Madison Medical Center

All Charges

Charge

Type

Setting

Price

HCY SCREENING NEW PT AGE 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	9599383
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 PT AGE 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	4299383
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 PT AGE 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	4299383
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

HCY SCREENING NEW PT AGE 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	9599383
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

HCY SCREENING NEW PT AGE 65 AND OVER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	9599387
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$278.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$230.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$278.46
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: UnitedHealthcare Commercial	$260.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING NEW PT AGE 65 AND OVER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	9599387
Hospital Revenue Code	521
Rate for Payer: Cash Price	$351.00

HCY SCREENING NEW PT AGE 65 & OVER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	3999387
Hospital Revenue Code	521
Rate for Payer: Cash Price	$351.00

HCY SCREENING NEW PT AGE 65 & OVER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	4299387
Hospital Revenue Code	521
Rate for Payer: Cash Price	$351.00

HCY SCREENING NEW PT AGE 65 & OVER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	3999387
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$278.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$230.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$278.46
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: UnitedHealthcare Commercial	$260.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING NEW PT AGE 65 & OVER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	4299387
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$278.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$230.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$278.46
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: UnitedHealthcare Commercial	$260.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HCY SCREENING NEW PT NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	9599381
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 NEW PT NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	4499381
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

HCY SCREENING NEW PT NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	9599381
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

HCY SCREENING NEW PT NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	4499381
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 NEW PT NEWBORN TO 1 YEAR

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	3999381
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 NEW PT NEWBORN TO 1 YEAR

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	3999381
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

HDL

Facility

$153.00

Service Code	CPT 83718
Hospital Charge Code	228888
Hospital Revenue Code	301
Rate for Payer: Cash Price	$137.70

HDL

Facility

$153.00

Service Code	CPT 83718
Hospital Charge Code	228888
Hospital Revenue Code	301
Min. Negotiated Rate	$7.37
Max. Negotiated Rate	$109.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.37
Rate for Payer: Aetna Medicare Advantage	$8.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cigna Commercial HMO & PPO	$8.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.89
Rate for Payer: Home State Health Plan Medicare Advantage	$8.19
Rate for Payer: Humana Commercial	$16.38
Rate for Payer: Humana Medicare Advantage	$8.19
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

HE4

Facility

$526.00

Service Code	CPT 86305
Hospital Charge Code	2286305
Hospital Revenue Code	301
Min. Negotiated Rate	$18.73
Max. Negotiated Rate	$375.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$18.73
Rate for Payer: Aetna Medicare Advantage	$20.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$311.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$375.56
Rate for Payer: Cash Price	$473.40
Rate for Payer: Cash Price	$473.40
Rate for Payer: Cash Price	$473.40
Rate for Payer: Cigna Commercial HMO & PPO	$20.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$18.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.04
Rate for Payer: Home State Health Plan Medicare Advantage	$20.81
Rate for Payer: Humana Commercial	$41.62
Rate for Payer: Humana Medicare Advantage	$20.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$18.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$189.36

HE4

Facility

$526.00

Service Code	CPT 86305
Hospital Charge Code	2286305
Hospital Revenue Code	301
Rate for Payer: Cash Price	$473.40

HEADACHES WITH MCC

Facility

$21,185.88

Service Code	MSDRG 102
Min. Negotiated Rate	$10,592.94
Max. Negotiated Rate	$21,185.88
Rate for Payer: Aetna Medicare Advantage	$10,592.94
Rate for Payer: Cigna Commercial HMO & PPO	$10,592.94
Rate for Payer: Home State Health Plan Medicare Advantage	$10,592.94
Rate for Payer: Humana Commercial	$21,185.88
Rate for Payer: Humana Medicare Advantage	$10,592.94

HEADACHES WITHOUT MCC

Facility

$16,732.10

Service Code	MSDRG 103
Min. Negotiated Rate	$8,366.05
Max. Negotiated Rate	$16,732.10
Rate for Payer: Aetna Medicare Advantage	$8,366.05
Rate for Payer: Cigna Commercial HMO & PPO	$8,366.05
Rate for Payer: Home State Health Plan Medicare Advantage	$8,366.05
Rate for Payer: Humana Commercial	$16,732.10
Rate for Payer: Humana Medicare Advantage	$8,366.05

HEAD BLOCKS

Facility

$43.00

Hospital Charge Code	181093
Hospital Revenue Code	271
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

HEAD BLOCKS

Facility

$43.00

Hospital Charge Code	181093
Hospital Revenue Code	271
Rate for Payer: Cash Price	$38.70

HEADLIGHT

Facility

$474.00

Hospital Charge Code	124903
Hospital Revenue Code	360
Min. Negotiated Rate	$170.64
Max. Negotiated Rate	$316.16
Rate for Payer: Cash Price	$426.60
Rate for Payer: UnitedHealthcare Commercial	$316.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$170.64

Know your out-of-pocket cost for care.

All Charges