Madison Medical Center

All Charges

Charge

Type

Setting

Price

OFFICE VISIT NEW PT INTERMEDIATE

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	9199203
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 - LIMITED

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	3999202
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

OFFICE VISIT - NEW PT - LIMITED

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	3999202
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 PT LIMITED

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	9199202
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 PT LIMITED

Facility

$175.00

Service Code	CPT 99202
Hospital Charge Code	9199202
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

OFFICE VISIT NEW PT MINIMAL

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	9199201
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 MINIMAL

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	9199201
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT - NP - BRIEF

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	9599201
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 - NP - BRIEF

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	9599201
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT NP BRIEF

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	9799201
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 NP BRIEF

Facility

$120.00

Service Code	CPT 99202
Hospital Charge Code	9799201
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OFFICE VISIT - NP - COMPREHENSIVE

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9599205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$436.50

OFFICE VISIT - NP - COMPREHENSIVE

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9599205
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 NP COMPREHENSIVE

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9799205
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 NP COMPREHENSIVE

Facility

$485.00

Service Code	CPT 99205
Hospital Charge Code	9799205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$436.50

OFFICE VISIT - NP EXTENDED

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	9699204
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 - NP EXTENDED

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	9699204
Hospital Revenue Code	521
Rate for Payer: Cash Price	$346.50

OFFICE VISIT - NP - EXTENDED

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	9599204
Hospital Revenue Code	521
Rate for Payer: Cash Price	$346.50

OFFICE VISIT - NP - EXTENDED

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	9599204
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 NP EXTENDED

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	9799204
Hospital Revenue Code	521
Rate for Payer: Cash Price	$346.50

OFFICE VISIT NP EXTENDED

Facility

$385.00

Service Code	CPT 99204
Hospital Charge Code	9799204
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 - NP INTERMEDIATE

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	9699203
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 - NP INTERMEDIATE

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	9699203
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

OFFICE VISIT - NP - INTERMEDIATE

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	9599203
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 - NP - INTERMEDIATE

Facility

$240.00

Service Code	CPT 99203
Hospital Charge Code	9599203
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

Know your out-of-pocket cost for care.

All Charges