Madison Medical Center

All Charges

Charge

Type

Setting

Price

NP NH VISIT LEVEL 1

Facility

$176.00

Service Code	CPT 99304
Hospital Charge Code	9499304
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

NP NH VISIT LEVEL 1

Facility

$140.00

Service Code	CPT 99304
Hospital Charge Code	9299304
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

NP NH VISIT LEVEL 2

Facility

$235.00

Service Code	CPT 99305
Hospital Charge Code	9499305
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 NH VISIT LEVEL 2

Facility

$235.00

Service Code	CPT 99305
Hospital Charge Code	9499305
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

NP NH VISIT LEVEL 3

Facility

$285.00

Service Code	CPT 99306
Hospital Charge Code	9499306
Hospital Revenue Code	521
Rate for Payer: Cash Price	$256.50

NP NH VISIT LEVEL 3

Facility

$205.00

Service Code	CPT 99306
Hospital Charge Code	9299306
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

NP NH VISIT LEVEL 3

Facility

$285.00

Service Code	CPT 99306
Hospital Charge Code	9499306
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

NP NH VISIT LEVEL 3

Facility

$205.00

Service Code	CPT 99306
Hospital Charge Code	9299306
Hospital Revenue Code	521
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

NP OFFICE VISIT BRIEF

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	9899201
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

NP OFFICE VISIT BRIEF

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	9899201
Hospital Revenue Code	521
Min. Negotiated Rate	$71.04
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$71.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$85.68
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: UnitedHealthcare Commercial	$80.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP OFFICE VISIT COMPREHENSIVE

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9899205
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$346.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$287.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$346.29
Rate for Payer: Cash Price	$436.50
Rate for Payer: Cash Price	$436.50
Rate for Payer: UnitedHealthcare Commercial	$323.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP OFFICE VISIT COMPREHENSIVE

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9899205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$436.50

NP OFFICE VISIT EXTENDED

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	9899204
Hospital Revenue Code	521
Rate for Payer: Cash Price	$346.50

NP OFFICE VISIT EXTENDED

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	9899204
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$274.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$227.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$274.89
Rate for Payer: Cash Price	$346.50
Rate for Payer: Cash Price	$346.50
Rate for Payer: UnitedHealthcare Commercial	$256.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP OFFICE VISIT INTERMEDIATE

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	9899203
Hospital Revenue Code	521
Min. Negotiated Rate	$142.08
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$142.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$171.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: UnitedHealthcare Commercial	$160.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP OFFICE VISIT INTERMEDIATE

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	9899203
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

NP OFFICE VISIT LEVEL 1

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	9499201
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

NP OFFICE VISIT LEVEL 1

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	9299201
Hospital Revenue Code	521
Min. Negotiated Rate	$71.04
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$71.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$85.68
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: UnitedHealthcare Commercial	$80.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP OFFICE VISIT LEVEL 1

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	9299201
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

NP OFFICE VISIT LEVEL 1

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	9499201
Hospital Revenue Code	521
Min. Negotiated Rate	$71.04
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$71.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$85.68
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: UnitedHealthcare Commercial	$80.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP OFFICE VISIT LEVEL 2

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	9299202
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

NP OFFICE VISIT LEVEL 2

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	9299202
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

NP OFFICE VISIT LEVEL 2

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	9499202
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

NP OFFICE VISIT LEVEL 2

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	9499202
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

NP OFFICE VISIT LEVEL 3

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	9299203
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

Know your out-of-pocket cost for care.

All Charges