Madison Medical Center

All Charges

Charge

Type

Setting

Price

OFFICE VISIT/NEW OP (LIMITED)

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	4499202
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

OFFICE VISIT/NEW OP (LIMITED)

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	4499202
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 PAT EXT 45 MIN

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	5499204
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 PAT EXT 45 MIN

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	5499204
Hospital Revenue Code	521
Rate for Payer: Cash Price	$346.50

OFFICE VISIT NEW PT - 12-17 YRS OLD

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	4499384
Hospital Revenue Code	521
Min. Negotiated Rate	$171.68
Max. Negotiated Rate	$207.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$171.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$207.06
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: UnitedHealthcare Commercial	$193.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT NEW PT - 12-17 YRS OLD

Facility

$290.00

Service Code	CPT 99384
Hospital Charge Code	4499384
Hospital Revenue Code	521
Rate for Payer: Cash Price	$261.00

OFFICE VISIT NEW PT - 18-39 YRS OLD

Facility

$315.00

Service Code	CPT 99385
Hospital Charge Code	9799385
Hospital Revenue Code	521
Rate for Payer: Cash Price	$283.50

OFFICE VISIT NEW PT - 18-39 YRS OLD

Facility

$315.00

Service Code	CPT 99385
Hospital Charge Code	9799385
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$224.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$186.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$224.91
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: UnitedHealthcare Commercial	$210.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT NEW PT - 18-39 YRS OLD

Facility

$315.00

Service Code	CPT 99385
Hospital Charge Code	4499385
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$224.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$186.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$224.91
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: UnitedHealthcare Commercial	$210.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT NEW PT - 18-39 YRS OLD

Facility

$315.00

Service Code	CPT 99385
Hospital Charge Code	4499385
Hospital Revenue Code	521
Rate for Payer: Cash Price	$283.50

OFFICE VISIT NEW PT - 40-64 YRS OLD

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	4499386
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$267.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$222.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$267.75
Rate for Payer: Cash Price	$337.50
Rate for Payer: Cash Price	$337.50
Rate for Payer: UnitedHealthcare Commercial	$250.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT NEW PT - 40-64 YRS OLD

Facility

$375.00

Service Code	CPT 99386
Hospital Charge Code	4499386
Hospital Revenue Code	521
Rate for Payer: Cash Price	$337.50

OFFICE VISIT NEW PT - 65 & OVER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	4499387
Hospital Revenue Code	521
Rate for Payer: Cash Price	$351.00

OFFICE VISIT NEW PT - 65 & OVER

Facility

$390.00

Service Code	CPT 99387
Hospital Charge Code	4499387
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$278.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$230.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$278.46
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: UnitedHealthcare Commercial	$260.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OFFICE VISIT - NEW PT - BRIEF

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	3999201
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 PT - BRIEF

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	3999201
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT - NEW PT - COMPREHENSIVE

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	3999205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$436.50

OFFICE VISIT - NEW PT - COMPREHENSIVE

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	3999205
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 PT COMPREHENSIVE

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9199205
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 PT COMPREHENSIVE

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9199205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$436.50

OFFICE VISIT - NEW PT - EXTENDED

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	3999204
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 PT - EXTENDED

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	3999204
Hospital Revenue Code	521
Rate for Payer: Cash Price	$346.50

OFFICE VISIT - NEW PT - INTERMEDIATE

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	3999203
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 PT - INTERMEDIATE

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	3999203
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

OFFICE VISIT NEW PT INTERMEDIATE

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	9199203
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

Know your out-of-pocket cost for care.

All Charges