Madison Medical Center

All Charges

Charge

Type

Setting

Price

OXYMIZER PENDANT

Facility

$165.00

Hospital Charge Code	4500422
Hospital Revenue Code	271
Min. Negotiated Rate	$59.40
Max. Negotiated Rate	$117.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: UnitedHealthcare Commercial	$110.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

OXYMIZER PENDANT

Facility

$165.00

Hospital Charge Code	4500422
Hospital Revenue Code	271
Rate for Payer: Cash Price	$148.50

OXYTOCIN INJ

Facility

$65.00

Service Code	HCPCS J2590
Hospital Charge Code	2058042
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

OXYTOCIN INJ

Facility

$65.00

Service Code	HCPCS J2590
Hospital Charge Code	2058042
Hospital Revenue Code	370
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

OXYTOCIN (PITOCIN) 10UNITS/ML INJ 1ML

Facility

$58.00

Service Code	HCPCS J2590
Hospital Charge Code	2655800
Hospital Revenue Code	250
Rate for Payer: Cash Price	$52.20

OXYTOCIN (PITOCIN) 10UNITS/ML INJ 1ML

Facility

$58.00

Service Code	HCPCS J2590
Hospital Charge Code	2655800
Hospital Revenue Code	250
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

OZARK BRIEF VISIT 15 MIN

Facility

$105.00

Service Code	CPT 99347
Hospital Charge Code	4299334
Hospital Revenue Code	525
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: UnitedHealthcare Commercial	$70.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OZARK BRIEF VISIT 15 MIN

Facility

$105.00

Service Code	CPT 99347
Hospital Charge Code	4299334
Hospital Revenue Code	525
Rate for Payer: Cash Price	$94.50

OZARK CPO <30 MIN

Facility

$165.00

Service Code	CPT 99417
Hospital Charge Code	4299339
Hospital Revenue Code	525
Rate for Payer: Cash Price	$148.50

OZARK CPO <30 MIN

Facility

$170.00

Service Code	CPT 99374
Hospital Charge Code	9899339
Hospital Revenue Code	521
Min. Negotiated Rate	$100.64
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$121.38
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: UnitedHealthcare Commercial	$113.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OZARK CPO <30 MIN

Facility

$170.00

Service Code	CPT 99417
Hospital Charge Code	5299339
Hospital Revenue Code	525
Rate for Payer: Cash Price	$153.00

OZARK CPO <30 MIN

Facility

$170.00

Service Code	CPT 99417
Hospital Charge Code	5299339
Hospital Revenue Code	525
Min. Negotiated Rate	$100.64
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$121.38
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: UnitedHealthcare Commercial	$113.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OZARK CPO <30 MIN

Facility

$170.00

Service Code	CPT 99374
Hospital Charge Code	9899339
Hospital Revenue Code	521
Rate for Payer: Cash Price	$153.00

OZARK CPO <30 MIN

Facility

$170.00

Service Code	CPT 99417
Hospital Charge Code	4499339
Hospital Revenue Code	525
Rate for Payer: Cash Price	$153.00

OZARK CPO <30 MIN

Facility

$165.00

Service Code	CPT 99417
Hospital Charge Code	4299339
Hospital Revenue Code	525
Min. Negotiated Rate	$97.68
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: UnitedHealthcare Commercial	$110.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OZARK CPO <30 MIN

Facility

$170.00

Service Code	CPT 99417
Hospital Charge Code	4499339
Hospital Revenue Code	525
Min. Negotiated Rate	$100.64
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$121.38
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: UnitedHealthcare Commercial	$113.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OZARK CPO >30 MIN

Facility

$250.00

Service Code	CPT 99418
Hospital Charge Code	9899340
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

OZARK CPO >30 MIN

Facility

$246.00

Service Code	CPT 99418
Hospital Charge Code	4299340
Hospital Revenue Code	525
Min. Negotiated Rate	$145.63
Max. Negotiated Rate	$175.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$145.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$175.64
Rate for Payer: Cash Price	$221.40
Rate for Payer: Cash Price	$221.40
Rate for Payer: UnitedHealthcare Commercial	$164.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OZARK CPO >30 MIN

Facility

$250.00

Service Code	CPT 99418
Hospital Charge Code	5299340
Hospital Revenue Code	525
Rate for Payer: Cash Price	$225.00

OZARK CPO >30 MIN

Facility

$246.00

Service Code	CPT 99418
Hospital Charge Code	4299340
Hospital Revenue Code	525
Rate for Payer: Cash Price	$221.40

OZARK CPO >30 MIN

Facility

$250.00

Service Code	CPT 99418
Hospital Charge Code	9899340
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

OZARK CPO >30 MIN

Facility

$250.00

Service Code	CPT 99418
Hospital Charge Code	4499340
Hospital Revenue Code	525
Rate for Payer: Cash Price	$225.00

OZARK CPO >30 MIN

Facility

$250.00

Service Code	CPT 99418
Hospital Charge Code	5299340
Hospital Revenue Code	525
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

OZARK CPO >30 MIN

Facility

$250.00

Service Code	CPT 99418
Hospital Charge Code	4499340
Hospital Revenue Code	525
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

OZARK EST HIGH 40 MIN

Facility

$215.00

Service Code	CPT 99349
Hospital Charge Code	4299336
Hospital Revenue Code	525
Min. Negotiated Rate	$127.28
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$127.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$153.51
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: UnitedHealthcare Commercial	$143.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges