Madison Medical Center

All Charges

Charge

Type

Setting

Price

SUBSEQ RH BRIEF VISIT

Facility

$105.00

Service Code	CPT 99347
Hospital Charge Code	9899334
Hospital Revenue Code	521
Rate for Payer: Cash Price	$94.50

SUBSEQ RH BRIEF VISIT

Facility

$105.00

Service Code	CPT 99347
Hospital Charge Code	9899334
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

SUBSEQ RH EXTENDED

Facility

$195.00

Service Code	CPT 99417
Hospital Charge Code	5299336
Hospital Revenue Code	525
Min. Negotiated Rate	$115.44
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$115.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$139.23
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: UnitedHealthcare Commercial	$130.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SUBSEQ RH EXTENDED

Facility

$195.00

Service Code	CPT 99417
Hospital Charge Code	5299336
Hospital Revenue Code	525
Rate for Payer: Cash Price	$175.50

SUBSEQ RH EXTENDED VISIT

Facility

$310.00

Service Code	CPT 99350
Hospital Charge Code	9899337
Hospital Revenue Code	521
Rate for Payer: Cash Price	$279.00

SUBSEQ RH EXTENDED VISIT

Facility

$215.00

Service Code	CPT 99349
Hospital Charge Code	9899336
Hospital Revenue Code	521
Rate for Payer: Cash Price	$193.50

SUBSEQ RH EXTENDED VISIT

Facility

$215.00

Service Code	CPT 99349
Hospital Charge Code	9899336
Hospital Revenue Code	521
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

SUBSEQ RH EXTENDED VISIT

Facility

$310.00

Service Code	CPT 99350
Hospital Charge Code	9899337
Hospital Revenue Code	521
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

SUBSEQ RH INTERMED

Facility

$135.00

Service Code	CPT 99350
Hospital Charge Code	5299335
Hospital Revenue Code	525
Min. Negotiated Rate	$79.92
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$79.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$96.39
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: UnitedHealthcare Commercial	$90.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SUBSEQ RH INTERMED

Facility

$135.00

Service Code	CPT 99350
Hospital Charge Code	5299335
Hospital Revenue Code	525
Rate for Payer: Cash Price	$121.50

SUBSEQ RH INTERMEDIATE VISIT

Facility

$145.00

Service Code	CPT 99348
Hospital Charge Code	9899335
Hospital Revenue Code	521
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

SUBSEQ RH INTERMEDIATE VISIT

Facility

$145.00

Service Code	CPT 99348
Hospital Charge Code	9899335
Hospital Revenue Code	521
Rate for Payer: Cash Price	$130.50

SUBSEQ RH UNSTABLE

Facility

$285.00

Service Code	CPT 99418
Hospital Charge Code	5299337
Hospital Revenue Code	525
Rate for Payer: Cash Price	$256.50

SUBSEQ RH UNSTABLE

Facility

$285.00

Service Code	CPT 99418
Hospital Charge Code	5299337
Hospital Revenue Code	525
Min. Negotiated Rate	$168.72
Max. Negotiated Rate	$203.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$168.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$203.49
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: UnitedHealthcare Commercial	$190.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SUBSEQUENT HOSP CARE INPATIENT MOD 25 MI

Facility

$170.00

Service Code	CPT 99232
Hospital Charge Code	9699232
Rate for Payer: Cash Price	$153.00

SUBSEQUENT OSCILLOMETRY

Facility

$151.00

Service Code	CPT 94726
Hospital Charge Code	4501001
Hospital Revenue Code	460
Rate for Payer: Cash Price	$135.90

SUBSEQUENT OSCILLOMETRY

Facility

$151.00

Service Code	CPT 94726
Hospital Charge Code	4501001
Hospital Revenue Code	460
Min. Negotiated Rate	$54.36
Max. Negotiated Rate	$762.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$336.38
Rate for Payer: Aetna Medicare Advantage	$381.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.81
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cigna Commercial HMO & PPO	$381.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$336.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$359.93
Rate for Payer: Home State Health Plan Medicare Advantage	$381.24
Rate for Payer: Humana Commercial	$762.48
Rate for Payer: Humana Medicare Advantage	$381.24
Rate for Payer: UnitedHealthcare Commercial	$100.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$336.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.36

SUBSEQUENT SPIROMETRY 2XDAY MAX

Facility

$215.00

Service Code	CPT 94668
Hospital Charge Code	4594012
Hospital Revenue Code	460
Rate for Payer: Cash Price	$193.50

SUBSEQUENT SPIROMETRY 2XDAY MAX

Facility

$215.00

Service Code	CPT 94668
Hospital Charge Code	4594012
Hospital Revenue Code	460
Min. Negotiated Rate	$77.40
Max. Negotiated Rate	$271.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
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: Cash Price	$193.50
Rate for Payer: Cigna Commercial HMO & PPO	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$119.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$143.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$77.40

SUBSEQUENT TRIFLO

Facility

$151.00

Service Code	CPT 94799
Hospital Charge Code	4500512
Hospital Revenue Code	460
Rate for Payer: Cash Price	$135.90

SUBSEQUENT TRIFLO

Facility

$151.00

Service Code	CPT 94799
Hospital Charge Code	4500512
Hospital Revenue Code	460
Min. Negotiated Rate	$54.36
Max. Negotiated Rate	$262.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$116.00
Rate for Payer: Aetna Medicare Advantage	$131.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.81
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cash Price	$135.90
Rate for Payer: Cigna Commercial HMO & PPO	$131.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$116.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$124.12
Rate for Payer: Home State Health Plan Medicare Advantage	$131.46
Rate for Payer: Humana Commercial	$262.92
Rate for Payer: Humana Medicare Advantage	$131.46
Rate for Payer: UnitedHealthcare Commercial	$100.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$116.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.36

SUBSQ.HOSP CARECUSED (EST)

Professional

Both

$130.00

Service Code	CPT 99231
Hospital Charge Code	5299231
Hospital Revenue Code	987
Min. Negotiated Rate	$31.75
Max. Negotiated Rate	$45.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$42.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$31.75
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cigna Commercial HMO & PPO	$42.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$34.92
Rate for Payer: Home State Health Plan Medicare Advantage	$42.91
Rate for Payer: Optum Medicare Advantage	$45.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.75

SUBSQ.HOSP CARECUSED EXT

Professional

Both

$295.00

Service Code	CPT 99233
Hospital Charge Code	5299233
Hospital Revenue Code	987
Min. Negotiated Rate	$84.01
Max. Negotiated Rate	$103.87
Rate for Payer: Aetna Commercial/Medicare Advantage	$103.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$84.01
Rate for Payer: Cash Price	$265.50
Rate for Payer: Cash Price	$265.50
Rate for Payer: Cigna Commercial HMO & PPO	$103.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$84.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$92.41
Rate for Payer: Home State Health Plan Medicare Advantage	$103.87
Rate for Payer: Optum Medicare Advantage	$103.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$84.01

SUBSQ.HOSP CARECUSED INTER

Professional

Both

$205.00

Service Code	CPT 99232
Hospital Charge Code	5299232
Hospital Revenue Code	987
Min. Negotiated Rate	$58.46
Max. Negotiated Rate	$71.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$68.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$58.46
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cash Price	$184.50
Rate for Payer: Cigna Commercial HMO & PPO	$68.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$64.31
Rate for Payer: Home State Health Plan Medicare Advantage	$68.53
Rate for Payer: Optum Medicare Advantage	$71.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$58.46

SUCCINYLCHOLINE 200MG/10ML INJ MDV

Facility

$133.00

Service Code	HCPCS J0330
Hospital Charge Code	2626334
Hospital Revenue Code	250
Min. Negotiated Rate	$47.88
Max. Negotiated Rate	$94.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$78.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$94.96
Rate for Payer: Cash Price	$119.70
Rate for Payer: UnitedHealthcare Commercial	$88.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.88

Know your out-of-pocket cost for care.

All Charges