Madison Medical Center

All Charges

Charge

Type

Setting

Price

NP PHYSICAL AGE 65 AND OLDER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	9299387
Hospital Revenue Code	521
Rate for Payer: Cash Price	$351.00

NP PHYSICAL AGE 65 AND OLDER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	9499387
Hospital Revenue Code	521
Rate for Payer: Cash Price	$351.00

NP PHYSICAL AGE 65 AND OLDER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	9499387
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

NP PHYSICAL AGE 65 & OLDER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	9799387
Hospital Revenue Code	521
Rate for Payer: Cash Price	$351.00

NP PHYSICAL AGE 65 & OLDER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	9799387
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

NP PHYSICAL AGE 65 & OVER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	4199387
Hospital Revenue Code	521
Rate for Payer: Cash Price	$351.00

NP PHYSICAL AGE 65 & OVER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	4199387
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

NP PREVENTATIVE EXAM 18 - 39

Facility

$315.00

Service Code	CPT 99385
Hospital Charge Code	9899385
Hospital Revenue Code	521
Rate for Payer: Cash Price	$283.50

NP PREVENTATIVE EXAM 18 - 39

Facility

$315.00

Service Code	CPT 99385
Hospital Charge Code	9899385
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 PREVENTATIVE EXAM 40 - 64

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	9899386
Hospital Revenue Code	521
Rate for Payer: Cash Price	$337.50

NP PREVENTATIVE EXAM 40 - 64

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	9899386
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 PREVENTATIVE EXAM 65 AND OVER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	9899387
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

NP PREVENTATIVE EXAM 65 AND OVER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	9899387
Hospital Revenue Code	521
Rate for Payer: Cash Price	$351.00

NP RH ADMIT <30 MIN ADMISSION

Facility

$175.00

Service Code	CPT 99342
Hospital Charge Code	9899325
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

NP RH ADMIT <30 MIN ADMISSION

Facility

$175.00

Service Code	CPT 99342
Hospital Charge Code	9899325
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 RH ADMIT >30 MIN ADMISSION

Facility

$245.00

Service Code	CPT 99342
Hospital Charge Code	9899326
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

NP RH ADMIT >30 MIN ADMISSION

Facility

$415.00

Service Code	CPT 99345
Hospital Charge Code	9899328
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$296.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$245.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$296.31
Rate for Payer: Cash Price	$373.50
Rate for Payer: Cash Price	$373.50
Rate for Payer: UnitedHealthcare Commercial	$276.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

NP RH ADMIT >30 MIN ADMISSION

Facility

$330.00

Service Code	CPT 99344
Hospital Charge Code	9899327
Hospital Revenue Code	521
Rate for Payer: Cash Price	$297.00

NP RH ADMIT >30 MIN ADMISSION

Facility

$245.00

Service Code	CPT 99342
Hospital Charge Code	9899326
Hospital Revenue Code	521
Rate for Payer: Cash Price	$220.50

NP RH ADMIT >30 MIN ADMISSION

Facility

$415.00

Service Code	CPT 99345
Hospital Charge Code	9899328
Hospital Revenue Code	521
Rate for Payer: Cash Price	$373.50

NP RH ADMIT >30 MIN ADMISSION

Facility

$330.00

Service Code	CPT 99344
Hospital Charge Code	9899327
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 RH BRIEF ADMISSION

Facility

$120.00

Service Code	CPT 99341
Hospital Charge Code	9899324
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

NP RH BRIEF ADMISSION

Facility

$120.00

Service Code	CPT 99341
Hospital Charge Code	9899324
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 THYROID 30MG TAB EMP

Facility

$12.00

Service Code	NDC 4.2192E+10
Hospital Charge Code	2623916
Hospital Revenue Code	250
Rate for Payer: Cash Price	$10.80

NP THYROID 30MG TAB EMP

Facility

$12.00

Service Code	NDC 4.2192E+10
Hospital Charge Code	2623916
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$8.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8.57
Rate for Payer: Cash Price	$10.80
Rate for Payer: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

Know your out-of-pocket cost for care.

All Charges