Madison Medical Center

All Charges

Charge

Type

Setting

Price

NH CARE PLAN OVERSIGHT HOME HEALTH L 2

Facility

$251.00

Service Code	CPT 99375
Hospital Charge Code	9499375
Hospital Revenue Code	521
Min. Negotiated Rate	$148.59
Max. Negotiated Rate	$179.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$179.21
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cash Price	$225.90
Rate for Payer: UnitedHealthcare Commercial	$167.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH CARE PLAN OVERSIGHT HOSPICE LVL 1

Facility

$172.00

Service Code	CPT 99377
Hospital Charge Code	9499377
Hospital Revenue Code	521
Rate for Payer: Cash Price	$154.80

NH CARE PLAN OVERSIGHT HOSPICE LVL 1

Facility

$172.00

Service Code	CPT 99377
Hospital Charge Code	9499377
Hospital Revenue Code	521
Min. Negotiated Rate	$101.82
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$101.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$122.81
Rate for Payer: Cash Price	$154.80
Rate for Payer: Cash Price	$154.80
Rate for Payer: UnitedHealthcare Commercial	$114.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH CARE PLAN OVERSIGHT HOSPICE LVL 2

Facility

$265.00

Service Code	CPT 99378
Hospital Charge Code	9499378
Hospital Revenue Code	521
Rate for Payer: Cash Price	$238.50

NH CARE PLAN OVERSIGHT HOSPICE LVL 2

Facility

$265.00

Service Code	CPT 99378
Hospital Charge Code	9499378
Hospital Revenue Code	521
Min. Negotiated Rate	$156.88
Max. Negotiated Rate	$189.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$156.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$189.21
Rate for Payer: Cash Price	$238.50
Rate for Payer: Cash Price	$238.50
Rate for Payer: UnitedHealthcare Commercial	$176.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH CARE PLAN OVERSIGHT NH PT NOT PRESENT

Facility

$172.00

Service Code	CPT 99379
Hospital Charge Code	9499379
Hospital Revenue Code	521
Rate for Payer: Cash Price	$154.80

NH CARE PLAN OVERSIGHT NH PT NOT PRESENT

Facility

$172.00

Service Code	CPT 99379
Hospital Charge Code	9499379
Hospital Revenue Code	521
Min. Negotiated Rate	$101.82
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$101.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$122.81
Rate for Payer: Cash Price	$154.80
Rate for Payer: Cash Price	$154.80
Rate for Payer: UnitedHealthcare Commercial	$114.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH CARE PLAN OVERSIGHT PT NOT PRST LVL 2

Facility

$254.00

Service Code	CPT 99380
Hospital Charge Code	9499380
Hospital Revenue Code	521
Rate for Payer: Cash Price	$228.60

NH CARE PLAN OVERSIGHT PT NOT PRST LVL 2

Facility

$254.00

Service Code	CPT 99380
Hospital Charge Code	9499380
Hospital Revenue Code	521
Min. Negotiated Rate	$150.37
Max. Negotiated Rate	$181.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$150.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$181.36
Rate for Payer: Cash Price	$228.60
Rate for Payer: Cash Price	$228.60
Rate for Payer: UnitedHealthcare Commercial	$169.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH DISCHARGE

Facility

$170.00

Service Code	CPT 99315
Hospital Charge Code	5299315
Hospital Revenue Code	525
Rate for Payer: Cash Price	$153.00

NH DISCHARGE

Facility

$170.00

Service Code	CPT 99315
Hospital Charge Code	5299315
Hospital Revenue Code	525
Min. Negotiated Rate	$100.64
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$121.38
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: UnitedHealthcare Commercial	$113.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH DISCHARGE <30 MIN

Facility

$135.00

Service Code	CPT 99315
Hospital Charge Code	9699315
Hospital Revenue Code	521
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

NH DISCHARGE <30 MIN

Facility

$170.00

Service Code	CPT 99315
Hospital Charge Code	9799315
Hospital Revenue Code	521
Rate for Payer: Cash Price	$153.00

NH DISCHARGE <30 MIN

Facility

$135.00

Service Code	CPT 99315
Hospital Charge Code	9699315
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

NH DISCHARGE <30 MIN

Facility

$170.00

Service Code	CPT 99315
Hospital Charge Code	9799315
Hospital Revenue Code	521
Min. Negotiated Rate	$100.64
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$121.38
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: UnitedHealthcare Commercial	$113.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH DISCHARGE >30 MIN

Facility

$230.00

Service Code	CPT 99316
Hospital Charge Code	9799316
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

NH DISCHARGE >30 MIN

Facility

$175.00

Service Code	CPT 99316
Hospital Charge Code	9699316
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

NH DISCHARGE >30 MIN

Facility

$230.00

Service Code	CPT 99316
Hospital Charge Code	5299316
Hospital Revenue Code	525
Rate for Payer: Cash Price	$207.00

NH DISCHARGE >30 MIN

Facility

$230.00

Service Code	CPT 99316
Hospital Charge Code	9799316
Hospital Revenue Code	521
Rate for Payer: Cash Price	$207.00

NH DISCHARGE >30 MIN

Facility

$175.00

Service Code	CPT 99316
Hospital Charge Code	9699316
Hospital Revenue Code	521
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$103.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$124.95
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cash Price	$157.50
Rate for Payer: UnitedHealthcare Commercial	$116.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH DISCHARGE >30 MIN

Facility

$230.00

Service Code	CPT 99316
Hospital Charge Code	5299316
Hospital Revenue Code	525
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

NH DISCHARGE -30 MIN

Facility

$165.00

Service Code	CPT 99315
Hospital Charge Code	4199315
Hospital Revenue Code	521
Rate for Payer: Cash Price	$148.50

NH DISCHARGE -30 MIN

Facility

$165.00

Service Code	CPT 99315
Hospital Charge Code	4199315
Hospital Revenue Code	521
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

NH DISCHARGE +30 MIN

Facility

$220.00

Service Code	CPT 99316
Hospital Charge Code	4199316
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

NH DISCHARGE +30 MIN

Facility

$220.00

Service Code	CPT 99316
Hospital Charge Code	4199316
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.00

Know your out-of-pocket cost for care.

All Charges