Madison Medical Center

All Charges

Charge

Type

Setting

Price

HCY NP NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	4299381
Hospital Revenue Code	521
Min. Negotiated Rate	$139.12
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.79
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: UnitedHealthcare Commercial	$156.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY NP NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	4299381
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

HCY Screening

Facility

$81.00

Service Code	CPT W0025
Hospital Charge Code	4400025
Hospital Revenue Code	521
Rate for Payer: Cash Price	$72.90

HCY Screening

Facility

$81.00

Service Code	CPT W0025
Hospital Charge Code	4400025
Hospital Revenue Code	521
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING

Facility

$81.00

Service Code	CPT W0025
Hospital Charge Code	3900025
Hospital Revenue Code	521
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING

Facility

$81.00

Hospital Charge Code	440025
Hospital Revenue Code	521
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING

Facility

$81.00

Service Code	CPT W0025
Hospital Charge Code	3900025
Hospital Revenue Code	521
Rate for Payer: Cash Price	$72.90

HCY SCREENING

Facility

$77.50

Hospital Charge Code	4200025
Hospital Revenue Code	521
Min. Negotiated Rate	$45.88
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$45.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$55.34
Rate for Payer: Cash Price	$69.75
Rate for Payer: Cash Price	$69.75
Rate for Payer: UnitedHealthcare Commercial	$51.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING

Facility

$81.00

Service Code	CPT 99211
Hospital Charge Code	9600025
Hospital Revenue Code	521
Rate for Payer: Cash Price	$72.90

HCY SCREENING

Facility

$81.00

Service Code	CPT 99211
Hospital Charge Code	9600025
Hospital Revenue Code	521
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING

Facility

$77.50

Hospital Charge Code	4200025
Hospital Revenue Code	521
Rate for Payer: Cash Price	$69.75

HCY SCREENING

Facility

$81.00

Hospital Charge Code	5200025
Hospital Revenue Code	521
Rate for Payer: Cash Price	$72.90

HCY SCREENING

Facility

$81.00

Hospital Charge Code	440025
Hospital Revenue Code	521
Rate for Payer: Cash Price	$72.90

HCY SCREENING

Facility

$81.00

Hospital Charge Code	5200025
Hospital Revenue Code	521
Min. Negotiated Rate	$47.95
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING EST PT 12 - 17

Facility

$235.00

Service Code	CPT 99394
Hospital Charge Code	9699394
Hospital Revenue Code	521
Min. Negotiated Rate	$139.12
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.79
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: UnitedHealthcare Commercial	$156.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING EST PT 12 - 17

Facility

$235.00

Service Code	CPT 99394
Hospital Charge Code	5299394
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

HCY SCREENING EST PT 12 - 17

Facility

$235.00

Service Code	CPT 99394
Hospital Charge Code	3999394
Hospital Revenue Code	521
Min. Negotiated Rate	$139.12
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.79
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: UnitedHealthcare Commercial	$156.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING EST PT 12 - 17

Facility

$235.00

Service Code	CPT 99394
Hospital Charge Code	5299394
Hospital Revenue Code	521
Min. Negotiated Rate	$139.12
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.79
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: UnitedHealthcare Commercial	$156.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING EST PT 12 - 17

Facility

$235.00

Service Code	CPT 99394
Hospital Charge Code	9699394
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

HCY SCREENING EST PT 12 - 17

Facility

$235.00

Service Code	CPT 99394
Hospital Charge Code	3999394
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

HCY Screening EST PT 12 - 17 YRS

Facility

$235.00

Service Code	CPT 99394
Hospital Charge Code	4499394
Hospital Revenue Code	521
Min. Negotiated Rate	$139.12
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.79
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: UnitedHealthcare Commercial	$156.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY Screening EST PT 12 - 17 YRS

Facility

$235.00

Service Code	CPT 99394
Hospital Charge Code	4499394
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

HCY SCREENING EST PT 1 - 4

Facility

$220.00

Service Code	CPT 99392
Hospital Charge Code	3999392
Hospital Revenue Code	521
Min. Negotiated Rate	$130.24
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$130.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.08
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: UnitedHealthcare Commercial	$146.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING EST PT 1 - 4

Facility

$220.00

Service Code	CPT 99392
Hospital Charge Code	5299392
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.00

HCY SCREENING EST PT 1 - 4

Facility

$220.00

Service Code	CPT 99392
Hospital Charge Code	3999392
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.00

Know your out-of-pocket cost for care.

All Charges