Madison Medical Center

All Charges

Charge

Type

Setting

Price

EST PT OFFICE VISIT LEVEL1

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9299211
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 LEVEL1

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9299211
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

EST PT OFFICE VISIT LEVEL 1

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9499211
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

EST PT OFFICE VISIT LEVEL 1

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9499211
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 LEVEL 2

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9299212
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

EST PT OFFICE VISIT LEVEL 2

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9499212
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

EST PT OFFICE VISIT LEVEL 2

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9299212
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 LEVEL 2

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9499212
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 LEVEL 3

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9299213
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 LEVEL 3

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9499213
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

EST PT OFFICE VISIT LEVEL 3

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9299213
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

EST PT OFFICE VISIT LEVEL 3

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9499213
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 LEVEL 4

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9299214
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 LEVEL 4

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9299214
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

EST PT OFFICE VISIT LEVEL 4

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9499214
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 LEVEL 4

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9499214
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

EST PT OFFICE VISIT LEVEL 5

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9499215
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

EST PT OFFICE VISIT LEVEL 5

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9299215
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

EST PT OFFICE VISIT LEVEL 5

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9499215
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 LEVEL 5

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9299215
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 OZARK VISIT LEVEL 1

Facility

$85.00

Service Code	CPT 99347
Hospital Charge Code	9299334
Hospital Revenue Code	521
Min. Negotiated Rate	$50.32
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$50.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$60.69
Rate for Payer: Cash Price	$76.50
Rate for Payer: Cash Price	$76.50
Rate for Payer: UnitedHealthcare Commercial	$56.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT OZARK VISIT LEVEL 1

Facility

$85.00

Service Code	CPT 99347
Hospital Charge Code	9499334
Hospital Revenue Code	521
Rate for Payer: Cash Price	$76.50

EST PT OZARK VISIT LEVEL 1

Facility

$85.00

Service Code	CPT 99347
Hospital Charge Code	9499334
Hospital Revenue Code	521
Min. Negotiated Rate	$50.32
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$50.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$60.69
Rate for Payer: Cash Price	$76.50
Rate for Payer: Cash Price	$76.50
Rate for Payer: UnitedHealthcare Commercial	$56.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EST PT OZARK VISIT LEVEL 1

Facility

$85.00

Service Code	CPT 99347
Hospital Charge Code	9299334
Hospital Revenue Code	521
Rate for Payer: Cash Price	$76.50

EST PT OZARK VISIT LEVEL 2

Facility

$130.00

Service Code	CPT 99348
Hospital Charge Code	9299335
Hospital Revenue Code	521
Rate for Payer: Cash Price	$117.00

Know your out-of-pocket cost for care.

All Charges