Madison Medical Center

All Charges

Charge

Type

Setting

Price

HOME VISIT EST PT LEVEL II

Facility

$155.00

Service Code	CPT 99348
Hospital Charge Code	4499348
Hospital Revenue Code	521
Rate for Payer: Cash Price	$139.50

HOME VISIT EST PT LEVEL II

Facility

$155.00

Service Code	CPT 99348
Hospital Charge Code	4499348
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 LEVEL 4

Facility

$300.00

Service Code	CPT 99350
Hospital Charge Code	9799350
Hospital Revenue Code	521
Rate for Payer: Cash Price	$270.00

HOME VISIT LEVEL 4

Facility

$300.00

Service Code	CPT 99350
Hospital Charge Code	9799350
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$214.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.20
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: UnitedHealthcare Commercial	$200.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HOMOCYSTINE

Facility

$210.00

Service Code	CPT 83090
Hospital Charge Code	2282133
Hospital Revenue Code	302
Min. Negotiated Rate	$16.13
Max. Negotiated Rate	$149.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.13
Rate for Payer: Aetna Medicare Advantage	$17.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$124.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cigna Commercial HMO & PPO	$17.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.26
Rate for Payer: Home State Health Plan Medicare Advantage	$17.92
Rate for Payer: Humana Commercial	$35.84
Rate for Payer: Humana Medicare Advantage	$17.92
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$75.60

HOMOCYSTINE

Facility

$210.00

Service Code	CPT 83090
Hospital Charge Code	2282133
Hospital Revenue Code	302
Rate for Payer: Cash Price	$189.00

HOMOCYSTINE URINE

Facility

$521.00

Service Code	CPT 83090
Hospital Charge Code	2282615
Hospital Revenue Code	302
Rate for Payer: Cash Price	$468.90

HOMOCYSTINE URINE

Facility

$521.00

Service Code	CPT 83090
Hospital Charge Code	2282615
Hospital Revenue Code	302
Min. Negotiated Rate	$16.13
Max. Negotiated Rate	$371.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.13
Rate for Payer: Aetna Medicare Advantage	$17.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$308.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$371.99
Rate for Payer: Cash Price	$468.90
Rate for Payer: Cash Price	$468.90
Rate for Payer: Cash Price	$468.90
Rate for Payer: Cigna Commercial HMO & PPO	$17.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.26
Rate for Payer: Home State Health Plan Medicare Advantage	$17.92
Rate for Payer: Humana Commercial	$35.84
Rate for Payer: Humana Medicare Advantage	$17.92
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$187.56

HOMORRHOIDECTOMY

Professional

Both

$1,231.00

Service Code	CPT 46255
Hospital Charge Code	4146255
Hospital Revenue Code	975
Min. Negotiated Rate	$328.02
Max. Negotiated Rate	$440.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$328.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$400.73
Rate for Payer: Cash Price	$1,107.90
Rate for Payer: Cash Price	$1,107.90
Rate for Payer: Cigna Commercial HMO & PPO	$328.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$400.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$440.80
Rate for Payer: Home State Health Plan Medicare Advantage	$328.02
Rate for Payer: Optum Medicare Advantage	$430.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$400.73

HOMOVANILLIC ACID RANDOM URINE

Facility

$91.00

Service Code	CPT 83150
Hospital Charge Code	2283150
Hospital Revenue Code	301
Rate for Payer: Cash Price	$81.90

HOMOVANILLIC ACID RANDOM URINE

Facility

$91.00

Service Code	CPT 83150
Hospital Charge Code	2283150
Hospital Revenue Code	301
Min. Negotiated Rate	$20.17
Max. Negotiated Rate	$64.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$20.17
Rate for Payer: Aetna Medicare Advantage	$22.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cigna Commercial HMO & PPO	$22.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21.58
Rate for Payer: Home State Health Plan Medicare Advantage	$22.41
Rate for Payer: Humana Commercial	$44.82
Rate for Payer: Humana Medicare Advantage	$22.41
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

HOSP. DISCH. < 30 MIN.

Professional

Both

$205.00

Service Code	CPT 99238
Hospital Charge Code	5299238
Hospital Revenue Code	987
Min. Negotiated Rate	$58.97
Max. Negotiated Rate	$71.86
Rate for Payer: Aetna Commercial/Medicare Advantage	$71.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$58.97
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$71.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$64.87
Rate for Payer: Home State Health Plan Medicare Advantage	$71.86
Rate for Payer: Optum Medicare Advantage	$71.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$58.97

HOSP. DISCH. > 30 MIN.

Professional

Both

$285.00

Service Code	CPT 99239
Hospital Charge Code	5299239
Hospital Revenue Code	987
Min. Negotiated Rate	$86.23
Max. Negotiated Rate	$102.35
Rate for Payer: Aetna Commercial/Medicare Advantage	$102.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$86.23
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cigna Commercial HMO & PPO	$102.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$86.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$94.85
Rate for Payer: Home State Health Plan Medicare Advantage	$102.35
Rate for Payer: Optum Medicare Advantage	$99.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$86.23

HOSP. DISCH. < 30 MINUTES

Professional

Both

$205.00

Service Code	CPT 99238
Hospital Charge Code	4499238
Hospital Revenue Code	987
Min. Negotiated Rate	$58.97
Max. Negotiated Rate	$71.86
Rate for Payer: Aetna Commercial/Medicare Advantage	$71.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$58.97
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$71.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$64.87
Rate for Payer: Home State Health Plan Medicare Advantage	$71.86
Rate for Payer: Optum Medicare Advantage	$71.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$58.97

HOSP. DISCH. > 30 MINUTES

Professional

Both

$285.00

Service Code	CPT 99239
Hospital Charge Code	9499239
Hospital Revenue Code	987
Min. Negotiated Rate	$86.23
Max. Negotiated Rate	$102.35
Rate for Payer: Aetna Commercial/Medicare Advantage	$102.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$86.23
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cigna Commercial HMO & PPO	$102.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$86.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$94.85
Rate for Payer: Home State Health Plan Medicare Advantage	$102.35
Rate for Payer: Optum Medicare Advantage	$99.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$86.23

HOSP. DISCH. > 30 MINUTES

Professional

Both

$290.00

Service Code	CPT 99239
Hospital Charge Code	4499239
Hospital Revenue Code	987
Min. Negotiated Rate	$86.23
Max. Negotiated Rate	$102.35
Rate for Payer: Aetna Commercial/Medicare Advantage	$102.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$86.23
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cigna Commercial HMO & PPO	$102.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$86.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$94.85
Rate for Payer: Home State Health Plan Medicare Advantage	$102.35
Rate for Payer: Optum Medicare Advantage	$101.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$86.23

HOSP INITIAL OBSERVATION CARE HIGH COMPL

Professional

Both

$450.00

Service Code	CPT 99223
Hospital Charge Code	4199220
Hospital Revenue Code	975
Min. Negotiated Rate	$151.92
Max. Negotiated Rate	$178.83
Rate for Payer: Aetna Commercial/Medicare Advantage	$151.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$162.57
Rate for Payer: Cash Price	$405.00
Rate for Payer: Cash Price	$405.00
Rate for Payer: Cigna Commercial HMO & PPO	$151.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$178.83
Rate for Payer: Home State Health Plan Medicare Advantage	$151.92
Rate for Payer: Optum Medicare Advantage	$157.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$162.57

HOSPITAL ADMISSIONS OPO

Professional

Both

$235.00

Service Code	CPT 99221
Hospital Charge Code	5499218
Hospital Revenue Code	975
Min. Negotiated Rate	$72.43
Max. Negotiated Rate	$90.62
Rate for Payer: Aetna Commercial/Medicare Advantage	$72.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$82.38
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cigna Commercial HMO & PPO	$72.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$82.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$90.62
Rate for Payer: Home State Health Plan Medicare Advantage	$72.43
Rate for Payer: Optum Medicare Advantage	$82.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$82.38

HOSPITAL ADMIT (30 MIN)

Facility

$230.00

Service Code	CPT 99221
Hospital Charge Code	9699221
Rate for Payer: Cash Price	$207.00

HOSPITAL ADMIT (70 MIN)

Facility

$415.00

Service Code	CPT 99223
Hospital Charge Code	9699223
Rate for Payer: Cash Price	$373.50

HOSPITAL DISCHARGE INPATIENT <30 MIN

Facility

$108.50

Service Code	CPT 99238
Hospital Charge Code	3999238
Hospital Revenue Code	521
Min. Negotiated Rate	$64.23
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$64.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$77.47
Rate for Payer: Cash Price	$97.65
Rate for Payer: Cash Price	$97.65
Rate for Payer: UnitedHealthcare Commercial	$72.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HOSPITAL DISCHARGE INPATIENT <30 MIN

Facility

$108.50

Service Code	CPT 99238
Hospital Charge Code	3999238
Hospital Revenue Code	521
Rate for Payer: Cash Price	$97.65

HOSPITAL DISCHARGE MANAGEMENT

Facility

$180.00

Service Code	CPT 99238
Hospital Charge Code	9699238
Rate for Payer: Cash Price	$162.00

HOSPITAL DISCHARGE OBS

Professional

Both

$204.00

Service Code	CPT 99238
Hospital Charge Code	5499217
Hospital Revenue Code	975
Min. Negotiated Rate	$58.97
Max. Negotiated Rate	$71.86
Rate for Payer: Aetna Commercial/Medicare Advantage	$71.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$58.97
Rate for Payer: Cash Price	$183.60
Rate for Payer: Cash Price	$183.60
Rate for Payer: Cigna Commercial HMO & PPO	$71.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$64.87
Rate for Payer: Home State Health Plan Medicare Advantage	$71.86
Rate for Payer: Optum Medicare Advantage	$71.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$58.97

HOSPITAL FOLLOW UP (15 MIN)

Facility

$115.00

Service Code	CPT 99231
Hospital Charge Code	9699231
Rate for Payer: Cash Price	$103.50

Know your out-of-pocket cost for care.

All Charges