Madison Medical Center

All Charges

Charge

Type

Setting

Price

INITIAL NH ADMIT

Facility

$185.00

Service Code	CPT 99304
Hospital Charge Code	5299304
Hospital Revenue Code	525
Min. Negotiated Rate	$109.52
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$109.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.09
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: UnitedHealthcare Commercial	$123.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INITIAL NH ADMIT

Facility

$91.00

Service Code	CPT 99304
Hospital Charge Code	5299301
Hospital Revenue Code	525
Rate for Payer: Cash Price	$81.90

INITIAL NH ADMIT

Facility

$185.00

Service Code	CPT 99304
Hospital Charge Code	5299304
Hospital Revenue Code	525
Rate for Payer: Cash Price	$166.50

INITIAL NH ADMIT <30 MIN

Facility

$330.00

Service Code	CPT 99306
Hospital Charge Code	5299306
Hospital Revenue Code	525
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

INITIAL NH ADMIT <30 MIN

Facility

$330.00

Service Code	CPT 99306
Hospital Charge Code	5299306
Hospital Revenue Code	525
Rate for Payer: Cash Price	$297.00

INITIAL NH ADMIT <30 MIN

Facility

$169.50

Service Code	CPT 99306
Hospital Charge Code	5299303
Hospital Revenue Code	525
Rate for Payer: Cash Price	$152.55

INITIAL NH ADMIT <30 MIN

Facility

$169.50

Service Code	CPT 99306
Hospital Charge Code	5299303
Hospital Revenue Code	525
Min. Negotiated Rate	$100.34
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$121.02
Rate for Payer: Cash Price	$152.55
Rate for Payer: Cash Price	$152.55
Rate for Payer: UnitedHealthcare Commercial	$113.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INITIAL NH ADMIT >30 MIN

Facility

$250.00

Service Code	CPT 99305
Hospital Charge Code	5299305
Hospital Revenue Code	525
Rate for Payer: Cash Price	$225.00

INITIAL NH ADMIT >30 MIN

Facility

$121.50

Service Code	CPT 99305
Hospital Charge Code	5299302
Hospital Revenue Code	525
Rate for Payer: Cash Price	$109.35

INITIAL NH ADMIT >30 MIN

Facility

$121.50

Service Code	CPT 99305
Hospital Charge Code	5299302
Hospital Revenue Code	525
Min. Negotiated Rate	$71.93
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$71.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$86.75
Rate for Payer: Cash Price	$109.35
Rate for Payer: Cash Price	$109.35
Rate for Payer: UnitedHealthcare Commercial	$81.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INITIAL NH ADMIT >30 MIN

Facility

$250.00

Service Code	CPT 99305
Hospital Charge Code	5299305
Hospital Revenue Code	525
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

INITIAL OBSERV. CARE .

Professional

Both

$333.00

Service Code	CPT 99222
Hospital Charge Code	4199219
Hospital Revenue Code	975
Min. Negotiated Rate	$110.86
Max. Negotiated Rate	$121.95
Rate for Payer: Aetna Commercial/Medicare Advantage	$113.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$110.86
Rate for Payer: Cash Price	$299.70
Rate for Payer: Cash Price	$299.70
Rate for Payer: Cigna Commercial HMO & PPO	$113.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$110.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$121.95
Rate for Payer: Home State Health Plan Medicare Advantage	$113.62
Rate for Payer: Optum Medicare Advantage	$116.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$110.86

INITIAL RH ADMIT

Facility

$100.00

Service Code	CPT 99341
Hospital Charge Code	5299324
Hospital Revenue Code	525
Rate for Payer: Cash Price	$90.00

INITIAL RH ADMIT

Facility

$100.00

Service Code	CPT 99341
Hospital Charge Code	5299324
Hospital Revenue Code	525
Min. Negotiated Rate	$59.20
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INITIAL RH ADMIT <30 MIN

Facility

$135.00

Service Code	CPT 99342
Hospital Charge Code	5299325
Hospital Revenue Code	525
Rate for Payer: Cash Price	$121.50

INITIAL RH ADMIT <30 MIN

Facility

$135.00

Service Code	CPT 99342
Hospital Charge Code	5299325
Hospital Revenue Code	525
Min. Negotiated Rate	$79.92
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INITIAL RH ADMIT >30 MIN

Facility

$165.00

Service Code	CPT 99344
Hospital Charge Code	5299326
Hospital Revenue Code	525
Rate for Payer: Cash Price	$148.50

INITIAL RH ADMIT >30 MIN

Facility

$165.00

Service Code	CPT 99344
Hospital Charge Code	5299326
Hospital Revenue Code	525
Min. Negotiated Rate	$97.68
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: UnitedHealthcare Commercial	$110.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INITIAL RH ADMIT 45 MIN

Facility

$185.00

Service Code	CPT 99344
Hospital Charge Code	5299327
Hospital Revenue Code	525
Min. Negotiated Rate	$109.52
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$109.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.09
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: UnitedHealthcare Commercial	$123.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INITIAL RH ADMIT 45 MIN

Facility

$185.00

Service Code	CPT 99344
Hospital Charge Code	5299327
Hospital Revenue Code	525
Rate for Payer: Cash Price	$166.50

INITIAL RH ADMIT 75 MIN

Facility

$205.00

Service Code	CPT 99345
Hospital Charge Code	5299328
Hospital Revenue Code	525
Rate for Payer: Cash Price	$184.50

INITIAL RH ADMIT 75 MIN

Facility

$205.00

Service Code	CPT 99345
Hospital Charge Code	5299328
Hospital Revenue Code	525
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

INIT INPAT CONS COMPLEX 80 MIN

Facility

$462.00

Service Code	CPT 99255
Hospital Charge Code	5499255
Rate for Payer: Cash Price	$415.80

INIT INPAT CONS EXTENDED 40 MIN

Facility

$284.00

Service Code	CPT 99253
Hospital Charge Code	5499253
Rate for Payer: Cash Price	$255.60

INIT INPAT CONS INTERMEDIATE 30 MIN

Facility

$226.00

Service Code	CPT 99252
Hospital Charge Code	5499252
Rate for Payer: Cash Price	$203.40

Know your out-of-pocket cost for care.

All Charges