospital Revenue Code	421
Min. Negotiated Rate	$25.20
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	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

PT UNLISTED THERAPUETIC PROCEDURE

Facility

$70.00

Service Code	CPT 97139
Hospital Charge Code	4697139
Hospital Revenue Code	421
Rate for Payer: Cash Price	$63.00

PT VASOPNEUMATIC DEVICES

Facility

$107.00

Service Code	CPT 97016
Hospital Charge Code	4697016
Hospital Revenue Code	421
Min. Negotiated Rate	$10.58
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.58
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	$10.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.32
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

PT VASOPNEUMATIC DEVICES

Facility

$107.00

Service Code	CPT 97016
Hospital Charge Code	4697016
Hospital Revenue Code	421
Rate for Payer: Cash Price	$96.30

PT WHEELCHAIR MGR

Facility

$76.00

Service Code	CPT 97542
Hospital Charge Code	4697542
Hospital Revenue Code	421
Rate for Payer: Cash Price	$68.40

PT WHEELCHAIR MGR

Facility

$76.00

Service Code	CPT 97542
Hospital Charge Code	4697542
Hospital Revenue Code	421
Min. Negotiated Rate	$27.32
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$27.32
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	$27.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29.23
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27.32
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.36

PT WHIRLPOOL

Facility

$183.00

Service Code	CPT 97022
Hospital Charge Code	4697022
Hospital Revenue Code	421
Min. Negotiated Rate	$13.71
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.71
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	$164.70
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cash Price	$164.70
Rate for Payer: Cash Price	$164.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.67
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.88

PT WHIRLPOOL

Facility

$183.00

Service Code	CPT 97022
Hospital Charge Code	4697022
Hospital Revenue Code	421
Rate for Payer: Cash Price	$164.70

PT WORK HARDENINGCONDITION EACH ADD HR

Facility

$165.00

Service Code	CPT 97546
Hospital Charge Code	4697546
Hospital Revenue Code	421
Rate for Payer: Cash Price	$148.50

PT WORK HARDENINGCONDITION EACH ADD HR

Facility

$165.00

Service Code	CPT 97546
Hospital Charge Code	4697546
Hospital Revenue Code	421
Min. Negotiated Rate	$59.40
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	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

PTWORK HARDENING CONDITIONING EVALUATION

Facility

$780.00

Service Code	CPT 97750
Hospital Charge Code	468020
Hospital Revenue Code	421
Rate for Payer: Cash Price	$702.00

PTWORK HARDENING CONDITIONING EVALUATION

Facility

$780.00

Service Code	CPT 97750
Hospital Charge Code	468020
Hospital Revenue Code	421
Min. Negotiated Rate	$29.57
Max. Negotiated Rate	$280.80
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	$702.00
Rate for Payer: Cash Price	$702.00
Rate for Payer: Cash Price	$702.00
Rate for Payer: Cash Price	$702.00
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	$280.80

Know your out-of-pocket cost for care.

All Charges