Madison Medical Center

All Charges

Charge

Type

Setting

Price

NP HCY AGES 5 - 11

Facility

$260.00

Service Code	CPT 99383
Hospital Charge Code	9499383
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

NP HCY NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	4199381
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

NP HCY NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	9499381
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

NP HCY NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	9899381
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

NP HCY NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	9499381
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

NP HCY NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	9299381
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

NP HCY NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	9299381
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

NP HCY NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	9899381
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

NP HCY NEWBORN

Facility

$235.00

Service Code	CPT 99381
Hospital Charge Code	4199381
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

NP NH ADMIT <30 MIN ADMISSION

Facility

$121.50

Service Code	CPT 99305
Hospital Charge Code	9899302
Hospital Revenue Code	521
Rate for Payer: Cash Price	$109.35

NP NH ADMIT <30 MIN ADMISSION

Facility

$121.50

Service Code	CPT 99305
Hospital Charge Code	9899302
Hospital Revenue Code	521
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

NP NH ADMIT <30 MIN ADMISSION

Facility

$250.00

Service Code	CPT 99305
Hospital Charge Code	9899305
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

NP NH ADMIT <30 MIN ADMISSION

Facility

$250.00

Service Code	CPT 99305
Hospital Charge Code	9899305
Hospital Revenue Code	521
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

NP NH ADMIT >30 MIN ADMISSION

Facility

$169.50

Service Code	CPT 99306
Hospital Charge Code	9899303
Hospital Revenue Code	521
Rate for Payer: Cash Price	$152.55

NP NH ADMIT >30 MIN ADMISSION

Facility

$169.50

Service Code	CPT 99306
Hospital Charge Code	9899303
Hospital Revenue Code	521
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

NP NH ADMIT >30 MIN ADMISSION

Facility

$330.00

Service Code	CPT 99306
Hospital Charge Code	9899306
Hospital Revenue Code	521
Rate for Payer: Cash Price	$297.00

NP NH ADMIT >30 MIN ADMISSION

Facility

$330.00

Service Code	CPT 99306
Hospital Charge Code	9899306
Hospital Revenue Code	521
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

NP NH BRIEF ADMISSION

Facility

$91.00

Service Code	CPT 99304
Hospital Charge Code	9899301
Hospital Revenue Code	521
Min. Negotiated Rate	$53.87
Max. Negotiated Rate	$173.53
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: UnitedHealthcare Commercial	$60.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP NH BRIEF ADMISSION

Facility

$91.00

Service Code	CPT 99304
Hospital Charge Code	9899301
Hospital Revenue Code	521
Rate for Payer: Cash Price	$81.90

NP NH BRIEF ADMISSION

Facility

$185.00

Service Code	CPT 99304
Hospital Charge Code	9899304
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

NP NH BRIEF ADMISSION

Facility

$185.00

Service Code	CPT 99304
Hospital Charge Code	9899304
Hospital Revenue Code	521
Rate for Payer: Cash Price	$166.50

NP NH INTERMEDIATE - PRIV P

Facility

$210.00

Hospital Charge Code	30500080
Hospital Revenue Code	110
Min. Negotiated Rate	$185.00
Max. Negotiated Rate	$1,754.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$185.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: UnitedHealthcare Commercial	$1,519.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,754.00

NP NH INTERMEDIATE - PRIV P

Facility

$210.00

Hospital Charge Code	30500080
Hospital Revenue Code	120
Min. Negotiated Rate	$742.00
Max. Negotiated Rate	$1,754.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$742.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$742.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: UnitedHealthcare Commercial	$1,519.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,754.00

NP NH VISIT LEVEL 1

Facility

$176.00

Service Code	CPT 99304
Hospital Charge Code	9499304
Hospital Revenue Code	521
Rate for Payer: Cash Price	$158.40

NP NH VISIT LEVEL 1

Facility

$140.00

Service Code	CPT 99304
Hospital Charge Code	9299304
Hospital Revenue Code	521
Rate for Payer: Cash Price	$126.00

Know your out-of-pocket cost for care.

All Charges