Madison Medical Center

All Charges

Charge

Type

Setting

Price

OBSERVATION CARE EXTENDED

Professional

Both

$450.00

Service Code	CPT 99223
Hospital Charge Code	5499220
Hospital Revenue Code	975
Min. Negotiated Rate	$151.92
Max. Negotiated Rate	$178.83
Rate for Payer: Aetna Commercial/Medicare Advantage	$151.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$162.57
Rate for Payer: Cash Price	$405.00
Rate for Payer: Cash Price	$405.00
Rate for Payer: Cigna Commercial HMO & PPO	$151.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$178.83
Rate for Payer: Home State Health Plan Medicare Advantage	$151.92
Rate for Payer: Optum Medicare Advantage	$157.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$162.57

OBSERVATION CARE INIT (BRIEF)

Facility

$250.00

Service Code	CPT 99221
Hospital Charge Code	4499218
Hospital Revenue Code	525
Rate for Payer: Cash Price	$225.00

OBSERVATION CARE INIT (BRIEF)

Facility

$250.00

Service Code	CPT 99221
Hospital Charge Code	4499218
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 CARE INIT.(INTER)

Facility

$480.00

Service Code	CPT 99223
Hospital Charge Code	4499220
Hospital Revenue Code	525
Rate for Payer: Cash Price	$432.00

OBSERVATION CARE INIT.(INTER)

Facility

$480.00

Service Code	CPT 99223
Hospital Charge Code	4499220
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 CARE INIT.(LIMITED)

Facility

$370.00

Service Code	CPT 99222
Hospital Charge Code	4499219
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 INIT.(LIMITED)

Facility

$370.00

Service Code	CPT 99222
Hospital Charge Code	4499219
Hospital Revenue Code	525
Rate for Payer: Cash Price	$333.00

OBSERVATION CARE INIT.(LIMITED)

Facility

$333.00

Service Code	CPT 99222
Hospital Charge Code	9499219
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$237.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$197.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$237.76
Rate for Payer: Cash Price	$299.70
Rate for Payer: Cash Price	$299.70
Rate for Payer: UnitedHealthcare Commercial	$222.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OBSERVATION CARE INIT.(LIMITED)

Facility

$333.00

Service Code	CPT 99222
Hospital Charge Code	9499219
Hospital Revenue Code	525
Rate for Payer: Cash Price	$299.70

OBSERVATION CARE INTERMEDIATE

Professional

Both

$333.00

Service Code	CPT 99222
Hospital Charge Code	5499219
Hospital Revenue Code	975
Min. Negotiated Rate	$110.86
Max. Negotiated Rate	$121.95
Rate for Payer: Aetna Commercial/Medicare Advantage	$113.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$110.86
Rate for Payer: Cash Price	$299.70
Rate for Payer: Cash Price	$299.70
Rate for Payer: Cigna Commercial HMO & PPO	$113.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$110.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$121.95
Rate for Payer: Home State Health Plan Medicare Advantage	$113.62
Rate for Payer: Optum Medicare Advantage	$116.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$110.86

OBSERVATION DISCHARGE

Facility

$205.00

Service Code	CPT 99238
Hospital Charge Code	9799217
Hospital Revenue Code	525
Rate for Payer: Cash Price	$184.50

OBSERVATION DISCHARGE

Facility

$205.00

Service Code	CPT 99238
Hospital Charge Code	9799217
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 VISIT INITIAL BRIEF

Facility

$127.50

Service Code	CPT 99221
Hospital Charge Code	3999218
Hospital Revenue Code	521
Min. Negotiated Rate	$75.48
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$91.03
Rate for Payer: Cash Price	$114.75
Rate for Payer: Cash Price	$114.75
Rate for Payer: UnitedHealthcare Commercial	$85.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OBSERVATION VISIT INITIAL BRIEF

Facility

$127.50

Service Code	CPT 99221
Hospital Charge Code	3999218
Hospital Revenue Code	521
Rate for Payer: Cash Price	$114.75

OBSESSIVE COMPULSIVE DISORDERS

Facility

$22,447.62

Service Code	APR-DRG 7623
Min. Negotiated Rate	$22,447.62
Max. Negotiated Rate	$22,447.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,447.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,447.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,447.62
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,447.62

OBSESSIVE COMPULSIVE DISORDERS

Facility

$11,326.76

Service Code	APR-DRG 7621
Min. Negotiated Rate	$11,326.76
Max. Negotiated Rate	$11,326.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,326.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,326.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,326.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,326.76

OBSESSIVE COMPULSIVE DISORDERS

Facility

$34,525.24

Service Code	APR-DRG 7624
Min. Negotiated Rate	$34,525.24
Max. Negotiated Rate	$34,525.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$34,525.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$34,525.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$34,525.24
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$34,525.24

OBSESSIVE COMPULSIVE DISORDERS

Facility

$12,587.07

Service Code	APR-DRG 7622
Min. Negotiated Rate	$12,587.07
Max. Negotiated Rate	$12,587.07
Rate for Payer: Aetna Better Health Medicaid/QHP	$12,587.07
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12,587.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12,587.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12,587.07

OBSTRUCTION SERIES

Facility

$693.00

Service Code	CPT 74022
Hospital Charge Code	3215163
Hospital Revenue Code	320
Rate for Payer: Cash Price	$623.70

OBSTRUCTION SERIES

Facility

$693.00

Service Code	CPT 74022
Hospital Charge Code	3215163
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$494.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$410.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$494.80
Rate for Payer: Cash Price	$623.70
Rate for Payer: Cash Price	$623.70
Rate for Payer: Cash Price	$623.70
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$249.48

OCCIPITAL NERVE BLOCK

Facility

$276.00

Service Code	CPT 64405
Hospital Charge Code	4464405
Hospital Revenue Code	521
Rate for Payer: Cash Price	$248.40

OCCIPITAL NERVE BLOCK

Facility

$276.00

Service Code	CPT 64405
Hospital Charge Code	4464405
Hospital Revenue Code	521
Min. Negotiated Rate	$163.39
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$163.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$197.06
Rate for Payer: Cash Price	$248.40
Rate for Payer: Cash Price	$248.40
Rate for Payer: Cash Price	$248.40
Rate for Payer: Cash Price	$248.40
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$184.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OCCULT BLOOD

Facility

$75.00

Service Code	CPT 82270
Hospital Charge Code	1882270
Hospital Revenue Code	306
Rate for Payer: Cash Price	$67.50

OCCULT BLOOD

Facility

$25.00

Service Code	CPT 82270
Hospital Charge Code	9682270
Hospital Revenue Code	301
Rate for Payer: Cash Price	$22.50

OCCULT BLOOD

Facility

$75.00

Service Code	CPT 82270
Hospital Charge Code	1882270
Hospital Revenue Code	306
Min. Negotiated Rate	$3.94
Max. Negotiated Rate	$53.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.94
Rate for Payer: Aetna Medicare Advantage	$4.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cash Price	$67.50
Rate for Payer: Cigna Commercial HMO & PPO	$4.38
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.22
Rate for Payer: Home State Health Plan Medicare Advantage	$4.38
Rate for Payer: Humana Commercial	$8.76
Rate for Payer: Humana Medicare Advantage	$4.38
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

Know your out-of-pocket cost for care.

All Charges