Madison Medical Center

All Charges

Charge

Type

Setting

Price

NP OFFICE VISIT LEVEL 3

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	9499203
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

NP OFFICE VISIT LEVEL 3

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	9299203
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 LEVEL 3

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	9499203
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 LEVEL 4

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	9499204
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 LEVEL 4

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	9299204
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 LEVEL 4

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	9499204
Hospital Revenue Code	521
Rate for Payer: Cash Price	$346.50

NP OFFICE VISIT LEVEL 4

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	9299204
Hospital Revenue Code	521
Rate for Payer: Cash Price	$346.50

NP OFFICE VISIT LEVEL 5

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9299205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$436.50

NP OFFICE VISIT LEVEL 5

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9299205
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 LEVEL 5

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9499205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$436.50

NP OFFICE VISIT LEVEL 5

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9499205
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 LIMITED

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	9899202
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 LIMITED

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	9899202
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

NP OZARK VISIT LEVEL 1

Facility

$100.00

Service Code	CPT 99341
Hospital Charge Code	9299324
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

NP OZARK VISIT LEVEL 1

Facility

$100.00

Service Code	CPT 99341
Hospital Charge Code	9299324
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

NP OZARK VISIT LEVEL 1

Facility

$100.00

Service Code	CPT 99341
Hospital Charge Code	9499324
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

NP OZARK VISIT LEVEL 1

Facility

$100.00

Service Code	CPT 99341
Hospital Charge Code	9499324
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

NP OZARK VISIT LEVEL 2

Facility

$135.00

Service Code	CPT 99342
Hospital Charge Code	9299325
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

NP OZARK VISIT LEVEL 2

Facility

$135.00

Service Code	CPT 99342
Hospital Charge Code	9499325
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

NP OZARK VISIT LEVEL 2

Facility

$135.00

Service Code	CPT 99342
Hospital Charge Code	9499325
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

NP OZARK VISIT LEVEL 2

Facility

$135.00

Service Code	CPT 99342
Hospital Charge Code	9299325
Hospital Revenue Code	521
Rate for Payer: Cash Price	$121.50

NP OZARK VISIT LEVEL 3

Facility

$165.00

Service Code	CPT 99342
Hospital Charge Code	9499326
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

NP OZARK VISIT LEVEL 3

Facility

$165.00

Service Code	CPT 99342
Hospital Charge Code	9499326
Hospital Revenue Code	521
Rate for Payer: Cash Price	$148.50

NP OZARK VISIT LEVEL 3

Facility

$165.00

Service Code	CPT 99342
Hospital Charge Code	9299326
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

NP OZARK VISIT LEVEL 3

Facility

$165.00

Service Code	CPT 99342
Hospital Charge Code	9299326
Hospital Revenue Code	521
Rate for Payer: Cash Price	$148.50

Know your out-of-pocket cost for care.

All Charges