Madison Medical Center

All Charges

Charge

Type

Setting

Price

OFFICE VISIT - EST PT INTERMEDIATE

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9699213
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 PT INTERMEDIATE

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9699213
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

OFFICE VISIT - EST PT - INTERMEDIATE

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9599213
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

OFFICE VISIT - EST PT - INTERMEDIATE

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9599213
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. PT - INTERMEDIATE

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	3999213
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. PT - INTERMEDIATE

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	3999213
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

OFFICE VISIT EST PT LEVEL 1

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9399211
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

OFFICE VISIT EST PT LEVEL 1

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9399211
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 PT LEVEL 2

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9399212
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 LEVEL 2

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	9399212
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT EST PT LEVEL 3

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9399213
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

OFFICE VISIT EST PT LEVEL 3

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	9399213
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 PT LEVEL 4

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9399214
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

OFFICE VISIT EST PT LEVEL 4

Facility

$250.00

Service Code	CPT 99214
Hospital Charge Code	9399214
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 LEVEL 5

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9399215
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 LEVEL 5

Facility

$350.00

Service Code	CPT 99215
Hospital Charge Code	9399215
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

OFFICE VISIT - EST PT - MINIMAL

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9599211
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

OFFICE VISIT - EST PT - MINIMAL

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	9599211
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. PT - MINIMAL

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	3999211
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

OFFICE VISIT - EST. PT - MINIMAL

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	3999211
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. PT.- MINIMAL .

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	4199211
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. PT.- MINIMAL .

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	4199211
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

OFFICE VISIT EXPAND (EST)

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	5299213
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

OFFICE VISIT EXPAND (EST)

Facility

$160.00

Service Code	CPT 99213
Hospital Charge Code	5299213
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 EXPAND (NEW)

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	5299202
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

Know your out-of-pocket cost for care.

All Charges