Madison Medical Center

All Charges

Charge

Type

Setting

Price

URIC ACID

Facility

$124.00

Service Code	CPT 84550
Hospital Charge Code	2221113
Hospital Revenue Code	301
Rate for Payer: Cash Price	$111.60

URIC ACID

Facility

$124.00

Service Code	CPT 84550
Hospital Charge Code	2221113
Hospital Revenue Code	301
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$88.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.07
Rate for Payer: Aetna Medicare Advantage	$4.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial HMO & PPO	$4.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.35
Rate for Payer: Home State Health Plan Medicare Advantage	$4.52
Rate for Payer: Humana Commercial	$9.04
Rate for Payer: Humana Medicare Advantage	$4.52
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

URIC ACID 24 HR URINE

Facility

$106.00

Service Code	CPT 84560
Hospital Charge Code	2221400
Hospital Revenue Code	301
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$75.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.57
Rate for Payer: Aetna Medicare Advantage	$5.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: Cash Price	$95.40
Rate for Payer: Cash Price	$95.40
Rate for Payer: Cigna Commercial HMO & PPO	$5.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.89
Rate for Payer: Home State Health Plan Medicare Advantage	$5.08
Rate for Payer: Humana Commercial	$10.16
Rate for Payer: Humana Medicare Advantage	$5.08
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

URIC ACID 24 HR URINE

Facility

$106.00

Service Code	CPT 84560
Hospital Charge Code	2221400
Hospital Revenue Code	301
Rate for Payer: Cash Price	$95.40

URIC ACID FLUID

Facility

$37.00

Service Code	CPT 84560
Hospital Charge Code	2221401
Hospital Revenue Code	301
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$26.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.57
Rate for Payer: Aetna Medicare Advantage	$5.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$26.42
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cigna Commercial HMO & PPO	$5.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.89
Rate for Payer: Home State Health Plan Medicare Advantage	$5.08
Rate for Payer: Humana Commercial	$10.16
Rate for Payer: Humana Medicare Advantage	$5.08
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.57
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.32

URIC ACID FLUID

Facility

$37.00

Service Code	CPT 84560
Hospital Charge Code	2221401
Hospital Revenue Code	301
Rate for Payer: Cash Price	$33.30

URIC ACID (LABCORP)

Facility

$124.00

Service Code	CPT 84550
Hospital Charge Code	2221114
Hospital Revenue Code	301
Min. Negotiated Rate	$4.07
Max. Negotiated Rate	$88.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.07
Rate for Payer: Aetna Medicare Advantage	$4.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$73.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$88.54
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cash Price	$111.60
Rate for Payer: Cigna Commercial HMO & PPO	$4.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.35
Rate for Payer: Home State Health Plan Medicare Advantage	$4.52
Rate for Payer: Humana Commercial	$9.04
Rate for Payer: Humana Medicare Advantage	$4.52
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$44.64

URIC ACID (LABCORP)

Facility

$124.00

Service Code	CPT 84550
Hospital Charge Code	2221114
Hospital Revenue Code	301
Rate for Payer: Cash Price	$111.60

URI-METER

Facility

$89.00

Hospital Charge Code	2821524
Hospital Revenue Code	271
Rate for Payer: Cash Price	$80.10

URI-METER

Facility

$89.00

Hospital Charge Code	2821524
Hospital Revenue Code	271
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$63.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: UnitedHealthcare Commercial	$59.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

URINAL H140D01

Facility

$22.00

Hospital Charge Code	2821795
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

URINAL H140D01

Facility

$22.00

Hospital Charge Code	2821795
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

.URINALYSIS

Facility

$78.00

Service Code	CPT 81003
Hospital Charge Code	2222105
Hospital Revenue Code	307
Rate for Payer: Cash Price	$70.20

.URINALYSIS

Facility

$78.00

Service Code	CPT 81003
Hospital Charge Code	2222105
Hospital Revenue Code	307
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$55.69
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	$46.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$55.69
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
Rate for Payer: Cash Price	$70.20
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	$28.08

URINALYSIS (DIP ONLY)

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	4281002
Hospital Revenue Code	307
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.13
Rate for Payer: Aetna Medicare Advantage	$3.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$15.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.28
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cash Price	$24.30
Rate for Payer: Cigna Commercial HMO & PPO	$3.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.35
Rate for Payer: Home State Health Plan Medicare Advantage	$3.48
Rate for Payer: Humana Commercial	$6.96
Rate for Payer: Humana Medicare Advantage	$3.48
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.13
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72

URINALYSIS (DIP ONLY)

Facility

$27.00

Service Code	CPT 81002
Hospital Charge Code	4281002
Hospital Revenue Code	307
Rate for Payer: Cash Price	$24.30

URINALYSIS (MICRO + DIP)

Facility

$40.00

Service Code	CPT 81000
Hospital Charge Code	4281000
Hospital Revenue Code	307
Min. Negotiated Rate	$3.62
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.62
Rate for Payer: Aetna Medicare Advantage	$4.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$4.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.87
Rate for Payer: Home State Health Plan Medicare Advantage	$4.02
Rate for Payer: Humana Commercial	$8.04
Rate for Payer: Humana Medicare Advantage	$4.02
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

URINALYSIS (MICRO + DIP)

Facility

$40.00

Service Code	CPT 81000
Hospital Charge Code	4281000
Hospital Revenue Code	307
Rate for Payer: Cash Price	$36.00

URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$32,326.73

Service Code	APR-DRG 4654
Min. Negotiated Rate	$32,326.73
Max. Negotiated Rate	$32,326.73
Rate for Payer: Aetna Better Health Medicaid/QHP	$32,326.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$32,326.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32,326.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$32,326.73

URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$11,182.98

Service Code	APR-DRG 4653
Min. Negotiated Rate	$11,182.98
Max. Negotiated Rate	$11,182.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,182.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,182.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,182.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,182.98

URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$4,410.88

Service Code	APR-DRG 4651
Min. Negotiated Rate	$4,410.88
Max. Negotiated Rate	$4,410.88
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,410.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,410.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,410.88
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,410.88

URINARY STONES AND ACQUIRED UPPER URINARY TRACT OBSTRUCTION

Facility

$5,737.56

Service Code	APR-DRG 4652
Min. Negotiated Rate	$5,737.56
Max. Negotiated Rate	$5,737.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,737.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,737.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,737.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,737.56

URINARY STONES WITH MCC

Facility

$24,685.08

Service Code	MSDRG 693
Min. Negotiated Rate	$12,342.54
Max. Negotiated Rate	$24,685.08
Rate for Payer: Aetna Medicare Advantage	$12,342.54
Rate for Payer: Cigna Commercial HMO & PPO	$12,342.54
Rate for Payer: Home State Health Plan Medicare Advantage	$12,342.54
Rate for Payer: Humana Commercial	$24,685.08
Rate for Payer: Humana Medicare Advantage	$12,342.54

URINARY STONES WITHOUT MCC

Facility

$15,877.64

Service Code	MSDRG 694
Min. Negotiated Rate	$7,938.82
Max. Negotiated Rate	$15,877.64
Rate for Payer: Aetna Medicare Advantage	$7,938.82
Rate for Payer: Cigna Commercial HMO & PPO	$7,938.82
Rate for Payer: Home State Health Plan Medicare Advantage	$7,938.82
Rate for Payer: Humana Commercial	$15,877.64
Rate for Payer: Humana Medicare Advantage	$7,938.82

URIN DIP TESTING

Facility

$40.00

Service Code	CPT 81000
Hospital Charge Code	5281000
Hospital Revenue Code	521
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.62
Rate for Payer: Aetna Medicare Advantage	$4.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$4.02
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.87
Rate for Payer: Home State Health Plan Medicare Advantage	$4.02
Rate for Payer: Humana Commercial	$8.04
Rate for Payer: Humana Medicare Advantage	$4.02
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.62
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges