Madison Medical Center

All Charges

Charge

Type

Setting

Price

CPO HOSPICE PT >30 MIN

Facility

$270.00

Service Code	CPT 99378
Hospital Charge Code	9899378
Hospital Revenue Code	521
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

$270.00

Service Code	CPT 99378
Hospital Charge Code	5299378
Hospital Revenue Code	525
Rate for Payer: Cash Price	$243.00

CPO HOSPICE PT >30 MIN

Facility

$270.00

Service Code	CPT 99378
Hospital Charge Code	5299378
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

$270.00

Service Code	CPT 99378
Hospital Charge Code	9899378
Hospital Revenue Code	521
Rate for Payer: Cash Price	$243.00

CPO HOSPICE PT NOT PRESENT <30 MIN

Facility

$175.00

Service Code	CPT 99377
Hospital Charge Code	9799377
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

CPO HOSPICE PT NOT PRESENT <30 MIN

Facility

$175.00

Service Code	CPT 99377
Hospital Charge Code	9799377
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 NH PT NOT PRESENT <30 MIN

Facility

$180.00

Service Code	CPT 99379
Hospital Charge Code	9899379
Hospital Revenue Code	521
Rate for Payer: Cash Price	$162.00

CPO NH PT NOT PRESENT <30 MIN

Facility

$180.00

Service Code	CPT 99379
Hospital Charge Code	9799379
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 NH PT NOT PRESENT <30 MIN

Facility

$180.00

Service Code	CPT 99379
Hospital Charge Code	9899379
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 NH PT NOT PRESENT <30 MIN

Facility

$180.00

Service Code	CPT 99379
Hospital Charge Code	9799379
Hospital Revenue Code	521
Rate for Payer: Cash Price	$162.00

CPO NH PT NOT PRESENT <30 MIN

Facility

$172.00

Service Code	CPT 99379
Hospital Charge Code	4299379
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 NH PT NOT PRESENT <30 MIN

Facility

$172.00

Service Code	CPT 99379
Hospital Charge Code	4299379
Hospital Revenue Code	525
Rate for Payer: Cash Price	$154.80

CPO NH PT NOT PRESENT >30 MIN

Facility

$265.00

Service Code	CPT 99380
Hospital Charge Code	9899380
Hospital Revenue Code	521
Rate for Payer: Cash Price	$238.50

CPO NH PT NOT PRESENT >30 MIN

Facility

$265.00

Service Code	CPT 99380
Hospital Charge Code	9899380
Hospital Revenue Code	521
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 NH PT NOT PRESENT >30 MIN

Facility

$265.00

Service Code	CPT 99380
Hospital Charge Code	5299380
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 NH PT NOT PRESENT >30 MIN

Facility

$180.00

Service Code	CPT 99379
Hospital Charge Code	5299379
Hospital Revenue Code	525
Rate for Payer: Cash Price	$162.00

CPO NH PT NOT PRESENT >30 MIN

Facility

$254.00

Service Code	CPT 99380
Hospital Charge Code	4299380
Hospital Revenue Code	525
Min. Negotiated Rate	$150.37
Max. Negotiated Rate	$181.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$181.36
Rate for Payer: Cash Price	$228.60
Rate for Payer: Cash Price	$228.60
Rate for Payer: UnitedHealthcare Commercial	$169.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CPO NH PT NOT PRESENT >30 MIN

Facility

$180.00

Service Code	CPT 99379
Hospital Charge Code	5299379
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 NH PT NOT PRESENT >30 MIN

Facility

$265.00

Service Code	CPT 99380
Hospital Charge Code	5299380
Hospital Revenue Code	525
Rate for Payer: Cash Price	$238.50

CPO NH PT NOT PRESENT >30 MIN

Facility

$254.00

Service Code	CPT 99380
Hospital Charge Code	4299380
Hospital Revenue Code	525
Rate for Payer: Cash Price	$228.60

CPO NH PT NOT PRESENT >30 MIN

Facility

$265.00

Service Code	CPT 99380
Hospital Charge Code	9799380
Hospital Revenue Code	521
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 NH PT NOT PRESENT >30 MIN

Facility

$265.00

Service Code	CPT 99380
Hospital Charge Code	9799380
Hospital Revenue Code	521
Rate for Payer: Cash Price	$238.50

CPR - PHYSICIAN ADMINISTERED

Professional

Both

$1,717.00

Service Code	CPT 92950
Hospital Charge Code	1892950
Hospital Revenue Code	981
Min. Negotiated Rate	$166.46
Max. Negotiated Rate	$600.95
Rate for Payer: Aetna Commercial/Medicare Advantage	$166.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$250.85
Rate for Payer: Cash Price	$1,545.30
Rate for Payer: Cash Price	$1,545.30
Rate for Payer: Cigna Commercial HMO & PPO	$166.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$250.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$275.94
Rate for Payer: Home State Health Plan Medicare Advantage	$166.46
Rate for Payer: Optum Medicare Advantage	$600.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$250.85

CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC

Facility

$28,765.66

Service Code	MSDRG 073
Min. Negotiated Rate	$14,382.83
Max. Negotiated Rate	$28,765.66
Rate for Payer: Aetna Medicare Advantage	$14,382.83
Rate for Payer: Cigna Commercial HMO & PPO	$14,382.83
Rate for Payer: Home State Health Plan Medicare Advantage	$14,382.83
Rate for Payer: Humana Commercial	$28,765.66
Rate for Payer: Humana Medicare Advantage	$14,382.83

Know your out-of-pocket cost for care.

All Charges