Madison Medical Center

All Charges

Charge

Type

Setting

Price

STERI STRIP 1/2 X 4

Facility

$55.00

Hospital Charge Code	2819293
Hospital Revenue Code	271
Rate for Payer: Cash Price	$49.50

STERI STRIP 1/4 X 4

Facility

$22.00

Hospital Charge Code	2819294
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

STERI STRIP 1/4 X 4

Facility

$22.00

Hospital Charge Code	2819294
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

STERNUM X-RAY

Facility

$360.00

Service Code	CPT 71120
Hospital Charge Code	3219124
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$257.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$213.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$257.04
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$129.60

STERNUM X-RAY

Facility

$360.00

Service Code	CPT 71120
Hospital Charge Code	3219124
Hospital Revenue Code	320
Rate for Payer: Cash Price	$324.00

STEROID INJECTION NOT IN JOINT

Professional

Both

$80.00

Service Code	CPT 96372
Hospital Charge Code	1896372
Hospital Revenue Code	981
Min. Negotiated Rate	$14.07
Max. Negotiated Rate	$28.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$14.07
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna Commercial HMO & PPO	$14.07
Rate for Payer: Home State Health Plan Medicare Advantage	$14.07
Rate for Payer: Optum Medicare Advantage	$28.00

ST EVAL ARTICULATION

Facility

$271.00

Service Code	CPT 92522
Hospital Charge Code	4792522
Hospital Revenue Code	441
Rate for Payer: Cash Price	$243.90

ST EVAL ARTICULATION

Facility

$271.00

Service Code	CPT 92522
Hospital Charge Code	4792522
Hospital Revenue Code	441
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$98.70
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	$243.90
Rate for Payer: Cash Price	$243.90
Rate for Payer: Cash Price	$243.90
Rate for Payer: Cash Price	$243.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$98.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$105.61
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$98.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.56

ST EVAL COMPREHENSION

Facility

$461.00

Service Code	CPT 92523
Hospital Charge Code	4792523
Hospital Revenue Code	441
Rate for Payer: Cash Price	$414.90

ST EVAL COMPREHENSION

Facility

$461.00

Service Code	CPT 92523
Hospital Charge Code	4792523
Hospital Revenue Code	441
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$213.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$199.58
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	$414.90
Rate for Payer: Cash Price	$414.90
Rate for Payer: Cash Price	$414.90
Rate for Payer: Cash Price	$414.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$199.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$213.55
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$199.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$165.96

ST EVAL FLUENCY

Facility

$271.00

Service Code	CPT 92521
Hospital Charge Code	4792521
Hospital Revenue Code	441
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$117.43
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	$243.90
Rate for Payer: Cash Price	$243.90
Rate for Payer: Cash Price	$243.90
Rate for Payer: Cash Price	$243.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$117.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$125.65
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$117.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.56

ST EVAL FLUENCY

Facility

$271.00

Service Code	CPT 92521
Hospital Charge Code	4792521
Hospital Revenue Code	441
Rate for Payer: Cash Price	$243.90

ST EVAL VOICE

Facility

$271.00

Service Code	CPT 92524
Hospital Charge Code	4792524
Hospital Revenue Code	441
Rate for Payer: Cash Price	$243.90

ST EVAL VOICE

Facility

$271.00

Service Code	CPT 92524
Hospital Charge Code	4792524
Hospital Revenue Code	441
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$136.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$96.68
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	$243.90
Rate for Payer: Cash Price	$243.90
Rate for Payer: Cash Price	$243.90
Rate for Payer: Cash Price	$243.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$96.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$103.45
Rate for Payer: UnitedHealthcare Commercial	$82.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$96.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.56

ST GOAL ATTENTION FUNCTIONAL

Facility

$4.00

Hospital Charge Code	479166
Hospital Revenue Code	441
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

ST GOAL ATTENTION FUNCTIONAL

Facility

$4.00

Hospital Charge Code	479166
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST GOAL MEMORY FUNCTIONAL

Facility

$4.00

Hospital Charge Code	479169
Hospital Revenue Code	441
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

ST GOAL MEMORY FUNCTIONAL

Facility

$4.00

Hospital Charge Code	479169
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST GOAL MOTOR SPEECH FUNCTIONAL LIM

Facility

$4.00

Hospital Charge Code	479186
Hospital Revenue Code	441
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

ST GOAL MOTOR SPEECH FUNCTIONAL LIM

Facility

$4.00

Hospital Charge Code	479186
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST GOAL OTHER SPEECH LANGUAGE PATH

Facility

$4.00

Hospital Charge Code	479175
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST GOAL OTHER SPEECH LANGUAGE PATH

Facility

$4.00

Hospital Charge Code	479175
Hospital Revenue Code	441
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

ST GOAL SPOKEN LANGUAGE EXPRESSION

Facility

$4.00

Hospital Charge Code	479163
Hospital Revenue Code	441
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

ST GOAL SPOKEN LANGUAGE EXPRESSION

Facility

$4.00

Hospital Charge Code	479163
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

ST GOAL SPOKEN LANGUAGE FUNCTIONAL LIM

Facility

$4.00

Hospital Charge Code	479160
Hospital Revenue Code	441
Rate for Payer: Cash Price	$3.60

Know your out-of-pocket cost for care.

All Charges