Madison Medical Center

All Charges

Charge

Type

Setting

Price

SUBSEQ NH COMPREHENSIVE

Facility

$260.00

Service Code	CPT 99310
Hospital Charge Code	5299310
Hospital Revenue Code	525
Min. Negotiated Rate	$153.92
Max. Negotiated Rate	$185.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$153.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$185.64
Rate for Payer: Cash Price	$234.00
Rate for Payer: Cash Price	$234.00
Rate for Payer: UnitedHealthcare Commercial	$173.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SUBSEQ NH COMPREHENSIVE

Facility

$260.00

Service Code	CPT 99310
Hospital Charge Code	9899310
Hospital Revenue Code	521
Rate for Payer: Cash Price	$234.00

SUBSEQ NH COMPREHENSIVE

Facility

$260.00

Service Code	CPT 99310
Hospital Charge Code	5299310
Hospital Revenue Code	525
Rate for Payer: Cash Price	$234.00

SUBSEQ NH EXTENDED

Facility

$190.00

Service Code	CPT 99309
Hospital Charge Code	5299309
Hospital Revenue Code	525
Rate for Payer: Cash Price	$171.00

SUBSEQ NH EXTENDED

Facility

$190.00

Service Code	CPT 99309
Hospital Charge Code	5299309
Hospital Revenue Code	525
Min. Negotiated Rate	$112.48
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: UnitedHealthcare Commercial	$126.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SUBSEQ NH EXTENDED

Facility

$114.00

Service Code	CPT 99309
Hospital Charge Code	5299313
Hospital Revenue Code	525
Min. Negotiated Rate	$67.49
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$67.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$81.40
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cash Price	$102.60
Rate for Payer: UnitedHealthcare Commercial	$76.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SUBSEQ NH EXTENDED

Facility

$114.00

Service Code	CPT 99309
Hospital Charge Code	5299313
Hospital Revenue Code	525
Rate for Payer: Cash Price	$102.60

SUBSEQ NH EXTENDED VISIT

Facility

$114.00

Service Code	CPT 99309
Hospital Charge Code	9899313
Hospital Revenue Code	521
Min. Negotiated Rate	$67.49
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$67.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$81.40
Rate for Payer: Cash Price	$102.60
Rate for Payer: Cash Price	$102.60
Rate for Payer: UnitedHealthcare Commercial	$76.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SUBSEQ NH EXTENDED VISIT

Facility

$190.00

Service Code	CPT 99309
Hospital Charge Code	9899309
Hospital Revenue Code	521
Rate for Payer: Cash Price	$171.00

SUBSEQ NH EXTENDED VISIT

Facility

$114.00

Service Code	CPT 99309
Hospital Charge Code	9899313
Hospital Revenue Code	521
Rate for Payer: Cash Price	$102.60

SUBSEQ NH EXTENDED VISIT

Facility

$190.00

Service Code	CPT 99309
Hospital Charge Code	9899309
Hospital Revenue Code	521
Min. Negotiated Rate	$112.48
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: UnitedHealthcare Commercial	$126.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SUBSEQ NH INTERMED

Facility

$150.00

Service Code	CPT 99308
Hospital Charge Code	5299308
Hospital Revenue Code	525
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

SUBSEQ NH INTERMED

Facility

$88.50

Service Code	CPT 99308
Hospital Charge Code	5299312
Hospital Revenue Code	525
Rate for Payer: Cash Price	$79.65

SUBSEQ NH INTERMED

Facility

$150.00

Service Code	CPT 99308
Hospital Charge Code	5299308
Hospital Revenue Code	525
Rate for Payer: Cash Price	$135.00

SUBSEQ NH INTERMED

Facility

$88.50

Service Code	CPT 99308
Hospital Charge Code	5299312
Hospital Revenue Code	525
Min. Negotiated Rate	$52.39
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.19
Rate for Payer: Cash Price	$79.65
Rate for Payer: Cash Price	$79.65
Rate for Payer: UnitedHealthcare Commercial	$59.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SUBSEQ NH INTERMEDIATE VISIT

Facility

$150.00

Service Code	CPT 99308
Hospital Charge Code	9899308
Hospital Revenue Code	521
Rate for Payer: Cash Price	$135.00

SUBSEQ NH INTERMEDIATE VISIT

Facility

$85.50

Service Code	CPT 99308
Hospital Charge Code	9899312
Hospital Revenue Code	521
Min. Negotiated Rate	$50.62
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$50.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$61.05
Rate for Payer: Cash Price	$76.95
Rate for Payer: Cash Price	$76.95
Rate for Payer: UnitedHealthcare Commercial	$57.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SUBSEQ NH INTERMEDIATE VISIT

Facility

$150.00

Service Code	CPT 99308
Hospital Charge Code	9899308
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

SUBSEQ NH INTERMEDIATE VISIT

Facility

$85.50

Service Code	CPT 99308
Hospital Charge Code	9899312
Hospital Revenue Code	521
Rate for Payer: Cash Price	$76.95

SUBSEQ NH VISIT BRIEF

Facility

$60.00

Service Code	CPT 99307
Hospital Charge Code	9799311
Hospital Revenue Code	521
Min. Negotiated Rate	$35.52
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SUBSEQ NH VISIT BRIEF

Facility

$100.00

Service Code	CPT 99307
Hospital Charge Code	9799307
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

SUBSEQ NH VISIT BRIEF

Facility

$60.00

Service Code	CPT 99307
Hospital Charge Code	9799311
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.00

SUBSEQ NH VISIT BRIEF

Facility

$100.00

Service Code	CPT 99307
Hospital Charge Code	9799307
Hospital Revenue Code	521
Min. Negotiated Rate	$59.20
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SUBSEQ RH BRIEF

Facility

$90.00

Service Code	CPT 99349
Hospital Charge Code	5299334
Hospital Revenue Code	525
Min. Negotiated Rate	$53.28
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.26
Rate for Payer: Cash Price	$81.00
Rate for Payer: Cash Price	$81.00
Rate for Payer: UnitedHealthcare Commercial	$60.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SUBSEQ RH BRIEF

Facility

$90.00

Service Code	CPT 99349
Hospital Charge Code	5299334
Hospital Revenue Code	525
Rate for Payer: Cash Price	$81.00

Know your out-of-pocket cost for care.

All Charges