Madison Medical Center

All Charges

Charge

Type

Setting

Price

NH DISCHARGE - LESS 30 MIN.

Facility

$88.50

Service Code	CPT 99315
Hospital Charge Code	3999315
Rate for Payer: Cash Price	$79.65

NH DISCHARGE - MORE 30 MIN.

Facility

$110.50

Service Code	CPT 99316
Hospital Charge Code	3999316
Rate for Payer: Cash Price	$99.45

NH INITIAL VISIT LEVEL 1

Facility

$176.00

Service Code	CPT 99304
Hospital Charge Code	4199304
Hospital Revenue Code	521
Rate for Payer: Cash Price	$158.40

NH INITIAL VISIT LEVEL 1

Facility

$176.00

Service Code	CPT 99304
Hospital Charge Code	4199304
Hospital Revenue Code	521
Min. Negotiated Rate	$104.19
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$104.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$125.66
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cash Price	$158.40
Rate for Payer: UnitedHealthcare Commercial	$117.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH INITIAL VISIT LEVEL 2

Facility

$235.00

Service Code	CPT 99305
Hospital Charge Code	4199305
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

NH INITIAL VISIT LEVEL 2

Facility

$235.00

Service Code	CPT 99305
Hospital Charge Code	4199305
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

NH INITIAL VISIT LEVEL 3

Facility

$285.00

Service Code	CPT 99306
Hospital Charge Code	4199306
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

NH INITIAL VISIT LEVEL 3

Facility

$285.00

Service Code	CPT 99306
Hospital Charge Code	4199306
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

NH STRAIGHTFORWARD VISIT

Facility

$100.00

Service Code	CPT 99307
Hospital Charge Code	9399307
Hospital Revenue Code	521
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

NH STRAIGHTFORWARD VISIT

Facility

$100.00

Service Code	CPT 99307
Hospital Charge Code	9399307
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

NH SUBSEQ LOW SEVERITY VISIT

Facility

$140.00

Service Code	CPT 99308
Hospital Charge Code	4299308
Hospital Revenue Code	525
Rate for Payer: Cash Price	$126.00

NH SUBSEQ LOW SEVERITY VISIT

Facility

$140.00

Service Code	CPT 99308
Hospital Charge Code	4299308
Hospital Revenue Code	525
Min. Negotiated Rate	$82.88
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$82.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$99.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: UnitedHealthcare Commercial	$93.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH SUBSEQ MODERATE SEVERITY VISIT

Facility

$185.00

Service Code	CPT 99309
Hospital Charge Code	4299309
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

NH SUBSEQ MODERATE SEVERITY VISIT

Facility

$185.00

Service Code	CPT 99309
Hospital Charge Code	4299309
Hospital Revenue Code	525
Rate for Payer: Cash Price	$166.50

NH SUBSEQ STRAIGHTFORWARD VISIT

Facility

$95.00

Service Code	CPT 99307
Hospital Charge Code	4299307
Hospital Revenue Code	525
Rate for Payer: Cash Price	$85.50

NH SUBSEQ STRAIGHTFORWARD VISIT

Facility

$95.00

Service Code	CPT 99307
Hospital Charge Code	4299307
Hospital Revenue Code	525
Min. Negotiated Rate	$56.24
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$67.83
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: UnitedHealthcare Commercial	$63.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH SUBSEQUENT VISIT LEVEL 1

Facility

$95.00

Service Code	CPT 99307
Hospital Charge Code	4199307
Hospital Revenue Code	521
Rate for Payer: Cash Price	$85.50

NH SUBSEQUENT VISIT LEVEL 1

Facility

$95.00

Service Code	CPT 99307
Hospital Charge Code	4199307
Hospital Revenue Code	521
Min. Negotiated Rate	$56.24
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$67.83
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: UnitedHealthcare Commercial	$63.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH SUBSEQUENT VISIT LEVEL 2

Facility

$140.00

Service Code	CPT 99308
Hospital Charge Code	4199308
Hospital Revenue Code	521
Rate for Payer: Cash Price	$126.00

NH SUBSEQUENT VISIT LEVEL 2

Facility

$140.00

Service Code	CPT 99308
Hospital Charge Code	4199308
Hospital Revenue Code	521
Min. Negotiated Rate	$82.88
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$82.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$99.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: UnitedHealthcare Commercial	$93.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH SUBSEQUENT VISIT LEVEL 3

Facility

$185.00

Service Code	CPT 99309
Hospital Charge Code	4199309
Hospital Revenue Code	521
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

NH SUBSEQUENT VISIT LEVEL 3

Facility

$185.00

Service Code	CPT 99309
Hospital Charge Code	4199309
Hospital Revenue Code	521
Rate for Payer: Cash Price	$166.50

NH SUBSEQUENT VISIT LEVEL 4

Facility

$245.00

Service Code	CPT 99310
Hospital Charge Code	4199310
Hospital Revenue Code	521
Rate for Payer: Cash Price	$220.50

NH SUBSEQUENT VISIT LEVEL 4

Facility

$245.00

Service Code	CPT 99310
Hospital Charge Code	4199310
Hospital Revenue Code	521
Min. Negotiated Rate	$145.04
Max. Negotiated Rate	$174.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$145.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.93
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: UnitedHealthcare Commercial	$163.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NH SUB VISIT LEVEL II

Facility

$150.00

Service Code	CPT 99308
Hospital Charge Code	9799308
Hospital Revenue Code	521
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges