Madison Medical Center

All Charges

Charge

Type

Setting

Price

OFFICE VISIT - EST PT BRIEF

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9699212
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 PT - BRIEF

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9599212
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 PT - BRIEF

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9599212
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT - EST. PT - BRIEF

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	3999212
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT - EST. PT - BRIEF

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	3999212
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. PT.- BRIEF

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	4199212
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. PT.- BRIEF

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	4199212
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT EST. PT.- COMPRE.

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	4199215
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

OFFICE VISIT EST. PT.- COMPRE.

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	4199215
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 PT COMPREHENSIVE

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9699215
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 PT COMPREHENSIVE

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9699215
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

OFFICE VISIT - EST PT - COMPREHENSIVE

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9599215
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 PT - COMPREHENSIVE

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9599215
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

OFFICE VISIT - EST. PT - COMPREHENSIVE

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	3999215
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

OFFICE VISIT - EST. PT - COMPREHENSIVE

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	3999215
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. PT.- EXTEND

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	4199214
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. PT.- EXTEND

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	4199214
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

OFFICE VISIT - EST PT EXTENDED

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9699214
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 PT EXTENDED

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9699214
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

OFFICE VISIT - EST PT - EXTENDED

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9599214
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 PT - EXTENDED

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9599214
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

OFFICE VISIT - EST. PT - EXTENDED

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	3999214
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. PT - EXTENDED

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	3999214
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

OFFICE VISIT EST. PT.- INTER.

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	4199213
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

OFFICE VISIT EST. PT.- INTER.

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	4199213
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

Know your out-of-pocket cost for care.

All Charges