Madison Medical Center

All Charges

Charge

Type

Setting

Price

NYSTAT/TRIAM(MYCOLOG) 30GM CRM

Facility

$479.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2697083
Hospital Revenue Code	250
Min. Negotiated Rate	$172.44
Max. Negotiated Rate	$342.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$283.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$342.01
Rate for Payer: Cash Price	$431.10
Rate for Payer: UnitedHealthcare Commercial	$319.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$172.44

O2 ANALIZER

Facility

$48.00

Hospital Charge Code	2024472
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

O2 ANALIZER

Facility

$48.00

Hospital Charge Code	2024472
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

OB FILMS PA & LAT

Facility

$157.00

Hospital Charge Code	3215161
Hospital Revenue Code	320
Rate for Payer: Cash Price	$141.30

OB FILMS PA & LAT

Facility

$157.00

Hospital Charge Code	3215161
Hospital Revenue Code	320
Min. Negotiated Rate	$56.52
Max. Negotiated Rate	$175.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$112.10
Rate for Payer: Cash Price	$141.30
Rate for Payer: Cash Price	$141.30
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.52

OBs Care Discharge

Professional

Both

$205.00

Service Code	CPT 99238
Hospital Charge Code	5299217
Hospital Revenue Code	987
Min. Negotiated Rate	$58.97
Max. Negotiated Rate	$71.86
Rate for Payer: Aetna Commercial/Medicare Advantage	$71.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$58.97
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$71.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$64.87
Rate for Payer: Home State Health Plan Medicare Advantage	$71.86
Rate for Payer: Optum Medicare Advantage	$71.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$58.97

OBSER.ADMIT/DISCHARGE

Professional

Both

$604.00

Service Code	CPT 99236
Hospital Charge Code	4199236
Hospital Revenue Code	975
Min. Negotiated Rate	$173.69
Max. Negotiated Rate	$211.40
Rate for Payer: Aetna Commercial/Medicare Advantage	$184.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$173.69
Rate for Payer: Cash Price	$543.60
Rate for Payer: Cash Price	$543.60
Rate for Payer: Cigna Commercial HMO & PPO	$184.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$173.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$191.06
Rate for Payer: Home State Health Plan Medicare Advantage	$184.70
Rate for Payer: Optum Medicare Advantage	$211.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$173.69

OBSERV. ACUTE CARE (BRIEF)

Facility

$355.00

Service Code	CPT 99234
Hospital Charge Code	4499234
Hospital Revenue Code	525
Rate for Payer: Cash Price	$319.50

OBSERV. ACUTE CARE (BRIEF)

Facility

$355.00

Service Code	CPT 99234
Hospital Charge Code	4499234
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$253.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$210.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$253.47
Rate for Payer: Cash Price	$319.50
Rate for Payer: Cash Price	$319.50
Rate for Payer: UnitedHealthcare Commercial	$236.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OBSERV. ACUTE CARE (INTER)

Facility

$605.00

Service Code	CPT 99236
Hospital Charge Code	4499236
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$431.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$358.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$431.97
Rate for Payer: Cash Price	$544.50
Rate for Payer: Cash Price	$544.50
Rate for Payer: UnitedHealthcare Commercial	$403.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OBSERV. ACUTE CARE (INTER)

Facility

$605.00

Service Code	CPT 99236
Hospital Charge Code	4499236
Hospital Revenue Code	525
Rate for Payer: Cash Price	$544.50

OBSERV. ACUTE CARE (LIMITED)

Facility

$470.00

Service Code	CPT 99235
Hospital Charge Code	4499235
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$335.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$278.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$335.58
Rate for Payer: Cash Price	$423.00
Rate for Payer: Cash Price	$423.00
Rate for Payer: UnitedHealthcare Commercial	$313.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OBSERV. ACUTE CARE (LIMITED)

Facility

$470.00

Service Code	CPT 99235
Hospital Charge Code	4499235
Hospital Revenue Code	525
Rate for Payer: Cash Price	$423.00

OBSERVATION ADMIT BRIEF

Facility

$250.00

Service Code	CPT 99221
Hospital Charge Code	9799218
Hospital Revenue Code	525
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

OBSERVATION ADMIT BRIEF

Facility

$250.00

Service Code	CPT 99221
Hospital Charge Code	9799218
Hospital Revenue Code	525
Rate for Payer: Cash Price	$225.00

OBSERVATION ADMIT EXTENDED

Facility

$480.00

Service Code	CPT 99223
Hospital Charge Code	9799220
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$342.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$284.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$342.72
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: UnitedHealthcare Commercial	$320.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OBSERVATION ADMIT EXTENDED

Facility

$480.00

Service Code	CPT 99223
Hospital Charge Code	9799220
Hospital Revenue Code	525
Rate for Payer: Cash Price	$432.00

OBSERVATION ADMIT INTERMEDIATE

Facility

$370.00

Service Code	CPT 99222
Hospital Charge Code	9799219
Hospital Revenue Code	525
Rate for Payer: Cash Price	$333.00

OBSERVATION ADMIT INTERMEDIATE

Facility

$370.00

Service Code	CPT 99222
Hospital Charge Code	9799219
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$264.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$219.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$264.18
Rate for Payer: Cash Price	$333.00
Rate for Payer: Cash Price	$333.00
Rate for Payer: UnitedHealthcare Commercial	$246.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OBSERVATION CARE

Professional

Both

$235.00

Service Code	CPT 99221
Hospital Charge Code	4199218
Hospital Revenue Code	975
Min. Negotiated Rate	$72.43
Max. Negotiated Rate	$90.62
Rate for Payer: Aetna Commercial/Medicare Advantage	$72.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$82.38
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cigna Commercial HMO & PPO	$72.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$82.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$90.62
Rate for Payer: Home State Health Plan Medicare Advantage	$72.43
Rate for Payer: Optum Medicare Advantage	$82.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$82.38

OBSERVATION CARE DISCHARGE

Facility

$205.00

Service Code	CPT 99238
Hospital Charge Code	4499217
Hospital Revenue Code	525
Rate for Payer: Cash Price	$184.50

OBSERVATION CARE DISCHARGE

Facility

$205.00

Service Code	CPT 99238
Hospital Charge Code	4499217
Hospital Revenue Code	525
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

OBSERVATION CARE DISCHARGE

Facility

$204.00

Service Code	CPT 99238
Hospital Charge Code	4299217
Rate for Payer: Cash Price	$183.60

OBSERVATION CARE DISCHARGE

Facility

$204.00

Service Code	CPT 99238
Hospital Charge Code	9499217
Hospital Revenue Code	525
Rate for Payer: Cash Price	$183.60

OBSERVATION CARE DISCHARGE

Facility

$204.00

Service Code	CPT 99238
Hospital Charge Code	9499217
Hospital Revenue Code	525
Min. Negotiated Rate	$120.77
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$120.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$145.66
Rate for Payer: Cash Price	$183.60
Rate for Payer: Cash Price	$183.60
Rate for Payer: UnitedHealthcare Commercial	$136.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges