Madison Medical Center

All Charges

Charge

Type

Setting

Price

OFFICE VISIT EXPAND (NEW)

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	5299202
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 VISIT FOCUSED (EST)

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	5299212
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 FOCUSED (EST)

Facility

$120.00

Service Code	CPT 99212
Hospital Charge Code	5299212
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT FOCUSED (NEW)

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	5299201
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 FOCUSED (NEW)

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	5299201
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT MIN. (EST)

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	5299211
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 MIN. (EST)

Facility

$70.00

Service Code	CPT 99211
Hospital Charge Code	5299211
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

OFFICE VISIT NEW LEVEL 1

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	4299201
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT NEW LEVEL 1

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	4299201
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 NEW LEVEL 2

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	4299202
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

OFFICE VISIT NEW LEVEL 2

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	4299202
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 VISIT NEW LEVEL 3

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	4299203
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 NEW LEVEL 3

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	4299203
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

OFFICE VISIT NEW LEVEL 4

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	4299204
Hospital Revenue Code	521
Rate for Payer: Cash Price	$346.50

OFFICE VISIT NEW LEVEL 4

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	4299204
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 NEW LEVEL 5

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	4299205
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 NEW LEVEL 5

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	4299205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$436.50

OFFICE VISIT/NEW OP (BRIEF)

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	4499201
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/NEW OP (BRIEF)

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	4499201
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT/NEW OP (COMPRE)

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	4499205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$436.50

OFFICE VISIT/NEW OP (COMPRE)

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	4499205
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/NEW OP (EXTENDED)

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	4499204
Hospital Revenue Code	521
Rate for Payer: Cash Price	$346.50

OFFICE VISIT/NEW OP (EXTENDED)

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	4499204
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/NEW OP (INTER)

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	4499203
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

OFFICE VISIT/NEW OP (INTER)

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	4499203
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

Know your out-of-pocket cost for care.

All Charges