Madison Medical Center

All Charges

Charge

Type

Setting

Price

CPO HH PT <30 MIN

Facility

$173.00

Service Code	CPT 99374
Hospital Charge Code	4299374
Hospital Revenue Code	521
Min. Negotiated Rate	$102.42
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$102.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$123.52
Rate for Payer: Cash Price	$155.70
Rate for Payer: Cash Price	$155.70
Rate for Payer: UnitedHealthcare Commercial	$115.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HH PT <30 MIN

Facility

$180.00

Service Code	CPT 99374
Hospital Charge Code	5299374
Hospital Revenue Code	521
Rate for Payer: Cash Price	$162.00

CPO HH PT <30 MIN

Facility

$180.00

Service Code	CPT 99374
Hospital Charge Code	9899374
Hospital Revenue Code	521
Rate for Payer: Cash Price	$162.00

CPO HH PT <30 MIN

Facility

$180.00

Service Code	CPT 99374
Hospital Charge Code	9899374
Hospital Revenue Code	521
Min. Negotiated Rate	$106.56
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$106.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$128.52
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: UnitedHealthcare Commercial	$120.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HH PT >30 MIN

Facility

$260.00

Service Code	CPT 99375
Hospital Charge Code	5299375
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

CPO HH PT >30 MIN

Facility

$251.00

Service Code	CPT 99375
Hospital Charge Code	4299375
Hospital Revenue Code	521
Min. Negotiated Rate	$148.59
Max. Negotiated Rate	$179.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$179.21
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cash Price	$225.90
Rate for Payer: UnitedHealthcare Commercial	$167.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HH PT >30 MIN

Facility

$260.00

Service Code	CPT 99375
Hospital Charge Code	5299375
Hospital Revenue Code	521
Min. Negotiated Rate	$153.92
Max. Negotiated Rate	$185.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: UnitedHealthcare Commercial	$173.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HH PT >30 MIN

Facility

$260.00

Service Code	CPT 99375
Hospital Charge Code	9899375
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

CPO HH PT >30 MIN

Facility

$251.00

Service Code	CPT 99375
Hospital Charge Code	4299375
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.90

CPO HH PT >30 MIN

Facility

$260.00

Service Code	CPT 99375
Hospital Charge Code	9899375
Hospital Revenue Code	521
Min. Negotiated Rate	$153.92
Max. Negotiated Rate	$185.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: UnitedHealthcare Commercial	$173.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HH PT NOT PRESENT <30 MIN

Facility

$180.00

Service Code	CPT 99379
Hospital Charge Code	4499379
Hospital Revenue Code	525
Min. Negotiated Rate	$106.56
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$106.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$128.52
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: UnitedHealthcare Commercial	$120.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HH PT NOT PRESENT <30 MIN

Facility

$180.00

Service Code	CPT 99379
Hospital Charge Code	4499379
Hospital Revenue Code	525
Rate for Payer: Cash Price	$162.00

CPO HH PT NOT PRESENT >30 MIN

Facility

$265.00

Service Code	CPT 99380
Hospital Charge Code	4499380
Hospital Revenue Code	525
Rate for Payer: Cash Price	$238.50

CPO HH PT NOT PRESENT >30 MIN

Facility

$265.00

Service Code	CPT 99380
Hospital Charge Code	4499380
Hospital Revenue Code	525
Min. Negotiated Rate	$156.88
Max. Negotiated Rate	$189.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$156.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$189.21
Rate for Payer: Cash Price	$238.50
Rate for Payer: Cash Price	$238.50
Rate for Payer: UnitedHealthcare Commercial	$176.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HOSPICE PT <30 MIN

Facility

$175.00

Service Code	CPT 99377
Hospital Charge Code	9899377
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

CPO HOSPICE PT <30 MIN

Facility

$175.00

Service Code	CPT 99377
Hospital Charge Code	9899377
Hospital Revenue Code	521
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$103.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$124.95
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cash Price	$157.50
Rate for Payer: UnitedHealthcare Commercial	$116.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HOSPICE PT <30 MIN

Facility

$175.00

Service Code	CPT 99377
Hospital Charge Code	5299377
Hospital Revenue Code	525
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$103.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$124.95
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cash Price	$157.50
Rate for Payer: UnitedHealthcare Commercial	$116.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HOSPICE PT <30 MIN

Facility

$175.00

Service Code	CPT 99377
Hospital Charge Code	5299377
Hospital Revenue Code	525
Rate for Payer: Cash Price	$157.50

CPO HOSPICE PT <30 MIN

Facility

$172.00

Service Code	CPT 99377
Hospital Charge Code	4299377
Hospital Revenue Code	525
Rate for Payer: Cash Price	$154.80

CPO HOSPICE PT <30 MIN

Facility

$172.00

Service Code	CPT 99377
Hospital Charge Code	4299377
Hospital Revenue Code	525
Min. Negotiated Rate	$101.82
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$101.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$122.81
Rate for Payer: Cash Price	$154.80
Rate for Payer: Cash Price	$154.80
Rate for Payer: UnitedHealthcare Commercial	$114.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HOSPICE PT <30 MIN

Facility

$175.00

Service Code	CPT 99377
Hospital Charge Code	4499377
Hospital Revenue Code	525
Rate for Payer: Cash Price	$157.50

CPO HOSPICE PT <30 MIN

Facility

$175.00

Service Code	CPT 99377
Hospital Charge Code	4499377
Hospital Revenue Code	525
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$103.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$124.95
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cash Price	$157.50
Rate for Payer: UnitedHealthcare Commercial	$116.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HOSPICE PT >30 MIN

Facility

$270.00

Service Code	CPT 99378
Hospital Charge Code	4499378
Hospital Revenue Code	525
Min. Negotiated Rate	$159.84
Max. Negotiated Rate	$192.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$159.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$192.78
Rate for Payer: Cash Price	$243.00
Rate for Payer: Cash Price	$243.00
Rate for Payer: UnitedHealthcare Commercial	$180.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO HOSPICE PT >30 MIN

Facility

$265.00

Service Code	CPT 99378
Hospital Charge Code	4299378
Hospital Revenue Code	525
Rate for Payer: Cash Price	$238.50

CPO HOSPICE PT >30 MIN

Facility

$265.00

Service Code	CPT 99378
Hospital Charge Code	4299378
Hospital Revenue Code	525
Min. Negotiated Rate	$156.88
Max. Negotiated Rate	$189.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$156.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$189.21
Rate for Payer: Cash Price	$238.50
Rate for Payer: Cash Price	$238.50
Rate for Payer: UnitedHealthcare Commercial	$176.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges