Madison Medical Center

All Charges

Charge

Type

Setting

Price

OFFICE VISIT EST EXTENDED

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9199214
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 EST EXTENDED

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9199214
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

OFFICE VISIT EST EXTENDED

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9799214
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

OFFICE VISIT EST EXTENDED

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9799214
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 EST INTERMEDIATE

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9799213
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

OFFICE VISIT EST INTERMEDIATE

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9799213
Hospital Revenue Code	521
Min. Negotiated Rate	$94.72
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$94.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.24
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: UnitedHealthcare Commercial	$106.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT EST INTERMEDIATE

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9199213
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

OFFICE VISIT EST INTERMEDIATE

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9199213
Hospital Revenue Code	521
Min. Negotiated Rate	$94.72
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$94.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.24
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: UnitedHealthcare Commercial	$106.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT EST LEVEL 1

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	4299211
Hospital Revenue Code	521
Min. Negotiated Rate	$41.44
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT EST LEVEL 1

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	4299211
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

OFFICE VISIT EST LEVEL 2

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	4299212
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 LEVEL 2

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	4299212
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT EST LEVEL 3

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	4299213
Hospital Revenue Code	521
Min. Negotiated Rate	$94.72
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$94.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.24
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: UnitedHealthcare Commercial	$106.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT EST LEVEL 3

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	4299213
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

OFFICE VISIT EST LEVEL 4

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	4299214
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 EST LEVEL 4

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	4299214
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

OFFICE VISIT EST LEVEL 5

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	4299215
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

OFFICE VISIT EST LEVEL 5

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	4299215
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 MINIMAL

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9199211
Hospital Revenue Code	521
Min. Negotiated Rate	$41.44
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT EST MINIMAL

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9799211
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

OFFICE VISIT EST MINIMAL

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9199211
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

OFFICE VISIT EST MINIMAL

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9799211
Hospital Revenue Code	521
Min. Negotiated Rate	$41.44
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT - EST PAT MINIMAL

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9699211
Hospital Revenue Code	521
Min. Negotiated Rate	$41.44
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT - EST PAT MINIMAL

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9699211
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

OFFICE VISIT - EST PT BRIEF

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9699212
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

Know your out-of-pocket cost for care.

All Charges