Madison Medical Center

All Charges

Charge

Type

Setting

Price

CONSULTATION INITIAL INTERMEDIATE

Facility

$225.00

Service Code	CPT 99242
Hospital Charge Code	9799242
Hospital Revenue Code	521
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$133.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$160.65
Rate for Payer: Cash Price	$202.50
Rate for Payer: Cash Price	$202.50
Rate for Payer: UnitedHealthcare Commercial	$150.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULTATION INTERMEDIATE

Facility

$190.00

Service Code	CPT 99242
Hospital Charge Code	9699242
Hospital Revenue Code	521
Min. Negotiated Rate	$112.48
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: UnitedHealthcare Commercial	$126.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULTATION INTERMEDIATE

Facility

$190.00

Service Code	CPT 99242
Hospital Charge Code	9699242
Hospital Revenue Code	521
Rate for Payer: Cash Price	$171.00

CONSULTATION INTERMEDIATE 30 MINUTES

Facility

$200.00

Service Code	CPT 99242
Hospital Charge Code	5499242
Hospital Revenue Code	521
Min. Negotiated Rate	$118.40
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$118.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.80
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: UnitedHealthcare Commercial	$133.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULTATION INTERMEDIATE 30 MINUTES

Facility

$200.00

Service Code	CPT 99242
Hospital Charge Code	5499242
Hospital Revenue Code	521
Rate for Payer: Cash Price	$180.00

CONSULTATIONS - INITIAL - COMPLEX

Facility

$475.00

Service Code	CPT 99245
Hospital Charge Code	3999245
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$339.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$281.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$339.15
Rate for Payer: Cash Price	$427.50
Rate for Payer: Cash Price	$427.50
Rate for Payer: UnitedHealthcare Commercial	$316.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULTATIONS - INITIAL - COMPLEX

Facility

$475.00

Service Code	CPT 99245
Hospital Charge Code	3999245
Hospital Revenue Code	521
Rate for Payer: Cash Price	$427.50

CONSULTATIONS - INITIAL - COMPREHENSIVE

Facility

$375.00

Service Code	CPT 99244
Hospital Charge Code	3999244
Hospital Revenue Code	521
Rate for Payer: Cash Price	$337.50

CONSULTATIONS - INITIAL - COMPREHENSIVE

Facility

$375.00

Service Code	CPT 99244
Hospital Charge Code	3999244
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$267.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$222.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$267.75
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: UnitedHealthcare Commercial	$250.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULTATIONS - INITIAL - EXTENDED

Facility

$275.00

Service Code	CPT 99243
Hospital Charge Code	3999243
Hospital Revenue Code	521
Min. Negotiated Rate	$162.80
Max. Negotiated Rate	$196.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$162.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$196.35
Rate for Payer: Cash Price	$247.50
Rate for Payer: Cash Price	$247.50
Rate for Payer: UnitedHealthcare Commercial	$183.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULTATIONS - INITIAL - EXTENDED

Facility

$275.00

Service Code	CPT 99243
Hospital Charge Code	3999243
Hospital Revenue Code	521
Rate for Payer: Cash Price	$247.50

CONSULTATIONS - INITIAL - INTERMEDIATE

Facility

$210.00

Service Code	CPT 99242
Hospital Charge Code	3999242
Hospital Revenue Code	521
Rate for Payer: Cash Price	$189.00

CONSULTATIONS - INITIAL - INTERMEDIATE

Facility

$210.00

Service Code	CPT 99242
Hospital Charge Code	3999242
Hospital Revenue Code	521
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$124.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: UnitedHealthcare Commercial	$140.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULT COMP

Facility

$275.00

Service Code	CPT 99244
Hospital Charge Code	5299244
Hospital Revenue Code	521
Min. Negotiated Rate	$162.80
Max. Negotiated Rate	$196.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$162.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$196.35
Rate for Payer: Cash Price	$247.50
Rate for Payer: Cash Price	$247.50
Rate for Payer: UnitedHealthcare Commercial	$183.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULT COMP

Facility

$275.00

Service Code	CPT 99244
Hospital Charge Code	5299244
Hospital Revenue Code	521
Rate for Payer: Cash Price	$247.50

CONSULT COMPLEX

Facility

$355.00

Service Code	CPT 99245
Hospital Charge Code	5299245
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$253.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$210.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$253.47
Rate for Payer: Cash Price	$319.50
Rate for Payer: Cash Price	$319.50
Rate for Payer: UnitedHealthcare Commercial	$236.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULT COMPLEX

Facility

$355.00

Service Code	CPT 99245
Hospital Charge Code	5299245
Hospital Revenue Code	521
Rate for Payer: Cash Price	$319.50

CONSULT EXTENDED

Facility

$275.00

Service Code	CPT 99243
Hospital Charge Code	5299243
Hospital Revenue Code	521
Rate for Payer: Cash Price	$247.50

CONSULT EXTENDED

Facility

$275.00

Service Code	CPT 99243
Hospital Charge Code	5299243
Hospital Revenue Code	521
Min. Negotiated Rate	$162.80
Max. Negotiated Rate	$196.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$162.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$196.35
Rate for Payer: Cash Price	$247.50
Rate for Payer: Cash Price	$247.50
Rate for Payer: UnitedHealthcare Commercial	$183.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULT INTERMEDIATED

Facility

$210.00

Service Code	CPT 99242
Hospital Charge Code	5299242
Hospital Revenue Code	521
Rate for Payer: Cash Price	$189.00

CONSULT INTERMEDIATED

Facility

$210.00

Service Code	CPT 99242
Hospital Charge Code	5299242
Hospital Revenue Code	521
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$124.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: UnitedHealthcare Commercial	$140.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULT LEVEL 2

Facility

$225.00

Service Code	CPT 99242
Hospital Charge Code	9399242
Hospital Revenue Code	521
Rate for Payer: Cash Price	$202.50

CONSULT LEVEL 2

Facility

$225.00

Service Code	CPT 99242
Hospital Charge Code	9399242
Hospital Revenue Code	521
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$133.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$160.65
Rate for Payer: Cash Price	$202.50
Rate for Payer: Cash Price	$202.50
Rate for Payer: UnitedHealthcare Commercial	$150.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CONSULT LEVEL 3

Facility

$300.00

Service Code	CPT 99243
Hospital Charge Code	9399243
Hospital Revenue Code	521
Rate for Payer: Cash Price	$270.00

CONSULT LEVEL 3

Facility

$300.00

Service Code	CPT 99243
Hospital Charge Code	9399243
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$214.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.20
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: UnitedHealthcare Commercial	$200.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges