Madison Medical Center

All Charges

Charge

Type

Setting

Price

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9190782
Hospital Revenue Code	521
Rate for Payer: Cash Price	$45.00

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9690782
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$147.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$73.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9190782
Hospital Revenue Code	521
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9290782
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$147.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$73.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	3990782
Hospital Revenue Code	521
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9590782
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$147.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$73.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9290782
Hospital Revenue Code	636
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$33.35
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	3996372
Hospital Revenue Code	521
Rate for Payer: Cash Price	$45.00

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9490782
Hospital Revenue Code	521
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	3990782
Hospital Revenue Code	521
Rate for Payer: Cash Price	$45.00

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	3996372
Hospital Revenue Code	521
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

THERAPEUTIC MASSAGE THERAPY 15 MIN

Facility

$95.00

Service Code	CPT 97124
Hospital Charge Code	9897124
Hospital Revenue Code	521
Rate for Payer: Cash Price	$85.50

THERAPEUTIC MASSAGE THERAPY 15 MIN

Facility

$95.00

Service Code	CPT 97124
Hospital Charge Code	9897124
Hospital Revenue Code	521
Min. Negotiated Rate	$23.39
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$25.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$67.83
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27.81
Rate for Payer: UnitedHealthcare Commercial	$63.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$25.99
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

THERAPEUTIC OF DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9790782
Hospital Revenue Code	521
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

THERAPEUTIC OF DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9790782
Hospital Revenue Code	521
Rate for Payer: Cash Price	$45.00

THERAPEUTIC OR DIAGNOSTIC INJ.

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	4490782
Hospital Revenue Code	636
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$33.35
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35

THERAPEUTIC OR DIAGNOSTIC INJ.

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	4490782
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$147.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$73.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

THERAPEUTIC OR DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	HCPCS 96372
Hospital Charge Code	4290782
Hospital Revenue Code	636
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$33.35
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35

THERAPEUTIC OR DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	HCPCS 96372
Hospital Charge Code	4290782
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$147.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$73.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

THERAP PNEUMO INJ

Facility

$8.00

Service Code	CPT G0009
Hospital Charge Code	4200009
Hospital Revenue Code	636
Min. Negotiated Rate	$4.74
Max. Negotiated Rate	$95.68
Rate for Payer: Aetna Medicare Advantage	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.71
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial HMO & PPO	$47.84
Rate for Payer: Home State Health Plan Medicare Advantage	$47.84
Rate for Payer: Humana Commercial	$95.68
Rate for Payer: Humana Medicare Advantage	$47.84
Rate for Payer: UnitedHealthcare Commercial	$47.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.84

THERAP PNEUMO INJ

Facility

$8.00

Service Code	CPT G0009
Hospital Charge Code	4200009
Hospital Revenue Code	636
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Cash Price	$7.20
Rate for Payer: UnitedHealthcare Commercial	$5.34

THERMOACTINOMYCES SACCHARII AB

Facility

$110.00

Service Code	CPT 86602
Hospital Charge Code	2286598
Hospital Revenue Code	305
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$78.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

THERMOACTINOMYCES SACCHARII AB

Facility

$110.00

Service Code	CPT 86602
Hospital Charge Code	2286598
Hospital Revenue Code	305
Rate for Payer: Cash Price	$99.00

THERMOACTINOMYCES VULGARIS AB

Facility

$110.00

Service Code	CPT 86602
Hospital Charge Code	2286597
Hospital Revenue Code	305
Rate for Payer: Cash Price	$99.00

THERMOACTINOMYCES VULGARIS AB

Facility

$110.00

Service Code	CPT 86602
Hospital Charge Code	2286597
Hospital Revenue Code	305
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$78.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

Know your out-of-pocket cost for care.

All Charges