Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

OZARK EST MODERATE VISIT 25 MIN

Facility

$145.00

Service Code	CPT 99348
Hospital Charge Code	4299335
Hospital Revenue Code	525
Rate for Payer: Cash Price	$130.50

OZARK EST MODERATE VISIT 25 MIN

Facility

$145.00

Service Code	CPT 99348
Hospital Charge Code	4299335
Hospital Revenue Code	525
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$85.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$103.53
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: UnitedHealthcare Commercial	$96.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OZARK EST UNSTABLE

Facility

$310.00

Service Code	CPT 99350
Hospital Charge Code	4299337
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$221.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$183.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$221.34
Rate for Payer: Cash Price	$279.00
Rate for Payer: Cash Price	$279.00
Rate for Payer: UnitedHealthcare Commercial	$206.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OZARK EST UNSTABLE

Facility

$310.00

Service Code	CPT 99350
Hospital Charge Code	4299337
Hospital Revenue Code	525
Rate for Payer: Cash Price	$279.00

OZARK INITIAL LOW 20 MIN

Facility

$120.00

Service Code	CPT 99341
Hospital Charge Code	4499324
Hospital Revenue Code	525
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

OZARK INITIAL LOW 20 MIN

Facility

$120.00

Service Code	CPT 99341
Hospital Charge Code	4499324
Hospital Revenue Code	525
Rate for Payer: Cash Price	$108.00

OZARK INITIAL MODERATE 30 MIN

Facility

$175.00

Service Code	CPT 99342
Hospital Charge Code	4499325
Hospital Revenue Code	525
Rate for Payer: Cash Price	$157.50

OZARK INITIAL MODERATE 30 MIN

Facility

$175.00

Service Code	CPT 99342
Hospital Charge Code	4499325
Hospital Revenue Code	525
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

OZARK MANOR ADMIT COMPLEX 60 MIN

Facility

$330.00

Service Code	CPT 99344
Hospital Charge Code	9799327
Hospital Revenue Code	521
Rate for Payer: Cash Price	$297.00

OZARK MANOR ADMIT COMPLEX 60 MIN

Facility

$330.00

Service Code	CPT 99344
Hospital Charge Code	9799327
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$235.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$195.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$235.62
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: UnitedHealthcare Commercial	$220.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OZARK MANOR ADMIT HIGH 45 MIN

Facility

$245.00

Service Code	CPT 99342
Hospital Charge Code	9799326
Hospital Revenue Code	521
Rate for Payer: Cash Price	$220.50

OZARK MANOR ADMIT HIGH 45 MIN

Facility

$245.00

Service Code	CPT 99342
Hospital Charge Code	9799326
Hospital Revenue Code	521
Min. Negotiated Rate	$145.04
Max. Negotiated Rate	$174.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$145.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.93
Rate for Payer: Cash Price	$220.50
Rate for Payer: Cash Price	$220.50
Rate for Payer: UnitedHealthcare Commercial	$163.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OZARK MANOR ADMIT LOW 20 MIN

Facility

$120.00

Service Code	CPT 99341
Hospital Charge Code	9799324
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

OZARK MANOR ADMIT LOW 20 MIN

Facility

$120.00

Service Code	CPT 99341
Hospital Charge Code	9799324
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

OZARK MANOR ADMIT MOD 30 MIN

Facility

$170.00

Service Code	CPT 99342
Hospital Charge Code	9799325
Hospital Revenue Code	521
Rate for Payer: Cash Price	$153.00

OZARK MANOR ADMIT MOD 30 MIN

Facility

$170.00

Service Code	CPT 99342
Hospital Charge Code	9799325
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 MANOR ADMIT UNSTABLE 75 MIN

Facility

$415.00

Service Code	CPT 99345
Hospital Charge Code	9799328
Hospital Revenue Code	521
Rate for Payer: Cash Price	$373.50

OZARK MANOR ADMIT UNSTABLE 75 MIN

Facility

$415.00

Service Code	CPT 99345
Hospital Charge Code	9799328
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$296.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$245.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$296.31
Rate for Payer: Cash Price	$373.50
Rate for Payer: Cash Price	$373.50
Rate for Payer: UnitedHealthcare Commercial	$276.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OZARK MANOR SUBSEQ HIGH 40 MIN

Facility

$220.00

Service Code	CPT 99349
Hospital Charge Code	9799336
Hospital Revenue Code	521
Min. Negotiated Rate	$130.24
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$130.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.08
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: UnitedHealthcare Commercial	$146.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

OZARK MANOR SUBSEQ HIGH 40 MIN

Facility

$220.00

Service Code	CPT 99349
Hospital Charge Code	9799336
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.00

OZARK MANOR SUBSEQ LOW 15 MIN

Facility

$105.00

Service Code	CPT 99347
Hospital Charge Code	9799334
Hospital Revenue Code	521
Rate for Payer: Cash Price	$94.50

OZARK MANOR SUBSEQ LOW 15 MIN

Facility

$105.00

Service Code	CPT 99347
Hospital Charge Code	9799334
Hospital Revenue Code	521
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 MANOR SUBSEQ MOD 25 MIN

Facility

$150.00

Service Code	CPT 99348
Hospital Charge Code	9799335
Hospital Revenue Code	521
Rate for Payer: Cash Price	$135.00

OZARK MANOR SUBSEQ MOD 25 MIN

Facility

$150.00

Service Code	CPT 99348
Hospital Charge Code	9799335
Hospital Revenue Code	521
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges