Madison Medical Center

All Charges

Charge

Type

Setting

Price

OFFICE CONS.(NEW) 60 MIN.

Facility

$410.00

Service Code	CPT 99244
Hospital Charge Code	4199244
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$292.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$242.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$292.74
Rate for Payer: Cash Price	$369.00
Rate for Payer: Cash Price	$369.00
Rate for Payer: UnitedHealthcare Commercial	$273.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE CONS.(NEW) 60 MIN.

Facility

$410.00

Service Code	CPT 99244
Hospital Charge Code	4199244
Hospital Revenue Code	521
Rate for Payer: Cash Price	$369.00

OFFICE CONS.(NEW) 80 MIN.

Facility

$515.00

Service Code	CPT 99245
Hospital Charge Code	4199245
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$367.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$304.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$367.71
Rate for Payer: Cash Price	$463.50
Rate for Payer: Cash Price	$463.50
Rate for Payer: UnitedHealthcare Commercial	$343.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE CONS.(NEW) 80 MIN.

Facility

$515.00

Service Code	CPT 99245
Hospital Charge Code	4199245
Hospital Revenue Code	521
Rate for Payer: Cash Price	$463.50

OFFICE CONSUL. (COMPRE)

Facility

$500.00

Service Code	CPT 99245
Hospital Charge Code	4499245
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$357.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$296.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$357.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: UnitedHealthcare Commercial	$333.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE CONSUL. (COMPRE)

Facility

$500.00

Service Code	CPT 99245
Hospital Charge Code	4499245
Hospital Revenue Code	525
Rate for Payer: Cash Price	$450.00

OFFICE CONSUL. (EXTENDED)

Facility

$400.00

Service Code	CPT 99244
Hospital Charge Code	4499244
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$285.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$236.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$285.60
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: UnitedHealthcare Commercial	$266.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE CONSUL. (EXTENDED)

Facility

$400.00

Service Code	CPT 99244
Hospital Charge Code	4499244
Hospital Revenue Code	525
Rate for Payer: Cash Price	$360.00

OFFICE CONSUL. (INTER)

Facility

$240.00

Service Code	CPT 99243
Hospital Charge Code	4499243
Hospital Revenue Code	525
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

OFFICE CONSUL. (INTER)

Facility

$240.00

Service Code	CPT 99243
Hospital Charge Code	4499243
Hospital Revenue Code	525
Rate for Payer: Cash Price	$216.00

OFFICE CONSUL. (LIMITED)

Facility

$225.00

Service Code	CPT 99242
Hospital Charge Code	4499242
Hospital Revenue Code	525
Rate for Payer: Cash Price	$202.50

OFFICE CONSUL. (LIMITED)

Facility

$225.00

Service Code	CPT 99242
Hospital Charge Code	4499242
Hospital Revenue Code	525
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$133.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$160.65
Rate for Payer: Cash Price	$202.50
Rate for Payer: Cash Price	$202.50
Rate for Payer: UnitedHealthcare Commercial	$150.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE CONSULT LEVEL 2

Facility

$225.00

Service Code	CPT 99242
Hospital Charge Code	4299242
Hospital Revenue Code	521
Rate for Payer: Cash Price	$202.50

OFFICE CONSULT LEVEL 2

Facility

$225.00

Service Code	CPT 99242
Hospital Charge Code	4299242
Hospital Revenue Code	521
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$173.53
Rate for Payer: Cash Price	$202.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$133.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$160.65
Rate for Payer: Cash Price	$202.50
Rate for Payer: UnitedHealthcare Commercial	$150.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE CONSULT LEVEL 3

Facility

$300.00

Service Code	CPT 99243
Hospital Charge Code	4299243
Hospital Revenue Code	521
Rate for Payer: Cash Price	$270.00

OFFICE CONSULT LEVEL 3

Facility

$300.00

Service Code	CPT 99243
Hospital Charge Code	4299243
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$214.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$177.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.20
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: UnitedHealthcare Commercial	$200.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE CONSULT LEVEL 4

Facility

$400.00

Service Code	CPT 99244
Hospital Charge Code	4299244
Hospital Revenue Code	521
Rate for Payer: Cash Price	$360.00

OFFICE CONSULT LEVEL 4

Facility

$400.00

Service Code	CPT 99244
Hospital Charge Code	4299244
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$285.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$236.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$285.60
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: UnitedHealthcare Commercial	$266.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE CONSULT LEVEL 5

Facility

$500.00

Service Code	CPT 99245
Hospital Charge Code	4299245
Hospital Revenue Code	521
Rate for Payer: Cash Price	$450.00

OFFICE CONSULT LEVEL 5

Facility

$500.00

Service Code	CPT 99245
Hospital Charge Code	4299245
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$357.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$296.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$357.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: UnitedHealthcare Commercial	$333.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE O/P (NEW) 10 MIN

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	4199201
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

OFFICE O/P (NEW) 10 MIN

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	4199201
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE O/P (NEW) COMPRE. HIST 45 MIN.

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	4199204
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

OFFICE O/P (NEW) COMPRE. HIST 45 MIN.

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	4199204
Hospital Revenue Code	521
Rate for Payer: Cash Price	$346.50

OFFICE O/P (NEW) COMPRE. HIST 60 MIN.

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	4199205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$436.50

Know your out-of-pocket cost for care.

All Charges