Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	4199205
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$346.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$287.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$346.29
Rate for Payer: Cash Price	$436.50
Rate for Payer: Cash Price	$436.50
Rate for Payer: UnitedHealthcare Commercial	$323.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE O/P (NEW) DETAIL HIST.

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	4199203
Hospital Revenue Code	521
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 O/P (NEW) DETAIL HIST.

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	4199203
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

OFFICE O/P (NEW) EXPANDED

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	4199202
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

OFFICE O/P (NEW) EXPANDED

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	4199202
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

OFFICE VISIT COMPRE. (COMPLEX)

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	5299205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$436.50

OFFICE VISIT COMPRE. (COMPLEX)

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	5299205
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$346.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$287.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$346.29
Rate for Payer: Cash Price	$436.50
Rate for Payer: Cash Price	$436.50
Rate for Payer: UnitedHealthcare Commercial	$323.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT COMPRE. (EST)

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	5299215
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

OFFICE VISIT COMPRE. (EST)

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	5299215
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$249.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$207.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$249.90
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: UnitedHealthcare Commercial	$233.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT - COMPREHENSIVE

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9699205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$436.50

OFFICE VISIT - COMPREHENSIVE

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9699205
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$346.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$287.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$346.29
Rate for Payer: Cash Price	$436.50
Rate for Payer: Cash Price	$436.50
Rate for Payer: UnitedHealthcare Commercial	$323.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT COMPRE. (NEW)

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	5299204
Hospital Revenue Code	521
Rate for Payer: Cash Price	$346.50

OFFICE VISIT COMPRE. (NEW)

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	5299204
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 VISIT DETAIL (EST)

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	5299214
Hospital Revenue Code	521
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

OFFICE VISIT DETAIL (EST)

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	5299214
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

OFFICE VISIT DETAIL (NEW)

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	5299203
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

OFFICE VISIT DETAIL (NEW)

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	5299203
Hospital Revenue Code	521
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 VISIT EST BRIEF

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9199212
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 VISIT EST BRIEF

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9199212
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT EST BRIEF

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9799212
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 VISIT EST BRIEF

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9799212
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT EST COMPREHENSIVE

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9799215
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$249.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$207.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$249.90
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: UnitedHealthcare Commercial	$233.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT EST COMPREHENSIVE

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9799215
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

OFFICE VISIT EST COMPREHENSIVE

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9199215
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

OFFICE VISIT EST COMPREHENSIVE

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9199215
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$249.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$207.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$249.90
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: UnitedHealthcare Commercial	$233.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges