Madison Medical Center

All Charges

Charge

Type

Setting

Price

PULM REHAB OTHER 15 MIN

Facility

$71.00

Service Code	CPT G0238
Hospital Charge Code	90238
Hospital Revenue Code	948
Min. Negotiated Rate	$25.56
Max. Negotiated Rate	$59.10
Rate for Payer: Aetna Medicare Advantage	$29.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial HMO & PPO	$29.55
Rate for Payer: Home State Health Plan Medicare Advantage	$29.55
Rate for Payer: Humana Commercial	$59.10
Rate for Payer: Humana Medicare Advantage	$29.55
Rate for Payer: UnitedHealthcare Commercial	$47.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

PULM REHAB OTHER 15 MIN

Facility

$71.00

Service Code	CPT G0238
Hospital Charge Code	90238
Hospital Revenue Code	948
Rate for Payer: Cash Price	$63.90

PULSE OX

Facility

$87.00

Service Code	CPT 94760
Hospital Charge Code	4500487
Hospital Revenue Code	460
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

PULSE OX

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	4194760
Hospital Revenue Code	412
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

PULSE OX

Facility

$87.00

Service Code	CPT 94760
Hospital Charge Code	2800487
Hospital Revenue Code	460
Rate for Payer: Cash Price	$78.30

PULSE OX

Facility

$87.00

Service Code	CPT 94760
Hospital Charge Code	4500487
Hospital Revenue Code	460
Rate for Payer: Cash Price	$78.30

PULSE OX

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	9794760
Hospital Revenue Code	412
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

PULSE OX

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	9794760
Hospital Revenue Code	412
Rate for Payer: Cash Price	$40.50

PULSE OX

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	4194760
Hospital Revenue Code	412
Rate for Payer: Cash Price	$40.50

PULSE OX

Facility

$87.00

Service Code	CPT 94760
Hospital Charge Code	2800487
Hospital Revenue Code	460
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

PULSE OX 24 HR OVERNIGHT

Facility

$47.50

Service Code	CPT 94762
Hospital Charge Code	4494762
Hospital Revenue Code	412
Min. Negotiated Rate	$17.10
Max. Negotiated Rate	$262.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$116.00
Rate for Payer: Aetna Medicare Advantage	$131.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$33.91
Rate for Payer: Cash Price	$42.75
Rate for Payer: Cash Price	$42.75
Rate for Payer: Cash Price	$42.75
Rate for Payer: Cigna Commercial HMO & PPO	$131.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$116.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$124.12
Rate for Payer: Home State Health Plan Medicare Advantage	$131.46
Rate for Payer: Humana Commercial	$262.92
Rate for Payer: Humana Medicare Advantage	$131.46
Rate for Payer: UnitedHealthcare Commercial	$31.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$116.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.10

PULSE OX 24 HR OVERNIGHT

Facility

$47.50

Service Code	CPT 94762
Hospital Charge Code	4494762
Hospital Revenue Code	412
Rate for Payer: Cash Price	$42.75

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	5294760
Hospital Revenue Code	521
Min. Negotiated Rate	$26.64
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	3994760
Hospital Revenue Code	412
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	4294760
Hospital Revenue Code	412
Rate for Payer: Cash Price	$40.50

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	9894760
Hospital Revenue Code	412
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	9494760
Hospital Revenue Code	412
Rate for Payer: Cash Price	$40.50

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	9594760
Hospital Revenue Code	412
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	9694760
Hospital Revenue Code	412
Rate for Payer: Cash Price	$40.50

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	4494760
Hospital Revenue Code	412
Rate for Payer: Cash Price	$40.50

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	9894760
Hospital Revenue Code	412
Rate for Payer: Cash Price	$40.50

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	9594760
Hospital Revenue Code	412
Rate for Payer: Cash Price	$40.50

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	9294760
Hospital Revenue Code	412
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	3994760
Hospital Revenue Code	412
Rate for Payer: Cash Price	$40.50

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	9694760
Hospital Revenue Code	412
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

Know your out-of-pocket cost for care.

All Charges