Madison Medical Center

All Charges

Charge

Type

Setting

Price

UNITHROID 125MCG TAB EMP

Facility

$45.00

Service Code	NDC 74706890
Hospital Charge Code	2698417
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

UNLISTED EVALUATION & MANAGEMENT

Facility

$167.00

Service Code	CPT 99499
Hospital Charge Code	9899499
Hospital Revenue Code	521
Rate for Payer: Cash Price	$150.30

UNLISTED EVALUATION & MANAGEMENT

Facility

$167.00

Service Code	CPT 99499
Hospital Charge Code	9899499
Hospital Revenue Code	521
Min. Negotiated Rate	$98.86
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$119.24
Rate for Payer: Cash Price	$150.30
Rate for Payer: Cash Price	$150.30
Rate for Payer: UnitedHealthcare Commercial	$111.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

UNLISTED LAPAROSCOPY PROC,BILIARY TRACT

Professional

Both

$1,680.00

Service Code	CPT 47579
Hospital Charge Code	5447579
Hospital Revenue Code	975
Min. Negotiated Rate	$588.00
Max. Negotiated Rate	$588.00
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Optum Medicare Advantage	$588.00

UNLISTED LYMPH NODE PROCEDURE

Professional

Both

$1,260.00

Service Code	CPT 38999
Hospital Charge Code	5438999
Hospital Revenue Code	975
Min. Negotiated Rate	$441.00
Max. Negotiated Rate	$441.00
Rate for Payer: Cash Price	$1,134.00
Rate for Payer: Optum Medicare Advantage	$441.00

UNMONITORED CR

Facility

$65.00

Service Code	CPT 93797
Hospital Charge Code	993797
Hospital Revenue Code	943
Rate for Payer: Cash Price	$58.50

UNMONITORED CR

Facility

$65.00

Service Code	CPT 93797
Hospital Charge Code	993797
Hospital Revenue Code	943
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$263.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$116.21
Rate for Payer: Aetna Medicare Advantage	$131.70
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: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial HMO & PPO	$131.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$116.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$124.34
Rate for Payer: Home State Health Plan Medicare Advantage	$131.70
Rate for Payer: Humana Commercial	$263.40
Rate for Payer: Humana Medicare Advantage	$131.70
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$116.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

UNNA BOOT

Facility

$150.00

Service Code	CPT 29580
Hospital Charge Code	9729580
Hospital Revenue Code	521
Rate for Payer: Cash Price	$135.00

UNNA BOOT

Facility

$155.00

Service Code	CPT 29580
Hospital Charge Code	4229580
Hospital Revenue Code	521
Rate for Payer: Cash Price	$139.50

UNNA BOOT

Facility

$155.00

Service Code	CPT 29580
Hospital Charge Code	4229580
Hospital Revenue Code	521
Min. Negotiated Rate	$91.76
Max. Negotiated Rate	$332.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$146.48
Rate for Payer: Aetna Medicare Advantage	$166.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$91.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$110.67
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cigna Commercial HMO & PPO	$166.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$131.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$156.73
Rate for Payer: Home State Health Plan Medicare Advantage	$166.02
Rate for Payer: Humana Commercial	$332.04
Rate for Payer: Humana Medicare Advantage	$166.02
Rate for Payer: UnitedHealthcare Commercial	$103.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$146.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

UNNA BOOT

Facility

$150.00

Service Code	CPT 29580
Hospital Charge Code	9729580
Hospital Revenue Code	521
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$332.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$146.48
Rate for Payer: Aetna Medicare Advantage	$166.02
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: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cigna Commercial HMO & PPO	$166.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$131.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$156.73
Rate for Payer: Home State Health Plan Medicare Advantage	$166.02
Rate for Payer: Humana Commercial	$332.04
Rate for Payer: Humana Medicare Advantage	$166.02
Rate for Payer: UnitedHealthcare Commercial	$100.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$146.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

UNNA BOOT EACH

Facility

$150.00

Service Code	CPT 29580
Hospital Charge Code	9829580
Hospital Revenue Code	521
Rate for Payer: Cash Price	$135.00

UNNA BOOT EACH

Facility

$150.00

Service Code	CPT 29580
Hospital Charge Code	9829580
Hospital Revenue Code	521
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$332.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$146.48
Rate for Payer: Aetna Medicare Advantage	$166.02
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: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cigna Commercial HMO & PPO	$166.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$131.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$156.73
Rate for Payer: Home State Health Plan Medicare Advantage	$166.02
Rate for Payer: Humana Commercial	$332.04
Rate for Payer: Humana Medicare Advantage	$166.02
Rate for Payer: UnitedHealthcare Commercial	$100.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$146.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

UNNA BOOT ELASTIC 650940

Facility

$21.00

Hospital Charge Code	283013
Hospital Revenue Code	270
Rate for Payer: Cash Price	$18.90

UNNA BOOT ELASTIC 650940

Facility

$21.00

Hospital Charge Code	283013
Hospital Revenue Code	270
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

UNTHREADED GUIDE WIRE 1.4MMX150MM

Facility

$453.00

Hospital Charge Code	123421
Hospital Revenue Code	271
Rate for Payer: Cash Price	$407.70

UNTHREADED GUIDE WIRE 1.4MMX150MM

Facility

$453.00

Hospital Charge Code	123421
Hospital Revenue Code	271
Min. Negotiated Rate	$163.08
Max. Negotiated Rate	$323.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$268.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$323.44
Rate for Payer: Cash Price	$407.70
Rate for Payer: UnitedHealthcare Commercial	$302.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$163.08

.UPEP (CHARGE)

Facility

$30.00

Service Code	CPT 84166
Hospital Charge Code	221958
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

.UPEP (CHARGE)

Facility

$30.00

Service Code	CPT 84166
Hospital Charge Code	221958
Hospital Revenue Code	301
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$35.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.05
Rate for Payer: Aetna Medicare Advantage	$17.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$17.83
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.17
Rate for Payer: Home State Health Plan Medicare Advantage	$17.83
Rate for Payer: Humana Commercial	$35.66
Rate for Payer: Humana Medicare Advantage	$17.83
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

UPPER BODY BLANKET

Facility

$141.00

Hospital Charge Code	122247
Hospital Revenue Code	271
Min. Negotiated Rate	$50.76
Max. Negotiated Rate	$100.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$83.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$100.67
Rate for Payer: Cash Price	$126.90
Rate for Payer: UnitedHealthcare Commercial	$94.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$50.76

UPPER BODY BLANKET

Facility

$141.00

Hospital Charge Code	122247
Hospital Revenue Code	271
Rate for Payer: Cash Price	$126.90

UPPER ENDOSCOPY

Professional

Both

$685.00

Service Code	CPT 43235
Hospital Charge Code	4143235
Hospital Revenue Code	975
Min. Negotiated Rate	$105.60
Max. Negotiated Rate	$254.10
Rate for Payer: Aetna Commercial/Medicare Advantage	$105.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$231.00
Rate for Payer: Cash Price	$616.50
Rate for Payer: Cash Price	$616.50
Rate for Payer: Cigna Commercial HMO & PPO	$105.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$231.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$254.10
Rate for Payer: Home State Health Plan Medicare Advantage	$105.60
Rate for Payer: Optum Medicare Advantage	$239.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$231.00

UPPER EXTREMITY INFANT 2(V)

Facility

$423.00

Service Code	CPT 73092
Hospital Charge Code	3273092
Hospital Revenue Code	320
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$302.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$250.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$302.02
Rate for Payer: Cash Price	$380.70
Rate for Payer: Cash Price	$380.70
Rate for Payer: Cash Price	$380.70
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$94.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$152.28

UPPER EXTREMITY INFANT 2(V)

Facility

$423.00

Service Code	CPT 73092
Hospital Charge Code	3273092
Hospital Revenue Code	320
Rate for Payer: Cash Price	$380.70

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC

Facility

$30,240.20

Service Code	MSDRG 256
Min. Negotiated Rate	$15,120.10
Max. Negotiated Rate	$30,240.20
Rate for Payer: Aetna Medicare Advantage	$15,120.10
Rate for Payer: Cigna Commercial HMO & PPO	$15,120.10
Rate for Payer: Home State Health Plan Medicare Advantage	$15,120.10
Rate for Payer: Humana Commercial	$30,240.20
Rate for Payer: Humana Medicare Advantage	$15,120.10

Know your out-of-pocket cost for care.

All Charges