Madison Medical Center

All Charges

Charge

Type

Setting

Price

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC

Facility

$46,000.12

Service Code	MSDRG 255
Min. Negotiated Rate	$23,000.06
Max. Negotiated Rate	$46,000.12
Rate for Payer: Aetna Medicare Advantage	$23,000.06
Rate for Payer: Cigna Commercial HMO & PPO	$23,000.06
Rate for Payer: Home State Health Plan Medicare Advantage	$23,000.06
Rate for Payer: Humana Commercial	$46,000.12
Rate for Payer: Humana Medicare Advantage	$23,000.06

UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$20,736.76

Service Code	MSDRG 257
Min. Negotiated Rate	$10,368.38
Max. Negotiated Rate	$20,736.76
Rate for Payer: Aetna Medicare Advantage	$10,368.38
Rate for Payer: Cigna Commercial HMO & PPO	$10,368.38
Rate for Payer: Home State Health Plan Medicare Advantage	$10,368.38
Rate for Payer: Humana Commercial	$20,736.76
Rate for Payer: Humana Medicare Advantage	$10,368.38

UREA 24 HR URINE

Facility

$112.00

Service Code	CPT 84540
Hospital Charge Code	2284540
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

UREA 24 HR URINE

Facility

$112.00

Service Code	CPT 84540
Hospital Charge Code	2284540
Hospital Revenue Code	301
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.00
Rate for Payer: Aetna Medicare Advantage	$5.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.35
Rate for Payer: Home State Health Plan Medicare Advantage	$5.56
Rate for Payer: Humana Commercial	$11.12
Rate for Payer: Humana Medicare Advantage	$5.56
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

UREAPLASMA/MYCOPLASMA CULTURE

Facility

$152.00

Service Code	CPT 87109
Hospital Charge Code	2287109
Hospital Revenue Code	306
Rate for Payer: Cash Price	$136.80

UREAPLASMA/MYCOPLASMA CULTURE

Facility

$152.00

Service Code	CPT 87109
Hospital Charge Code	2287109
Hospital Revenue Code	306
Min. Negotiated Rate	$13.85
Max. Negotiated Rate	$108.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.85
Rate for Payer: Aetna Medicare Advantage	$15.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$108.53
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cigna Commercial HMO & PPO	$15.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.82
Rate for Payer: Home State Health Plan Medicare Advantage	$15.39
Rate for Payer: Humana Commercial	$30.78
Rate for Payer: Humana Medicare Advantage	$15.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.72

URETERAL STENT 6FRX26CM

Facility

$427.00

Hospital Charge Code	1299004
Hospital Revenue Code	271
Rate for Payer: Cash Price	$384.30

URETERAL STENT 6FRX26CM

Facility

$427.00

Hospital Charge Code	1299004
Hospital Revenue Code	271
Min. Negotiated Rate	$153.72
Max. Negotiated Rate	$304.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$252.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$304.88
Rate for Payer: Cash Price	$384.30
Rate for Payer: UnitedHealthcare Commercial	$284.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$153.72

URETHERAL CATHETER, SIMPLE

Professional

Both

$610.00

Service Code	CPT 51702
Hospital Charge Code	1853670
Hospital Revenue Code	981
Min. Negotiated Rate	$22.10
Max. Negotiated Rate	$213.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$22.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$55.69
Rate for Payer: Cash Price	$549.00
Rate for Payer: Cash Price	$549.00
Rate for Payer: Cigna Commercial HMO & PPO	$22.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$61.26
Rate for Payer: Home State Health Plan Medicare Advantage	$22.10
Rate for Payer: Optum Medicare Advantage	$213.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55.69

URETHRA CULT/GRAMS

Facility

$113.00

Service Code	CPT 87070
Hospital Charge Code	3014000
Hospital Revenue Code	306
Min. Negotiated Rate	$7.76
Max. Negotiated Rate	$80.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.76
Rate for Payer: Aetna Medicare Advantage	$8.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cash Price	$101.70
Rate for Payer: Cigna Commercial HMO & PPO	$8.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.30
Rate for Payer: Home State Health Plan Medicare Advantage	$8.62
Rate for Payer: Humana Commercial	$17.24
Rate for Payer: Humana Medicare Advantage	$8.62
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

URETHRA CULT/GRAMS

Facility

$113.00

Service Code	CPT 87070
Hospital Charge Code	3014000
Hospital Revenue Code	306
Rate for Payer: Cash Price	$101.70

URETHRAL AND TRANSURETHRAL PROCEDURES

Facility

$5,558.21

Service Code	APR-DRG 4461
Min. Negotiated Rate	$5,558.21
Max. Negotiated Rate	$5,558.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,558.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,558.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,558.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,558.21

URETHRAL AND TRANSURETHRAL PROCEDURES

Facility

$9,858.15

Service Code	APR-DRG 4462
Min. Negotiated Rate	$9,858.15
Max. Negotiated Rate	$9,858.15
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,858.15
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,858.15
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,858.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,858.15

URETHRAL AND TRANSURETHRAL PROCEDURES

Facility

$17,744.29

Service Code	APR-DRG 4463
Min. Negotiated Rate	$17,744.29
Max. Negotiated Rate	$17,744.29
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,744.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,744.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,744.29
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,744.29

URETHRAL AND TRANSURETHRAL PROCEDURES

Facility

$31,679.57

Service Code	APR-DRG 4464
Min. Negotiated Rate	$31,679.57
Max. Negotiated Rate	$31,679.57
Rate for Payer: Aetna Better Health Medicaid/QHP	$31,679.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31,679.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$31,679.57
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31,679.57

URETHRAL DILATORS

Facility

$155.00

Hospital Charge Code	2821038
Hospital Revenue Code	271
Min. Negotiated Rate	$55.80
Max. Negotiated Rate	$110.67
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: UnitedHealthcare Commercial	$103.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.80

URETHRAL DILATORS

Facility

$155.00

Hospital Charge Code	2821038
Hospital Revenue Code	271
Rate for Payer: Cash Price	$139.50

URETHRAL PROCEDURES WITH CC/MCC

Facility

$31,769.92

Service Code	MSDRG 671
Min. Negotiated Rate	$15,884.96
Max. Negotiated Rate	$31,769.92
Rate for Payer: Aetna Medicare Advantage	$15,884.96
Rate for Payer: Cigna Commercial HMO & PPO	$15,884.96
Rate for Payer: Home State Health Plan Medicare Advantage	$15,884.96
Rate for Payer: Humana Commercial	$31,769.92
Rate for Payer: Humana Medicare Advantage	$15,884.96

URETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$20,538.00

Service Code	MSDRG 672
Min. Negotiated Rate	$10,269.00
Max. Negotiated Rate	$20,538.00
Rate for Payer: Aetna Medicare Advantage	$10,269.00
Rate for Payer: Cigna Commercial HMO & PPO	$10,269.00
Rate for Payer: Home State Health Plan Medicare Advantage	$10,269.00
Rate for Payer: Humana Commercial	$20,538.00
Rate for Payer: Humana Medicare Advantage	$10,269.00

URETHRAL STRICTURE

Facility

$20,511.40

Service Code	MSDRG 697
Min. Negotiated Rate	$10,255.70
Max. Negotiated Rate	$20,511.40
Rate for Payer: Aetna Medicare Advantage	$10,255.70
Rate for Payer: Cigna Commercial HMO & PPO	$10,255.70
Rate for Payer: Home State Health Plan Medicare Advantage	$10,255.70
Rate for Payer: Humana Commercial	$20,511.40
Rate for Payer: Humana Medicare Advantage	$10,255.70

URETHRETOME

Facility

$67.00

Hospital Charge Code	1221036
Hospital Revenue Code	360
Rate for Payer: Cash Price	$60.30

URETHRETOME

Facility

$67.00

Hospital Charge Code	1221036
Hospital Revenue Code	360
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$44.69
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

URETHROPEXY

Facility

$2,084.00

Service Code	CPT 51840
Hospital Charge Code	5251840
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,875.60

URETHROPEXY

Facility

$2,084.00

Service Code	CPT 51840
Hospital Charge Code	5251840
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$10,221.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,509.45
Rate for Payer: Aetna Medicare Advantage	$5,110.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,233.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,487.98
Rate for Payer: Cash Price	$1,875.60
Rate for Payer: Cash Price	$1,875.60
Rate for Payer: Cash Price	$1,875.60
Rate for Payer: Cash Price	$1,875.60
Rate for Payer: Cigna Commercial HMO & PPO	$5,110.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,058.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,825.11
Rate for Payer: Home State Health Plan Medicare Advantage	$5,110.80
Rate for Payer: Humana Commercial	$10,221.60
Rate for Payer: Humana Medicare Advantage	$5,110.80
Rate for Payer: UnitedHealthcare Commercial	$1,390.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,509.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

URETHROPEXY

Professional

Both

$2,066.00

Service Code	CPT 51840-80
Hospital Charge Code	4151840
Hospital Revenue Code	975
Min. Negotiated Rate	$723.10
Max. Negotiated Rate	$723.10
Rate for Payer: Cash Price	$1,859.40
Rate for Payer: Optum Medicare Advantage	$723.10

Know your out-of-pocket cost for care.

All Charges