Understanding Health Care Costs

Many patients are concerned about the cost of health care services. We understand this uncertainty can be stressful and make it hard to plan your personal or household finances. University of Missouri Health Care’s intent is to make pricing information more accessible to you. We hope the information below will make it easier for you to make decisions about your health care.

Our goal is to help you learn more about health insurance and out-of-pocket costs. Today's health care market requires everyone to pay more than we have in the past. Knowing your share of the cost and what you'll be expected to pay is very important and will help you avoid selecting care that is of limited benefit.

Quality matters, too

Though the cost of health care is important, it shouldn't be your only consideration. You should consider many factors when choosing a hospital. Among the most important factors are quality of care and patient safety.

MU Health Care focuses on creating a health care environment known for excellent, safe and effective patient-and-family-centered care. We follow rigorous quality, patient safety and service practices throughout all our hospitals and clinics and have received several awards and honors for this, including the 2014 University Health System Consortium Quality Leadership Award.

COVID-19 information

Please see below for COVID-19 diagnostic (testing) lab charges.

  • Sofia SARS POC Antigen test; CPT Code 87426; Price $57. (Currently only offered in Emergency Department and Urgent Care for symptomatic patients).
  • SARS-CoV-2 Covid-19 test; HCPCS Code U0003 and U0005; Price $125.
  • SARS Coronavirus 2 IgG and IgM Ab antibody test; CPT Code 86769; Price $50.

Please see below for COVID-19 vaccine charges.

  • Vaccine: No charge.
  • Vaccine administration fee: $38.

If you have insurance, your insurance company will be billed. At this time, there is no co-pay or co-insurance. If your insurance denies the claim, you will receive a bill. If you do not have insurance, there is no charge.

Our commitment to price transparency and information

Please know that it is our policy to provide you with information upon your request about hospital standard charges for services obtained across MU Health Care hospitals and clinics. This complies with Affordable Care Act Section 2718c of the Public Health Service Act.

In addition to this requirement, CMS FFY 2019 IPPS guidance requires hospitals to make available online a list of standard hospital charges. It also requires hospitals to make available a list of average charge for inpatient episodes of care listed by Diagnosis Related Grouping (DRG). DRG is a classification of inpatient care as defined by Medicare.

Please note the following key points when reviewing the list of charges.

  • The information contained in the Charge Description Master (CDM) listing is specific to MU Health Care (hospitals and clinics). The charge information provided does NOT include physician and professional fees (CRNAs, APNs, PAs, etc.). Physicians and professional providers bill separately for their professional service.
  • The charges in this CDM were valid on January 1, 2021, and will be updated annually. Charges may have changed since that date due to changes in technology, the addition or elimination of services or supplies including the underlying acquisition costs of the supplies and drugs to the hospital.
  • The CDM includes all standard items that are available and potentially chargeable to MU Health Care patients, insurers, guarantors. The charges contained in this CDM are the same for all patients of MU Health Care regardless of insurance carrier or coverage. The charges do not reflect expected payment. What you will pay out of pocket will be based on factors including health insurance, benefit plans, applicable discounts and services provided based on each patient’s needs.
  • The bill for a hospital stay or an outpatient service includes many CDM items, including charges for accommodations and/or use of special facilities such as the operating room, supplies, devices, procedures, diagnostic tests such as radiology, laboratory tests, and pharmaceuticals. Due to the wide range of services that may be provided during a patient’s outpatient visit or hospital stay, this CDM should not be utilized to estimate the full estimate or final patient charges in advance of a visit or stay.
  • At MU Health Care, we are committed to providing meaningful information about how much health care services may cost based on your personal health care coverage:

    • If you are insured. If you have some form of insurance or government coverage like Medicare or Medicaid, your health insurance provider should serve as your primary source for price information. This is now a service provided by major insurance carriers. You should contact your insurance company to ensure it covers the services you are seeking.
    • If you are uninsured. If you do not have health insurance or coverage, MU Health Care can provide you with a pre-service price estimate for a standard procedure without complications. If there are complications or other unforeseen circumstances, the price may increase. Cost of common outpatient procedures and tests for persons with no insurance are posted on this webpage and include the hospital’s self-pay discount. View cost estimates.

    For information on MU Health Care’s (hospital and clinics) standard charges — including Charge Description Master (CDM) file listing the gross (standard) charge, self-pay cost, and payer-specific negotiated charges — please click the button below.

    Data last updated June 14, 2021.

    Standard Charges

    For information on MU Health Care’s (hospital) average/median charge for inpatient episodes of care listed by Diagnosis Related Grouping (DRG), please click the button below.

    Data last updated Jan. 1, 2021.

    Median Charges by DRG

    For more information about hospital costs, quality measures and community health data in Missouri, please visit FocusOnHospitals.com, an online resource provided by the Missouri Hospital Association.

    Things to consider

    Cost is linked to your insurance coverage

    The amount you pay for care depends on the health insurance plan you have. You and your insurance plan will share the cost of your care. Cost sharing includes copayments, your deductible and coinsurance. The level of benefit determines how much you pay and how much your health insurance plan pays.

    Your provider network is another factor in the cost of your care. The price you pay is typically lower when you receive care from an in-network provider. Before making an appointment with an MU Health Care provider, check to make sure the provider is in-network with your health insurance plan. If the provider is not in-network, ask your insurance how this will affect your out-of-pocket costs.

    For information on the kinds of questions to ask to make sure you understand your bill, please visit Avoiding Surprises in Your Medical Bills A Guide for Consumers (PDF) by the American Hospital Association (AHA), America’s Health Insurance Plans (AHIP) and Healthcare Financial Management Association (HFMA).

    Plan ahead

    When possible, schedule health care services and procedures ahead of time. This will allow you to take financial considerations into account. For example, schedule elective procedures in advance so you have time to plan how you will pay for the procedure.

    Get the specifics

    Before going through a treatment or procedure, ask your health care team for the following information:

    • The technical name of the procedure
    • The insurance codes (see below)
    • The tests you may need before the procedure
    • The expected length of your hospital stay if you will be hospitalized
    • The follow-up care you will need such as rehabilitation or therapy

    What You Need To Know About Insurance Codes

    Health care providers and insurance plans use several types of codes to communicate with each other about payment. The codes are designed to make sure they handle billing and payments correctly.

    To get a cost estimate, you should have the following code information:

    • ICD-9 or ICD-10 code. ICD stands for international classification of diseases. These codes identify your health condition or diagnosis. For example, 250.0 means diabetes with no complications and 493.0 is the code for asthma.
    • CPT code. CPT stands for current procedural terminology. Providers often use these codes on medical bills to identify the charge billed to you or your insurance plan for each service and procedure.

    Request a cost estimate

    MU Health Care wants to make it easy for you to estimate your costs for hospital charges.

    If you do not have health insurance, a cost estimate from MU Health Care will include the following information:

    • The procedure codes used to prepare your estimate
    • The estimated median cost for the procedure based on historical data
    • The total cost for your care and the portion of that cost you're expected to pay with the self-pay discount applied

    If you do have health insurance, a price estimate from MU Health Care will include the following information:

    • The procedure codes used to prepare your estimate
    • The estimated median price for the procedure based on historical data
    • The total price for your care and the portion of that price you're expected to pay based on the benefit information available at the time the estimate is prepare

    Once you have your details, look to your health insurance plan for a price estimate. Visit your health plan's website. Some plans have estimate tools online for their members.

    If the information you need is not available online, you might be able to find it by calling your insurance company’s customer service number. You can usually find this number on the back of your insurance card. Be sure to have your card available when you call.

    See cost information

    Cost estimates provided below will help you better understand potential out-of-pocket hospital costs for health care services provided by MU Health Care. The estimate does not include physician or professional service costs, such as office visits, or the costs of surgeons, anesthesiologists, emergency room physicians, radiologists, pathologists, consulting physician, nurse practitioners or physician assistants.

    If you have health insurance, specific policy coverage (including deductibles, co-pay, co-insurance, out-of-pocket maximums, covered services and medical necessity) will further determine the amount you might owe. Please check with your insurance company if you need more information.

    Click the "Cost Estimate" button below to download a spreadsheet with a list of hospital standard charges for 300 shoppable procedures and services.

    Data last updated Jan. 1, 2021.

    Cost Estimate

    If you need help with a cost estimate, contact Financial Counseling at 573-884-9900 between 8 a.m. and 4:30 p.m. Monday through Friday.

    Know the limitations of an estimate

    There's always a chance the bill you receive will turn out to be higher than the estimate. The estimate information provided by MU Health Care will be a best estimate based on the information you provided. It is not a guarantee of what you will be charged.

    Please understand that, in many cases, it is impossible to predict final charges due to factors that may vary in your actual services such as:

    • Length of time spent in surgery or recovery
    • Specific equipment, supplies and medications required
    • Additional tests required by your physician
    • Any unusual special care or unexpected conditions or complications

    If you have health insurance, your benefits will ultimately determine the amount you owe (including deductibles, copayments, coinsurance and out-of-pocket maximums). If you do not have insurance, you may be eligible for financial assistance.

    Know that some services aren't covered by insurance

    You'll be responsible for paying the full amount due for any health care service, procedure or product that is not covered by your health insurance plan.

    Examples of services, procedures and products not covered by health insurance include:

    • Laser eye surgery such as LASIK or PRK
    • Cosmetic surgery
    • Fertility testing
    • Services or procedures considered experimental by your health plan

    Generally, services not covered by your health insurance plan do not count toward your annual out-of-pocket maximum. Check with your health insurance plan for more details.

    Cost estimates for uninsured patients

    Please note: We cannot give you an exact total cost of care prior to a visit as it depends on the kind, severity and number of problems you address with your doctor privately in the office visit. However, we can give you some general information and definitions.

    Terms to know

    • Average (mean): the number resulting from adding up all the numbers and then dividing by the number of numbers.
    • Charge Description Master (CDM). CDM includes all standard items that are available and potentially chargeable to MU Health Care patients, insurers and guarantors. The charges contained in the CDM are the same for all patients of MU Health Care regardless of insurance carrier or coverage.
    • Combined charge. This is the total of University Physician fees and University Hospital fees.
    • Current procedural terminology (CPT) code. A unique number assigned to specific medical services and procedures.
    • Deposit. This is the amount we ask you to pay toward the total charges for your care. We request the deposit at the time of your visit before the visit begins.
    • Diagnosis related group (DRG): any of the payment categories that are used to classify patients and especially Medicare patients for the purpose of reimbursing hospitals for each case in a given category with a fixed fee regardless of the actual costs incurred.
    • Established patient. This is a person who has been seen in the physician’s office or practice group within the past three years. Note: The charges are different depending on if you are a new or established patient.
    • Hospital charge. This is the charge by an MU Health Care hospital for the facility, ancillary testing and supplies.
    • Length of stay (LOS): term to describe the duration of a single episode of hospitalization. Inpatient days are calculated by subtracting day of admission from day of discharge, and based on the number of nights spent in hospital.
    • Median: the number in the middle when arranged in order. The median can be a better representation of the data when the distribution of data is skewed by either low or high numbers.
    • New patient. This is a person who has not been seen in the physician’s office for three years or who has never been seen in that clinic practice group.
    • Physician charge. This is the charge of the health professional that cared for you.
    • Self-pay discount. If you have no health insurance or third-party liability, you will be eligible for the self-pay discount from your total charges (University Hospital 60 percent discount; University Physicians 25 percent discount plus an additional 20 percent discount if paid in full within 30 days).

    Estimated charges with self-pay discount

    Below are examples of office visit charges with the self-pay discount. The level of office visit and amount you owe will depend on the kind, severity and number of problems you address with your doctor privately in the office visit.

    The physician and hospital bill separately for the services provided. As a result, you will receive two (2) separate bills for services provided in the clinic that you are expected to pay: one from the doctor and one from the hospital.

    Charges updated July 1, 2021. Charges good through March 31, 2022.

      CPT Code Physician Fee, Discounted1 Hospital Fee, Discounted1,2 Combined Fee, Discounted Deposit at Time of Service3
    New Patient Office Visit 99203 $151.50 $48.00 $199.50 $50.00
    Established Patient Office Visit 99213 $121.50 $48.00 $169.50 $50.00

    1 Physician fee discounted 25%; Hospital fee discounted 60%.

    2 The hospital charge supports the cost of the clinical and other support staff, equipment, facilities in the clinic, and, ultimately, our organizational missions of patient care, education and research.

    3 Some clinics may require a deposit at the time of service.

    If you cannot pay your bill in full, you may be eligible for a payment plan or financial assistance. For information on payment plan options, please contact the Customer Service department at 573-884-3300. If you need additional financial assistance, you may discuss options with one of our customer service representatives or financial counselors.

    Cost of common outpatient procedures and tests with self-pay discount

    View examples of common procedures performed or ordered during a clinic visit and the amount you may owe with the self-pay discount. The charges listed do not include supplies, dyes or contrast used in delivery of a service. The charges are good through March 31, 2021.

    View self-pay cost estimates