Madison Medical Center

All Charges

Charge

Type

Setting

Price

USE #4500420

Facility

$21.00

Hospital Charge Code	4500421
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

USE #4500420

Facility

$21.00

Hospital Charge Code	4500421
Hospital Revenue Code	271
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

US ECHO-COAT NEEDLES

Facility

$149.00

Hospital Charge Code	3576550
Hospital Revenue Code	272
Rate for Payer: Cash Price	$134.10

US ECHO-COAT NEEDLES

Facility

$149.00

Hospital Charge Code	3576550
Hospital Revenue Code	272
Min. Negotiated Rate	$53.64
Max. Negotiated Rate	$106.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$106.39
Rate for Payer: Cash Price	$134.10
Rate for Payer: UnitedHealthcare Commercial	$99.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

US ECHO - COLOR FLOW DOPPLER

Facility

$1,126.00

Service Code	CPT 93325
Hospital Charge Code	3593325
Hospital Revenue Code	480
Min. Negotiated Rate	$405.36
Max. Negotiated Rate	$803.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$666.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$803.96
Rate for Payer: Cash Price	$1,013.40
Rate for Payer: UnitedHealthcare Commercial	$751.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$405.36

US ECHO - COLOR FLOW DOPPLER

Facility

$1,126.00

Service Code	CPT 93325
Hospital Charge Code	3593325
Hospital Revenue Code	480
Rate for Payer: Cash Price	$1,013.40

US ECHOENCEPHALOGRAPHY

Facility

$849.00

Service Code	CPT 76506
Hospital Charge Code	3576506
Hospital Revenue Code	402
Rate for Payer: Cash Price	$764.10

US ECHOENCEPHALOGRAPHY

Facility

$849.00

Service Code	CPT 76506
Hospital Charge Code	3576506
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$606.19
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	$502.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$606.19
Rate for Payer: Cash Price	$764.10
Rate for Payer: Cash Price	$764.10
Rate for Payer: Cash Price	$764.10
Rate for Payer: Cash Price	$764.10
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	$305.64

US ECHOGRAPHY CHEST

Facility

$862.00

Service Code	CPT 76604
Hospital Charge Code	3576604
Hospital Revenue Code	402
Rate for Payer: Cash Price	$775.80

US ECHOGRAPHY CHEST

Facility

$862.00

Service Code	CPT 76604
Hospital Charge Code	3576604
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$615.47
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	$510.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$615.47
Rate for Payer: Cash Price	$775.80
Rate for Payer: Cash Price	$775.80
Rate for Payer: Cash Price	$775.80
Rate for Payer: Cash Price	$775.80
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	$310.32

US ECHO M-MODE & COLOR DOPPLER

Facility

$3,702.00

Service Code	CPT 93306
Hospital Charge Code	3593306
Hospital Revenue Code	480
Rate for Payer: Cash Price	$3,331.80

US ECHO M-MODE & COLOR DOPPLER

Facility

$3,702.00

Service Code	CPT 93306
Hospital Charge Code	3593306
Hospital Revenue Code	480
Min. Negotiated Rate	$492.57
Max. Negotiated Rate	$2,643.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$492.57
Rate for Payer: Aetna Medicare Advantage	$558.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,191.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,643.23
Rate for Payer: Cash Price	$3,331.80
Rate for Payer: Cash Price	$3,331.80
Rate for Payer: Cash Price	$3,331.80
Rate for Payer: Cigna Commercial HMO & PPO	$558.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$492.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$527.05
Rate for Payer: Home State Health Plan Medicare Advantage	$558.25
Rate for Payer: Humana Commercial	$1,116.50
Rate for Payer: Humana Medicare Advantage	$558.25
Rate for Payer: UnitedHealthcare Commercial	$2,469.23
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$492.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,332.72

US FEMORAL DOPPLER

Facility

$973.00

Service Code	CPT 93307
Hospital Charge Code	3500244
Hospital Revenue Code	921
Min. Negotiated Rate	$215.09
Max. Negotiated Rate	$694.72
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	$576.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$694.72
Rate for Payer: Cash Price	$875.70
Rate for Payer: Cash Price	$875.70
Rate for Payer: Cash Price	$875.70
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	$648.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$350.28

US FEMORAL DOPPLER

Facility

$973.00

Service Code	CPT 93307
Hospital Charge Code	3500244
Hospital Revenue Code	921
Rate for Payer: Cash Price	$875.70

US FETAL BIOPHYSICAL PROFILE

Facility

$1,142.00

Service Code	CPT 76818
Hospital Charge Code	3576818
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$815.39
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
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	$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: Cash Price	$1,027.80
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	$411.12

US FETAL BIOPHYSICAL PROFILE

Facility

$1,142.00

Service Code	CPT 76818
Hospital Charge Code	3576818
Hospital Revenue Code	402
Rate for Payer: Cash Price	$1,027.80

US GB,CBD,CHD,/RUQ

Facility

$1,124.00

Service Code	CPT 76705
Hospital Charge Code	3576705
Hospital Revenue Code	402
Rate for Payer: Cash Price	$1,011.60

US GB,CBD,CHD,/RUQ

Facility

$1,124.00

Service Code	CPT 76705
Hospital Charge Code	3576705
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$802.54
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	$665.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$802.54
Rate for Payer: Cash Price	$1,011.60
Rate for Payer: Cash Price	$1,011.60
Rate for Payer: Cash Price	$1,011.60
Rate for Payer: Cash Price	$1,011.60
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	$404.64

US GUIDANCE FOR THOROCENTISIS

Facility

$550.00

Service Code	CPT 76934
Hospital Charge Code	3576934
Hospital Revenue Code	402
Rate for Payer: Cash Price	$495.00

US GUIDANCE FOR THOROCENTISIS

Facility

$550.00

Service Code	CPT 76934
Hospital Charge Code	3576934
Hospital Revenue Code	402
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$392.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$325.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$392.70
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$198.00

US GUIDED PERCUTANIOUS DRAINAGE

Facility

$529.00

Service Code	CPT 75989
Hospital Charge Code	3575989
Hospital Revenue Code	320
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$377.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$313.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$377.71
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cash Price	$476.10
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$190.44

US GUIDED PERCUTANIOUS DRAINAGE

Facility

$529.00

Service Code	CPT 75989
Hospital Charge Code	3575989
Hospital Revenue Code	320
Rate for Payer: Cash Price	$476.10

US LIMITED M-MODE ECHO

Facility

$357.00

Service Code	CPT 93307
Hospital Charge Code	3500205
Hospital Revenue Code	402
Rate for Payer: Cash Price	$321.30

US LIMITED M-MODE ECHO

Facility

$357.00

Service Code	CPT 93307
Hospital Charge Code	3500205
Hospital Revenue Code	402
Min. Negotiated Rate	$128.52
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	$211.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$254.90
Rate for Payer: Cash Price	$321.30
Rate for Payer: Cash Price	$321.30
Rate for Payer: Cash Price	$321.30
Rate for Payer: Cash Price	$321.30
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	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$215.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$128.52

US LIMITED OB (AFI & ECT.)

Facility

$744.00

Service Code	CPT 76815
Hospital Charge Code	3576815
Hospital Revenue Code	402
Rate for Payer: Cash Price	$669.60

Know your out-of-pocket cost for care.

All Charges