Madison Medical Center

All Charges

Charge

Type

Setting

Price

HCY SCREENING EST PT 1 - 4

Facility

$220.00

Service Code	CPT 99392
Hospital Charge Code	5299392
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 18 - 39

Facility

$255.00

Service Code	CPT 99395
Hospital Charge Code	3999395
Hospital Revenue Code	521
Rate for Payer: Cash Price	$229.50

HCY SCREENING EST PT 18 - 39

Facility

$255.00

Service Code	CPT 99395
Hospital Charge Code	3999395
Hospital Revenue Code	521
Min. Negotiated Rate	$150.96
Max. Negotiated Rate	$182.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.07
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: UnitedHealthcare Commercial	$170.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING EST PT 18 - 39

Facility

$255.00

Service Code	CPT 99395
Hospital Charge Code	5299395
Hospital Revenue Code	521
Rate for Payer: Cash Price	$229.50

HCY SCREENING EST PT 18 - 39

Facility

$255.00

Service Code	CPT 99395
Hospital Charge Code	9699395
Hospital Revenue Code	521
Rate for Payer: Cash Price	$229.50

HCY SCREENING EST PT 18 - 39

Facility

$255.00

Service Code	CPT 99395
Hospital Charge Code	9699395
Hospital Revenue Code	521
Min. Negotiated Rate	$150.96
Max. Negotiated Rate	$182.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.07
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: UnitedHealthcare Commercial	$170.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING EST PT 18 - 39

Facility

$255.00

Service Code	CPT 99395
Hospital Charge Code	5299395
Hospital Revenue Code	521
Min. Negotiated Rate	$150.96
Max. Negotiated Rate	$182.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.07
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: UnitedHealthcare Commercial	$170.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY Screening EST PT 18 - 39 YEARS

Facility

$255.00

Service Code	CPT 99395
Hospital Charge Code	4499395
Hospital Revenue Code	521
Min. Negotiated Rate	$150.96
Max. Negotiated Rate	$182.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.07
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: UnitedHealthcare Commercial	$170.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY Screening EST PT 18 - 39 YEARS

Facility

$255.00

Service Code	CPT 99395
Hospital Charge Code	4499395
Hospital Revenue Code	521
Rate for Payer: Cash Price	$229.50

HCY SCREENING EST PT 40 - 64

Facility

$285.00

Service Code	CPT 99396
Hospital Charge Code	3999396
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
Max. Negotiated Rate	$203.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: UnitedHealthcare Commercial	$190.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING EST PT 40 - 64

Facility

$285.00

Service Code	CPT 99396
Hospital Charge Code	5299396
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

HCY SCREENING EST PT 40 - 64

Facility

$280.00

Service Code	CPT 99396
Hospital Charge Code	9699396
Hospital Revenue Code	521
Rate for Payer: Cash Price	$252.00

HCY SCREENING EST PT 40 - 64

Facility

$280.00

Service Code	CPT 99396
Hospital Charge Code	9699396
Hospital Revenue Code	521
Min. Negotiated Rate	$165.76
Max. Negotiated Rate	$199.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$165.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$199.92
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: UnitedHealthcare Commercial	$186.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING EST PT 40 - 64

Facility

$285.00

Service Code	CPT 99396
Hospital Charge Code	3999396
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

HCY SCREENING EST PT 40 - 64

Facility

$285.00

Service Code	CPT 99396
Hospital Charge Code	5299396
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
Max. Negotiated Rate	$203.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: UnitedHealthcare Commercial	$190.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY Screening EST PT 40 - 64 YEARS

Facility

$285.00

Service Code	CPT 99396
Hospital Charge Code	4499396
Hospital Revenue Code	521
Min. Negotiated Rate	$168.72
Max. Negotiated Rate	$203.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: UnitedHealthcare Commercial	$190.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY Screening EST PT 40 - 64 YEARS

Facility

$285.00

Service Code	CPT 99396
Hospital Charge Code	4499396
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

HCY SCREENING EST PT 5 - 11

Facility

$220.00

Service Code	CPT 99393
Hospital Charge Code	3999393
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 5 - 11

Facility

$220.00

Service Code	CPT 99393
Hospital Charge Code	5299393
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.00

HCY SCREENING EST PT 5 - 11

Facility

$220.00

Service Code	CPT 99393
Hospital Charge Code	5299393
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 5 - 11

Facility

$220.00

Service Code	CPT 99393
Hospital Charge Code	3999393
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.00

HCY SCREENING EST PT 65 & OLDER

Facility

$330.00

Service Code	CPT 99397
Hospital Charge Code	3999397
Hospital Revenue Code	521
Rate for Payer: Cash Price	$297.00

HCY SCREENING EST PT 65 & OLDER

Facility

$330.00

Service Code	CPT 99397
Hospital Charge Code	3999397
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$235.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$195.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$235.62
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: UnitedHealthcare Commercial	$220.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY Screening EST PT 65 & OVER

Facility

$330.00

Service Code	CPT 99397
Hospital Charge Code	4499397
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$235.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$195.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$235.62
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: UnitedHealthcare Commercial	$220.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY Screening EST PT 65 & OVER

Facility

$330.00

Service Code	CPT 99397
Hospital Charge Code	4499397
Hospital Revenue Code	521
Rate for Payer: Cash Price	$297.00

Know your out-of-pocket cost for care.

All Charges