Madison Medical Center

All Charges

Charge

Type

Setting

Price

TURBT TRANSURETHRAL RESEC OF BLADDER

Professional

Both

$2,200.00

Service Code	CPT 52235
Hospital Charge Code	9352235
Hospital Revenue Code	975
Min. Negotiated Rate	$246.37
Max. Negotiated Rate	$770.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$246.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$287.54
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Cigna Commercial HMO & PPO	$246.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$287.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$316.29
Rate for Payer: Home State Health Plan Medicare Advantage	$246.37
Rate for Payer: Optum Medicare Advantage	$770.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$287.54

TX OF NASAL FX W/O MANIPULATIO

Professional

Both

$742.00

Service Code	CPT 21310
Hospital Charge Code	1821310
Hospital Revenue Code	981
Min. Negotiated Rate	$259.70
Max. Negotiated Rate	$259.70
Rate for Payer: Cash Price	$667.80
Rate for Payer: Optum Medicare Advantage	$259.70

TX OF SUPERFICIAL WOUND DEHIS; SIMPLE CL

Facility

$580.00

Service Code	CPT 12020
Hospital Charge Code	9812020
Hospital Revenue Code	521
Rate for Payer: Cash Price	$522.00

TX OF SUPERFICIAL WOUND DEHIS; SIMPLE CL

Facility

$580.00

Service Code	CPT 12020
Hospital Charge Code	9812020
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,510.16
Rate for Payer: Aetna Better Health Medicaid/QHP	$666.23
Rate for Payer: Aetna Medicare Advantage	$755.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$343.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$414.12
Rate for Payer: Cash Price	$522.00
Rate for Payer: Cash Price	$522.00
Rate for Payer: Cash Price	$522.00
Rate for Payer: Cash Price	$522.00
Rate for Payer: Cigna Commercial HMO & PPO	$755.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$599.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$712.87
Rate for Payer: Home State Health Plan Medicare Advantage	$755.08
Rate for Payer: Humana Commercial	$1,510.16
Rate for Payer: Humana Medicare Advantage	$755.08
Rate for Payer: UnitedHealthcare Commercial	$386.86
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$666.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TYMPANIC MEMBRANE REPAIR

Professional

Both

$1,000.00

Service Code	CPT 69610
Hospital Charge Code	9369610
Hospital Revenue Code	975
Min. Negotiated Rate	$237.49
Max. Negotiated Rate	$355.99
Rate for Payer: Aetna Commercial/Medicare Advantage	$237.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$323.63
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cigna Commercial HMO & PPO	$237.49
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$323.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$355.99
Rate for Payer: Home State Health Plan Medicare Advantage	$237.49
Rate for Payer: Optum Medicare Advantage	$350.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$323.63

TYMPANOSTOMY REQ INS TUBE W/ANESTH

Professional

Both

$900.00

Service Code	CPT 69436
Hospital Charge Code	9369436
Hospital Revenue Code	975
Min. Negotiated Rate	$134.75
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$134.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$140.83
Rate for Payer: Cash Price	$810.00
Rate for Payer: Cash Price	$810.00
Rate for Payer: Cigna Commercial HMO & PPO	$134.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$140.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$154.91
Rate for Payer: Home State Health Plan Medicare Advantage	$134.75
Rate for Payer: Optum Medicare Advantage	$315.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$140.83

.UA COMP CHG ONLY

Facility

$77.00

Service Code	CPT 81001
Hospital Charge Code	2222106
Hospital Revenue Code	307
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$54.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.85
Rate for Payer: Aetna Medicare Advantage	$3.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$45.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.98
Rate for Payer: Cash Price	$69.30
Rate for Payer: Cash Price	$69.30
Rate for Payer: Cash Price	$69.30
Rate for Payer: Cigna Commercial HMO & PPO	$3.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.05
Rate for Payer: Home State Health Plan Medicare Advantage	$3.17
Rate for Payer: Humana Commercial	$6.34
Rate for Payer: Humana Medicare Advantage	$3.17
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.72

.UA COMP CHG ONLY

Facility

$77.00

Service Code	CPT 81001
Hospital Charge Code	2222106
Hospital Revenue Code	307
Rate for Payer: Cash Price	$69.30

.UA DIP CHG ONLY

Facility

$80.00

Service Code	CPT 81003
Hospital Charge Code	2222107
Hospital Revenue Code	307
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$57.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.03
Rate for Payer: Aetna Medicare Advantage	$2.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna Commercial HMO & PPO	$2.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2.17
Rate for Payer: Home State Health Plan Medicare Advantage	$2.25
Rate for Payer: Humana Commercial	$4.50
Rate for Payer: Humana Medicare Advantage	$2.25
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.80

.UA DIP CHG ONLY

Facility

$80.00

Service Code	CPT 81003
Hospital Charge Code	2222107
Hospital Revenue Code	307
Rate for Payer: Cash Price	$72.00

U-DRAPE 54X76

Facility

$15.00

Hospital Charge Code	2820738
Hospital Revenue Code	271
Rate for Payer: Cash Price	$13.50

U-DRAPE 54X76

Facility

$15.00

Hospital Charge Code	2820738
Hospital Revenue Code	271
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

UGI

Facility

$766.00

Service Code	CPT 74240
Hospital Charge Code	3221148
Hospital Revenue Code	320
Rate for Payer: Cash Price	$689.40

UGI

Facility

$766.00

Service Code	CPT 74240
Hospital Charge Code	3221148
Hospital Revenue Code	320
Min. Negotiated Rate	$158.12
Max. Negotiated Rate	$546.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$158.12
Rate for Payer: Aetna Medicare Advantage	$179.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$453.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$546.92
Rate for Payer: Cash Price	$689.40
Rate for Payer: Cash Price	$689.40
Rate for Payer: Cash Price	$689.40
Rate for Payer: Cigna Commercial HMO & PPO	$179.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$158.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$169.19
Rate for Payer: Home State Health Plan Medicare Advantage	$179.20
Rate for Payer: Humana Commercial	$358.40
Rate for Payer: Humana Medicare Advantage	$179.20
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$158.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$275.76

UGI BA CUP

Facility

$48.00

Hospital Charge Code	3200123
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

UGI BA CUP

Facility

$48.00

Hospital Charge Code	2800123
Hospital Revenue Code	271
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

UGI BA CUP

Facility

$48.00

Hospital Charge Code	3200123
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

UGI BA CUP

Facility

$48.00

Hospital Charge Code	2800123
Hospital Revenue Code	271
Rate for Payer: Cash Price	$43.20

UGI GASTRO KIT

Facility

$153.00

Hospital Charge Code	3200125
Hospital Revenue Code	271
Min. Negotiated Rate	$55.08
Max. Negotiated Rate	$109.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: UnitedHealthcare Commercial	$102.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

UGI GASTRO KIT

Facility

$153.00

Hospital Charge Code	3200125
Hospital Revenue Code	271
Rate for Payer: Cash Price	$137.70

UGT1A1 (Irinotecan Toxicity)

Facility

$623.00

Service Code	CPT 81350
Hospital Charge Code	22281350
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$468.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$210.60
Rate for Payer: Aetna Medicare Advantage	$234.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$368.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$444.82
Rate for Payer: Cash Price	$560.70
Rate for Payer: Cash Price	$560.70
Rate for Payer: Cash Price	$560.70
Rate for Payer: Cigna Commercial HMO & PPO	$234.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$210.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$225.34
Rate for Payer: Home State Health Plan Medicare Advantage	$234.00
Rate for Payer: Humana Commercial	$468.00
Rate for Payer: Humana Medicare Advantage	$234.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$210.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$224.28

UGT1A1 (Irinotecan Toxicity)

Facility

$623.00

Service Code	CPT 81350
Hospital Charge Code	22281350
Hospital Revenue Code	301
Rate for Payer: Cash Price	$560.70

ULTANE

Facility

$521.00

Hospital Charge Code	207950
Hospital Revenue Code	370
Rate for Payer: Cash Price	$468.90

ULTANE

Facility

$521.00

Hospital Charge Code	207950
Hospital Revenue Code	370
Min. Negotiated Rate	$187.56
Max. Negotiated Rate	$371.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$308.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$371.99
Rate for Payer: Cash Price	$468.90
Rate for Payer: UnitedHealthcare Commercial	$347.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$187.56

ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC

Facility

$91,495.96

Service Code	MSDRG 278
Min. Negotiated Rate	$45,747.98
Max. Negotiated Rate	$91,495.96
Rate for Payer: Aetna Medicare Advantage	$45,747.98
Rate for Payer: Cigna Commercial HMO & PPO	$45,747.98
Rate for Payer: Home State Health Plan Medicare Advantage	$45,747.98
Rate for Payer: Humana Commercial	$91,495.96
Rate for Payer: Humana Medicare Advantage	$45,747.98

Know your out-of-pocket cost for care.

All Charges