Madison Medical Center

All Charges

Charge

Type

Setting

Price

HCY Screening EST PT AGE 5 - 11

Facility

$220.00

Service Code	CPT 99393
Hospital Charge Code	4499393
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 AGE 5 - 11

Facility

$220.00

Service Code	CPT 99393
Hospital Charge Code	9699393
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.00

HCY SCREENING EST PT AGE 5 - 11

Facility

$220.00

Service Code	CPT 99393
Hospital Charge Code	9599393
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.00

HCY SCREENING EST PT AGE 5 - 11

Facility

$220.00

Service Code	CPT 99393
Hospital Charge Code	9699393
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 AGE 5 - 11

Facility

$220.00

Service Code	CPT 99393
Hospital Charge Code	9599393
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 AGE 65 AND OVER

Facility

$330.00

Service Code	CPT 99397
Hospital Charge Code	9599397
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 AGE 65 AND OVER

Facility

$330.00

Service Code	CPT 99397
Hospital Charge Code	9599397
Hospital Revenue Code	521
Rate for Payer: Cash Price	$297.00

HCY SCREENING EST PT AGE 65 & OVER

Facility

$330.00

Service Code	CPT 99397
Hospital Charge Code	4299397
Hospital Revenue Code	521
Rate for Payer: Cash Price	$297.00

HCY SCREENING EST PT AGE 65 & OVER

Facility

$330.00

Service Code	CPT 99397
Hospital Charge Code	4299397
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 NEWBORN

Facility

$205.00

Service Code	CPT 99391
Hospital Charge Code	4499391
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY Screening EST PT NEWBORN

Facility

$205.00

Service Code	CPT 99391
Hospital Charge Code	4499391
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

HCY SCREENING EST PT NEWBORN

Facility

$205.00

Service Code	CPT 99391
Hospital Charge Code	5299391
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

HCY SCREENING EST PT NEWBORN

Facility

$205.00

Service Code	CPT 99391
Hospital Charge Code	9699391
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

HCY SCREENING EST PT NEWBORN

Facility

$205.00

Service Code	CPT 99391
Hospital Charge Code	9599391
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING EST PT NEWBORN

Facility

$205.00

Service Code	CPT 99391
Hospital Charge Code	9699391
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING EST PT NEWBORN

Facility

$205.00

Service Code	CPT 99391
Hospital Charge Code	5299391
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING EST PT NEWBORN

Facility

$205.00

Service Code	CPT 99391
Hospital Charge Code	9599391
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

HCY SCREENING EST PT NEWBORN TO 1 YEAR

Facility

$205.00

Service Code	CPT 99391
Hospital Charge Code	3999391
Hospital Revenue Code	521
Min. Negotiated Rate	$121.36
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING EST PT NEWBORN TO 1 YEAR

Facility

$205.00

Service Code	CPT 99391
Hospital Charge Code	3999391
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

HCY SCREENING NEW PATIENT 1 - 4

Facility

$250.00

Service Code	CPT 99382
Hospital Charge Code	9699382
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

HCY SCREENING NEW PATIENT 1 - 4

Facility

$250.00

Service Code	CPT 99382
Hospital Charge Code	9699382
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

HCY SCREENING NEW PATIENT 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	9699383
Hospital Revenue Code	521
Min. Negotiated Rate	$153.92
Max. Negotiated Rate	$185.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: UnitedHealthcare Commercial	$173.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING NEW PATIENT 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	9699383
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

HCY SCREENING NEW PATIENT AGE 12 - 17

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	5299384
Hospital Revenue Code	521
Min. Negotiated Rate	$171.68
Max. Negotiated Rate	$207.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$171.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$207.06
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: UnitedHealthcare Commercial	$193.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING NEW PATIENT AGE 12 - 17

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	5299384
Hospital Revenue Code	521
Rate for Payer: Cash Price	$261.00

Know your out-of-pocket cost for care.

All Charges