Observation direct referral from physician office for admission at St. Joseph Health Madison Hospital
100 West Cross Street, Madisonville, TX · CommonSpirit Health · · NPI 1780731737
$272.65
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
$1,558.00
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$198.49 with PGT vs $7,367.00 with United — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| PGT | Medicare|All Plans | $198.49 | ↓ -27% |
| AETNA | Medicare|All Plans | $202.54 | ↓ -26% |
| BCBS | Medicare|All Plans | $202.54 | ↓ -26% |
| UNITED | Medicare|All Plans | $206.60 | ↓ -24% |
| AMERIVANTAGE | Medicare|All Plans | $208.62 | ↓ -23% |
| SCANHealth | Medicare|All Plans | $216.72 | ↓ -21% |
| BCBS-TX | Commercial|Blue Advantage HMO | $253.17 | ↓ -7% |
| Ambetter | Commercial|All Plans | $293.69 | ↑ +8% |
| BCBS-TX | Commercial|Blue Premier | $297.69 | ↑ +9% |
| Wellpoint | Commercial|Exchange | $303.81 | ↑ +11% |
| BCBS-TX | Commercial|HMO | $315.51 | ↑ +16% |
| BCBS-TX | Commercial|PPO | $351.13 | ↑ +29% |
| SUPERIOR | Medicaid|CHIP | $373.92 | ↑ +37% |
| UNITED | Medicaid|All Other Plans | $381.40 | ↑ +40% |
| UNITED | Medicaid|STARKIDS | $381.40 | ↑ +40% |
| SUPERIOR | Medicaid|All Other Plans | $392.62 | ↑ +44% |
| Wellpoint | Medicaid|All Other Plans | $392.62 | ↑ +44% |
| BCBS | Medicaid|STARKIDS | $392.62 | ↑ +44% |
| Wellpoint | Medicaid|STAR | $539.85 | ↑ +98% |
| SUPERIOR | Medicaid|STAR | $542.19 | ↑ +99% |
| Bright Health | Commercial|All Plans | $582.39 | ↑ +114% |
| Ellwood | Commercial|All Plans | $607.62 | ↑ +123% |
| Entrust | Commercial|All Plans | $654.36 | ↑ +140% |
| NX Health | Commercial|All Plans | $658.26 | ↑ +141% |
| Health Smart | Commercial|All Plans | $856.90 | ↑ +214% |
| SUPERIOR | Medicaid|STARPLUS | $927.33 | ↑ +240% |
| First Health | Commercial|All Plans | $934.80 | ↑ +243% |
| UNITED | Medicaid|STARPLUS | $946.02 | ↑ +247% |
| Humana | Commercial|All Plans | $950.38 | ↑ +249% |
| Cigna | Commercial|All Other Plans | $997.12 | ↑ +266% |
| Aetna | Commercial|All Plans | $1,028.28 | ↑ +277% |
| PHCS | Commercial|All Plans | $1,324.30 | ↑ +386% |
| Multiplan | Commercial|All Plans | $1,402.20 | ↑ +414% |
| BCBS-TX | Commercial|Ref Lab | $1,558.00 | ↑ +471% |
| Cigna | Commercial|Local Plus | $2,731.00 | ↑ +902% |
| United | Commercial|Exchange | $3,754.00 | ↑ +1277% |
| United | Commercial|All Other Plans | $7,367.00 | ↑ +2602% |
Visitor-reported prices
Comments
Observation direct referral from physician office for admission at other Texas hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Adventhealth Rollins Brook | Lampasas | $162.54 | $489.80 – $489.80 |
| BAYLOR UNIVERSITY MEDICAL CENTER | Dallas | $554.33 | $157.06 – $1,591.17 |
| BAYLOR SCOTT & WHITE MEDICAL CENTER - BRENHAM | Brenham | $527.99 | $71.00 – $1,591.17 |
| BAYLOR SCOTT & WHITE MEDICAL CENTER - BUDA | Suite 110 | $602.45 | $71.00 – $1,591.17 |
| BAYLOR SCOTT & WHITE MEDICAL CENTER - CENTENNIAL | Frisco | $554.33 | $147.82 – $1,591.17 |
| BAYLOR SCOTT & WHITE MEDICAL CENTER - COLLEGE STATION | College Station | $527.99 | $169.48 – $1,591.17 |
| BAYLOR SCOTT & WHITE CONTINUING CARE HOSPITAL | Temple | $527.99 | $272.79 – $1,591.17 |
| BAYLOR SCOTT & WHITE EMERGENCY MEDICAL CENTER - CEDAR PARK | Cedar Park | $602.45 | $71.00 – $1,591.17 |