Madison Medical Center

All Charges

Charge

Type

Setting

Price

NP OZARK VISIT LEVEL 4

Facility

$185.00

Service Code	CPT 99344
Hospital Charge Code	9299327
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 OZARK VISIT LEVEL 4

Facility

$185.00

Service Code	CPT 99344
Hospital Charge Code	9499327
Hospital Revenue Code	521
Rate for Payer: Cash Price	$166.50

NP OZARK VISIT LEVEL 4

Facility

$185.00

Service Code	CPT 99344
Hospital Charge Code	9499327
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 OZARK VISIT LEVEL 4

Facility

$185.00

Service Code	CPT 99344
Hospital Charge Code	9299327
Hospital Revenue Code	521
Rate for Payer: Cash Price	$166.50

NP OZARK VISIT LEVEL 5

Facility

$205.00

Service Code	CPT 99345
Hospital Charge Code	9499328
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

NP OZARK VISIT LEVEL 5

Facility

$205.00

Service Code	CPT 99345
Hospital Charge Code	9299328
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 OZARK VISIT LEVEL 5

Facility

$205.00

Service Code	CPT 99345
Hospital Charge Code	9499328
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 OZARK VISIT LEVEL 5

Facility

$205.00

Service Code	CPT 99345
Hospital Charge Code	9299328
Hospital Revenue Code	521
Rate for Payer: Cash Price	$184.50

NP PHYSICAL 40-65

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	5499386
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$267.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$222.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$267.75
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: UnitedHealthcare Commercial	$250.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP PHYSICAL 40-65

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	5499386
Hospital Revenue Code	521
Rate for Payer: Cash Price	$337.50

NP PHYSICAL AGE 18 - 39

Facility

$315.00

Service Code	CPT 99385
Hospital Charge Code	9299385
Hospital Revenue Code	521
Rate for Payer: Cash Price	$283.50

NP PHYSICAL AGE 18 - 39

Facility

$315.00

Service Code	CPT 99385
Hospital Charge Code	9299385
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$224.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$186.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$224.91
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: UnitedHealthcare Commercial	$210.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP PHYSICAL AGE 18 - 39

Facility

$315.00

Service Code	CPT 99385
Hospital Charge Code	9499385
Hospital Revenue Code	521
Rate for Payer: Cash Price	$283.50

NP PHYSICAL AGE 18 - 39

Facility

$315.00

Service Code	CPT 99385
Hospital Charge Code	9499385
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$224.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$186.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$224.91
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: UnitedHealthcare Commercial	$210.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP PHYSICAL AGE 18 - 39

Facility

$315.00

Service Code	CPT 99385
Hospital Charge Code	4199385
Hospital Revenue Code	521
Rate for Payer: Cash Price	$283.50

NP PHYSICAL AGE 18 - 39

Facility

$315.00

Service Code	CPT 99385
Hospital Charge Code	4199385
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$224.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$186.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$224.91
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: UnitedHealthcare Commercial	$210.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP PHYSICAL AGE 40 - 64

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	9299386
Hospital Revenue Code	521
Rate for Payer: Cash Price	$337.50

NP PHYSICAL AGE 40 - 64

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	9299386
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$267.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$222.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$267.75
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: UnitedHealthcare Commercial	$250.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP PHYSICAL AGE 40 - 64

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	9499386
Hospital Revenue Code	521
Rate for Payer: Cash Price	$337.50

NP PHYSICAL AGE 40 - 64

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	9799386
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$267.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$222.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$267.75
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: UnitedHealthcare Commercial	$250.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP PHYSICAL AGE 40 - 64

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	9499386
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$267.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$222.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$267.75
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: UnitedHealthcare Commercial	$250.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP PHYSICAL AGE 40 - 64

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	9799386
Hospital Revenue Code	521
Rate for Payer: Cash Price	$337.50

NP PHYSICAL AGE 40-64

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	4199386
Hospital Revenue Code	521
Rate for Payer: Cash Price	$337.50

NP PHYSICAL AGE 40-64

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	4199386
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$267.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$222.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$267.75
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: UnitedHealthcare Commercial	$250.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP PHYSICAL AGE 65 AND OLDER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	9299387
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$278.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$230.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$278.46
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: UnitedHealthcare Commercial	$260.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges