Madison Medical Center

All Charges

Charge

Type

Setting

Price

US ANKLE BRACHIAL INDICES (ABI)

Facility

$460.00

Service Code	CPT 93922
Hospital Charge Code	3593922
Hospital Revenue Code	921
Rate for Payer: Cash Price	$414.00

US AORTA SCREENING

Facility

$482.00

Service Code	CPT 76705
Hospital Charge Code	3576706
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$344.15
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$285.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$344.15
Rate for Payer: Cash Price	$433.80
Rate for Payer: Cash Price	$433.80
Rate for Payer: Cash Price	$433.80
Rate for Payer: Cash Price	$433.80
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.52

US AORTA SCREENING

Facility

$482.00

Service Code	CPT 76705
Hospital Charge Code	3576706
Hospital Revenue Code	402
Rate for Payer: Cash Price	$433.80

US ARTERIAL DOPPLER LOWER EXT

Facility

$831.00

Service Code	CPT 93925
Hospital Charge Code	3593925
Hospital Revenue Code	921
Rate for Payer: Cash Price	$747.90

US ARTERIAL DOPPLER LOWER EXT

Facility

$831.00

Service Code	CPT 93925
Hospital Charge Code	3593925
Hospital Revenue Code	921
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$593.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$491.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$593.33
Rate for Payer: Cash Price	$747.90
Rate for Payer: Cash Price	$747.90
Rate for Payer: Cash Price	$747.90
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$554.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$299.16

US ARTERIAL DOPPLER UPPER EXT

Facility

$1,118.00

Service Code	CPT 93930
Hospital Charge Code	3593930
Hospital Revenue Code	921
Rate for Payer: Cash Price	$1,006.20

US ARTERIAL DOPPLER UPPER EXT

Facility

$1,118.00

Service Code	CPT 93930
Hospital Charge Code	3593930
Hospital Revenue Code	921
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$798.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$661.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$798.25
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Cash Price	$1,006.20
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$745.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$402.48

US ARTERIAL DOPP LOWER EXT W SEG PRESS

Facility

$1,846.00

Service Code	CPT 93923
Hospital Charge Code	3593923
Hospital Revenue Code	921
Rate for Payer: Cash Price	$1,661.40

US ARTERIAL DOPP LOWER EXT W SEG PRESS

Facility

$1,846.00

Service Code	CPT 93923
Hospital Charge Code	3593923
Hospital Revenue Code	921
Min. Negotiated Rate	$194.65
Max. Negotiated Rate	$1,318.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$194.65
Rate for Payer: Aetna Medicare Advantage	$220.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,092.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,318.04
Rate for Payer: Cash Price	$1,661.40
Rate for Payer: Cash Price	$1,661.40
Rate for Payer: Cash Price	$1,661.40
Rate for Payer: Cigna Commercial HMO & PPO	$220.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$194.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$208.28
Rate for Payer: Home State Health Plan Medicare Advantage	$220.60
Rate for Payer: Humana Commercial	$441.20
Rate for Payer: Humana Medicare Advantage	$220.60
Rate for Payer: UnitedHealthcare Commercial	$1,231.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$194.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$664.56

US ARTERIAL UNILAT./LIMITED

Facility

$706.00

Service Code	CPT 93926
Hospital Charge Code	3593926
Hospital Revenue Code	921
Rate for Payer: Cash Price	$635.40

US ARTERIAL UNILAT./LIMITED

Facility

$706.00

Service Code	CPT 93926
Hospital Charge Code	3593926
Hospital Revenue Code	921
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$504.08
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$417.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$504.08
Rate for Payer: Cash Price	$635.40
Rate for Payer: Cash Price	$635.40
Rate for Payer: Cash Price	$635.40
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$470.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$254.16

US BIOPSY GUN

Facility

$165.00

Hospital Charge Code	3500267
Hospital Revenue Code	272
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: UnitedHealthcare Commercial	$110.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

US BIOPSY GUN

Facility

$165.00

Hospital Charge Code	3500267
Hospital Revenue Code	272
Rate for Payer: Cash Price	$148.50

US BREAST UNILATERAL

Facility

$584.00

Service Code	CPT 76641
Hospital Charge Code	3576641
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$416.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$345.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$416.98
Rate for Payer: Cash Price	$525.60
Rate for Payer: Cash Price	$525.60
Rate for Payer: Cash Price	$525.60
Rate for Payer: Cash Price	$525.60
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$210.24

US BREAST UNILATERAL

Facility

$584.00

Service Code	CPT 76641
Hospital Charge Code	3576641
Hospital Revenue Code	402
Rate for Payer: Cash Price	$525.60

US CARDIAC DOPPLER WITH

Facility

$1,072.00

Service Code	CPT 93320
Hospital Charge Code	3593320
Hospital Revenue Code	480
Min. Negotiated Rate	$385.92
Max. Negotiated Rate	$765.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$634.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$765.41
Rate for Payer: Cash Price	$964.80
Rate for Payer: UnitedHealthcare Commercial	$715.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$385.92

US CARDIAC DOPPLER WITH

Facility

$1,072.00

Service Code	CPT 93320
Hospital Charge Code	3593320
Hospital Revenue Code	480
Rate for Payer: Cash Price	$964.80

US CAROTID DOPPLER

Facility

$1,125.00

Service Code	CPT 93880
Hospital Charge Code	3593880
Hospital Revenue Code	921
Rate for Payer: Cash Price	$1,012.50

US CAROTID DOPPLER

Facility

$1,125.00

Service Code	CPT 93880
Hospital Charge Code	3593880
Hospital Revenue Code	921
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$803.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$666.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$803.25
Rate for Payer: Cash Price	$1,012.50
Rate for Payer: Cash Price	$1,012.50
Rate for Payer: Cash Price	$1,012.50
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$750.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$405.00

US CAROTID DOPPLER STUDY

Facility

$1,321.00

Service Code	CPT 93880
Hospital Charge Code	3500489
Hospital Revenue Code	921
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$943.19
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$782.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$943.19
Rate for Payer: Cash Price	$1,188.90
Rate for Payer: Cash Price	$1,188.90
Rate for Payer: Cash Price	$1,188.90
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$881.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$475.56

US CAROTID DOPPLER STUDY

Facility

$1,321.00

Service Code	CPT 93880
Hospital Charge Code	3500489
Hospital Revenue Code	921
Rate for Payer: Cash Price	$1,188.90

US DUPLEX OF ABD PELVIS

Facility

$1,142.00

Service Code	CPT 93975
Hospital Charge Code	3593975
Hospital Revenue Code	921
Rate for Payer: Cash Price	$1,027.80

US DUPLEX OF ABD PELVIS

Facility

$1,142.00

Service Code	CPT 93975
Hospital Charge Code	3593975
Hospital Revenue Code	921
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$815.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$676.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$815.39
Rate for Payer: Cash Price	$1,027.80
Rate for Payer: Cash Price	$1,027.80
Rate for Payer: Cash Price	$1,027.80
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$761.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$411.12

US DUPLEX SCAN OF AORTA

Facility

$673.00

Service Code	CPT 93978
Hospital Charge Code	3593978
Hospital Revenue Code	921
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$487.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$215.09
Rate for Payer: Aetna Medicare Advantage	$243.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$398.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$480.52
Rate for Payer: Cash Price	$605.70
Rate for Payer: Cash Price	$605.70
Rate for Payer: Cash Price	$605.70
Rate for Payer: Cigna Commercial HMO & PPO	$243.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$215.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$230.15
Rate for Payer: Home State Health Plan Medicare Advantage	$243.77
Rate for Payer: Humana Commercial	$487.54
Rate for Payer: Humana Medicare Advantage	$243.77
Rate for Payer: UnitedHealthcare Commercial	$448.89
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$242.28

US DUPLEX SCAN OF AORTA

Facility

$673.00

Service Code	CPT 93978
Hospital Charge Code	3593978
Hospital Revenue Code	921
Rate for Payer: Cash Price	$605.70

Know your out-of-pocket cost for care.

All Charges