Madison Medical Center

All Charges

Charge

Type

Setting

Price

HOLTOR MONITORING HOOKUP,RECORD,& DISCON

Facility

$263.00

Service Code	CPT 93225
Hospital Charge Code	5293225
Hospital Revenue Code	521
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$155.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$187.78
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$175.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HOLTOR MONITORING HOOKUP,RECORD,& DISCON

Facility

$263.00

Service Code	CPT 93225
Hospital Charge Code	4493225
Hospital Revenue Code	521
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$155.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$187.78
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$175.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HOLTOR MONITORING HOOKUP,RECORD,& DISCON

Facility

$263.00

Service Code	CPT 93225
Hospital Charge Code	4493225
Hospital Revenue Code	521
Rate for Payer: Cash Price	$236.70

HOLTOR MONITORING, HOOKUP,RECORD&DISCONN

Facility

$621.00

Service Code	CPT 93225
Hospital Charge Code	4093225
Hospital Revenue Code	731
Rate for Payer: Cash Price	$558.90

HOLTOR MONITORING, HOOKUP,RECORD&DISCONN

Facility

$621.00

Service Code	CPT 93225
Hospital Charge Code	4093225
Hospital Revenue Code	731
Min. Negotiated Rate	$119.94
Max. Negotiated Rate	$443.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$367.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$443.39
Rate for Payer: Cash Price	$558.90
Rate for Payer: Cash Price	$558.90
Rate for Payer: Cash Price	$558.90
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$119.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$414.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$223.56

HOLTOR MONITORING PHYSICIAN REV & INTERP

Facility

$315.00

Service Code	CPT 93227
Hospital Charge Code	4493227
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$224.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$186.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$224.91
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: UnitedHealthcare Commercial	$210.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HOLTOR MONITORING PHYSICIAN REV & INTERP

Facility

$315.00

Service Code	CPT 93227
Hospital Charge Code	4493227
Hospital Revenue Code	521
Rate for Payer: Cash Price	$283.50

HOME OXYGEN QUALIFIER

Facility

$280.00

Service Code	CPT 94761
Hospital Charge Code	4594761
Hospital Revenue Code	272
Min. Negotiated Rate	$100.80
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: UnitedHealthcare Commercial	$186.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$100.80

HOME OXYGEN QUALIFIER

Facility

$280.00

Service Code	CPT 94761
Hospital Charge Code	4594761
Hospital Revenue Code	272
Rate for Payer: Cash Price	$252.00

HOME VISIT

Facility

$130.00

Service Code	CPT 99341
Hospital Charge Code	4499341
Hospital Revenue Code	521
Rate for Payer: Cash Price	$117.00

HOME VISIT

Facility

$130.00

Service Code	CPT 99341
Hospital Charge Code	4499341
Hospital Revenue Code	521
Min. Negotiated Rate	$76.96
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.82
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: UnitedHealthcare Commercial	$86.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HOME VISIT +60MIN

Facility

$285.00

Service Code	CPT 99344
Hospital Charge Code	4199344
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

HOME VISIT +60MIN

Facility

$285.00

Service Code	CPT 99344
Hospital Charge Code	4199344
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

HOME VISIT EST PT COMP OVER 60 MIN

Facility

$325.00

Service Code	CPT 99350
Hospital Charge Code	4499350
Hospital Revenue Code	521
Rate for Payer: Cash Price	$292.50

HOME VISIT EST PT COMP OVER 60 MIN

Facility

$325.00

Service Code	CPT 99350
Hospital Charge Code	4499350
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$232.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.05
Rate for Payer: Cash Price	$292.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: UnitedHealthcare Commercial	$216.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HOME VISIT EST PT DETAILED VISIT

Facility

$230.00

Service Code	CPT 99349
Hospital Charge Code	9799349
Hospital Revenue Code	521
Rate for Payer: Cash Price	$207.00

HOME VISIT EST PT DETAILED VISIT

Facility

$230.00

Service Code	CPT 99349
Hospital Charge Code	9799349
Hospital Revenue Code	521
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$136.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$164.22
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: UnitedHealthcare Commercial	$153.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HOME VISIT EST PT LEVEL 1

Facility

$110.00

Service Code	CPT 99347
Hospital Charge Code	4299347
Hospital Revenue Code	521
Rate for Payer: Cash Price	$99.00

HOME VISIT EST PT LEVEL 1

Facility

$110.00

Service Code	CPT 99347
Hospital Charge Code	4299347
Hospital Revenue Code	521
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: UnitedHealthcare Commercial	$73.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HOME VISIT EST PT LEVEL 2

Facility

$155.00

Service Code	CPT 99348
Hospital Charge Code	4299348
Hospital Revenue Code	521
Min. Negotiated Rate	$91.76
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$91.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$110.67
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: UnitedHealthcare Commercial	$103.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HOME VISIT EST PT LEVEL 2

Facility

$155.00

Service Code	CPT 99348
Hospital Charge Code	4299348
Hospital Revenue Code	521
Rate for Payer: Cash Price	$139.50

HOME VISIT EST PT LEVEL 3

Facility

$230.00

Service Code	CPT 99349
Hospital Charge Code	4299349
Hospital Revenue Code	521
Rate for Payer: Cash Price	$207.00

HOME VISIT EST PT LEVEL 3

Facility

$230.00

Service Code	CPT 99349
Hospital Charge Code	4299349
Hospital Revenue Code	521
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$136.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$164.22
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: UnitedHealthcare Commercial	$153.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HOME VISIT EST PT LEVEL 4

Facility

$325.00

Service Code	CPT 99350
Hospital Charge Code	4299350
Hospital Revenue Code	521
Rate for Payer: Cash Price	$292.50

HOME VISIT EST PT LEVEL 4

Facility

$325.00

Service Code	CPT 99350
Hospital Charge Code	4299350
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$232.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$192.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$232.05
Rate for Payer: Cash Price	$292.50
Rate for Payer: Cash Price	$292.50
Rate for Payer: UnitedHealthcare Commercial	$216.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges