Madison Medical Center

All Charges

Charge

Type

Setting

Price

URINE MICROSCOPIC EXAM

Facility

$127.00

Service Code	CPT 81003
Hospital Charge Code	2222104
Hospital Revenue Code	307
Rate for Payer: Cash Price	$114.30

URINE MICROSCOPIC EXAM

Facility

$127.00

Service Code	CPT 81003
Hospital Charge Code	2222104
Hospital Revenue Code	307
Min. Negotiated Rate	$2.03
Max. Negotiated Rate	$90.68
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	$75.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$90.68
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
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	$45.72

URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	4281025
Hospital Revenue Code	307
Rate for Payer: Cash Price	$36.00

URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9681025
Hospital Revenue Code	307
Rate for Payer: Cash Price	$36.00

URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	4281025
Hospital Revenue Code	307
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.75
Rate for Payer: Aetna Medicare Advantage	$8.61
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	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.29
Rate for Payer: Home State Health Plan Medicare Advantage	$8.61
Rate for Payer: Humana Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$8.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	4181025
Hospital Revenue Code	307
Rate for Payer: Cash Price	$36.00

URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	5281025
Hospital Revenue Code	521
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.75
Rate for Payer: Aetna Medicare Advantage	$8.61
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	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.29
Rate for Payer: Home State Health Plan Medicare Advantage	$8.61
Rate for Payer: Humana Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$8.61
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9181025
Hospital Revenue Code	521
Min. Negotiated Rate	$6.97
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.75
Rate for Payer: Aetna Medicare Advantage	$8.61
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	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.29
Rate for Payer: Home State Health Plan Medicare Advantage	$8.61
Rate for Payer: Humana Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$8.61
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	4181025
Hospital Revenue Code	307
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.75
Rate for Payer: Aetna Medicare Advantage	$8.61
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	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.29
Rate for Payer: Home State Health Plan Medicare Advantage	$8.61
Rate for Payer: Humana Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$8.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	5281025
Hospital Revenue Code	521
Rate for Payer: Cash Price	$36.00

URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9181025
Hospital Revenue Code	521
Rate for Payer: Cash Price	$36.00

URINE PREGNANCY TEST

Facility

$40.00

Service Code	CPT 81025
Hospital Charge Code	9681025
Hospital Revenue Code	307
Min. Negotiated Rate	$7.75
Max. Negotiated Rate	$28.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.75
Rate for Payer: Aetna Medicare Advantage	$8.61
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	$8.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8.29
Rate for Payer: Home State Health Plan Medicare Advantage	$8.61
Rate for Payer: Humana Commercial	$17.22
Rate for Payer: Humana Medicare Advantage	$8.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

UROLIFT SYSTEM DISPOSABLE

Facility

$838.00

Hospital Charge Code	1289003
Hospital Revenue Code	271
Rate for Payer: Cash Price	$754.20

UROLIFT SYSTEM DISPOSABLE

Facility

$838.00

Hospital Charge Code	1289003
Hospital Revenue Code	271
Min. Negotiated Rate	$301.68
Max. Negotiated Rate	$598.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$496.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$598.33
Rate for Payer: Cash Price	$754.20
Rate for Payer: UnitedHealthcare Commercial	$558.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$301.68

UROLIFT TRAY

Facility

$774.00

Hospital Charge Code	1220849
Hospital Revenue Code	272
Rate for Payer: Cash Price	$696.60

UROLIFT TRAY

Facility

$774.00

Hospital Charge Code	1220849
Hospital Revenue Code	272
Min. Negotiated Rate	$278.64
Max. Negotiated Rate	$552.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$458.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$552.64
Rate for Payer: Cash Price	$696.60
Rate for Payer: UnitedHealthcare Commercial	$516.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$278.64

UROLOGICAL DRAIN BAG

Facility

$24.00

Hospital Charge Code	124770
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

UROLOGICAL DRAIN BAG

Facility

$24.00

Hospital Charge Code	124770
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

URSODIOL 300MG CAP EMP

Facility

$22.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2625957
Hospital Revenue Code	250
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

URSODIOL 300MG CAP EMP

Facility

$22.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2625957
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

US ABDOMEN COMPLETE

Facility

$1,197.00

Service Code	CPT 76700
Hospital Charge Code	3576700
Hospital Revenue Code	402
Min. Negotiated Rate	$94.24
Max. Negotiated Rate	$854.66
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	$708.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$854.66
Rate for Payer: Cash Price	$1,077.30
Rate for Payer: Cash Price	$1,077.30
Rate for Payer: Cash Price	$1,077.30
Rate for Payer: Cash Price	$1,077.30
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	$269.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$430.92

US ABDOMEN COMPLETE

Facility

$1,197.00

Service Code	CPT 76700
Hospital Charge Code	3576700
Hospital Revenue Code	402
Rate for Payer: Cash Price	$1,077.30

US AMNIOCENTESIS

Facility

$486.00

Service Code	CPT 76946
Hospital Charge Code	3576946
Hospital Revenue Code	402
Min. Negotiated Rate	$174.96
Max. Negotiated Rate	$347.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$287.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$347.00
Rate for Payer: Cash Price	$437.40
Rate for Payer: Cash Price	$437.40
Rate for Payer: UnitedHealthcare Commercial	$269.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$174.96

US AMNIOCENTESIS

Facility

$486.00

Service Code	CPT 76946
Hospital Charge Code	3576946
Hospital Revenue Code	402
Rate for Payer: Cash Price	$437.40

US ANKLE BRACHIAL INDICES (ABI)

Facility

$460.00

Service Code	CPT 93922
Hospital Charge Code	3593922
Hospital Revenue Code	921
Rate for Payer: Cash Price	$414.00

Know your out-of-pocket cost for care.

All Charges