Madison Medical Center

All Charges

Charge

Type

Setting

Price

EST PT NH VISIT LEVEL 1

Facility

$95.00

Service Code	CPT 99307
Hospital Charge Code	9499307
Hospital Revenue Code	521
Min. Negotiated Rate	$56.24
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$67.83
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: UnitedHealthcare Commercial	$63.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT NH VISIT LEVEL 1

Facility

$75.00

Service Code	CPT 99307
Hospital Charge Code	9299307
Hospital Revenue Code	521
Rate for Payer: Cash Price	$67.50

EST PT NH VISIT LEVEL 1

Facility

$75.00

Service Code	CPT 99307
Hospital Charge Code	9299307
Hospital Revenue Code	521
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT NH VISIT LEVEL 2

Facility

$115.00

Service Code	CPT 99308
Hospital Charge Code	9299308
Hospital Revenue Code	521
Min. Negotiated Rate	$68.08
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$68.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$82.11
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: UnitedHealthcare Commercial	$76.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT NH VISIT LEVEL 2

Facility

$140.00

Service Code	CPT 99308
Hospital Charge Code	9499308
Hospital Revenue Code	521
Min. Negotiated Rate	$82.88
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$82.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$99.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: UnitedHealthcare Commercial	$93.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT NH VISIT LEVEL 2

Facility

$140.00

Service Code	CPT 99308
Hospital Charge Code	9499308
Hospital Revenue Code	521
Rate for Payer: Cash Price	$126.00

EST PT NH VISIT LEVEL 2

Facility

$115.00

Service Code	CPT 99308
Hospital Charge Code	9299308
Hospital Revenue Code	521
Rate for Payer: Cash Price	$103.50

EST PT NH VISIT LEVEL 3

Facility

$185.00

Service Code	CPT 99309
Hospital Charge Code	9499309
Hospital Revenue Code	521
Min. Negotiated Rate	$109.52
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$109.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.09
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: UnitedHealthcare Commercial	$123.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT NH VISIT LEVEL 3

Facility

$185.00

Service Code	CPT 99309
Hospital Charge Code	9499309
Hospital Revenue Code	521
Rate for Payer: Cash Price	$166.50

EST PT NH VISIT LEVEL 3

Facility

$150.00

Service Code	CPT 99309
Hospital Charge Code	9299309
Hospital Revenue Code	521
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT NH VISIT LEVEL 3

Facility

$150.00

Service Code	CPT 99309
Hospital Charge Code	9299309
Hospital Revenue Code	521
Rate for Payer: Cash Price	$135.00

EST PT NH VISIT LEVEL 4

Facility

$245.00

Service Code	CPT 99310
Hospital Charge Code	9499310
Hospital Revenue Code	521
Rate for Payer: Cash Price	$220.50

EST PT NH VISIT LEVEL 4

Facility

$190.00

Service Code	CPT 99310
Hospital Charge Code	9299310
Hospital Revenue Code	521
Rate for Payer: Cash Price	$171.00

EST PT NH VISIT LEVEL 4

Facility

$190.00

Service Code	CPT 99310
Hospital Charge Code	9299310
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

EST PT NH VISIT LEVEL 4

Facility

$245.00

Service Code	CPT 99310
Hospital Charge Code	9499310
Hospital Revenue Code	521
Min. Negotiated Rate	$145.04
Max. Negotiated Rate	$174.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$145.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.93
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: UnitedHealthcare Commercial	$163.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT OFFICE VISIT BRIEF

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9899211
Hospital Revenue Code	521
Min. Negotiated Rate	$41.44
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT OFFICE VISIT BRIEF

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9899211
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

EST PT OFFICE VISIT COMPREHENSIVE

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9899215
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

EST PT OFFICE VISIT COMPREHENSIVE

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9899215
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$249.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$207.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$249.90
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: UnitedHealthcare Commercial	$233.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT OFFICE VISIT EXTENDED

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9899213
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

EST PT OFFICE VISIT EXTENDED

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9899214
Hospital Revenue Code	521
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$178.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT OFFICE VISIT EXTENDED

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9899213
Hospital Revenue Code	521
Min. Negotiated Rate	$94.72
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$94.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.24
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: UnitedHealthcare Commercial	$106.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT OFFICE VISIT EXTENDED

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9899214
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

EST PT OFFICE VISIT INTERMEDIATE

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9899212
Hospital Revenue Code	521
Min. Negotiated Rate	$71.04
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$71.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$85.68
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: UnitedHealthcare Commercial	$80.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT OFFICE VISIT INTERMEDIATE

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9899212
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

Know your out-of-pocket cost for care.

All Charges