Madison Medical Center

All Charges

Charge

Type

Setting

Price

CRYOFREEZE FIRST LESION

Facility

$45.00

Service Code	CPT 17000
Hospital Charge Code	9617000
Hospital Revenue Code	521
Min. Negotiated Rate	$26.64
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
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: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE FIRST LESION

Facility

$145.00

Service Code	CPT 17000
Hospital Charge Code	5417000
Hospital Revenue Code	521
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$85.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$103.53
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$96.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE FIRST LESION

Facility

$145.00

Service Code	CPT 17000
Hospital Charge Code	9217000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$130.50

CRYOFREEZE FIRST LESION

Facility

$145.00

Service Code	CPT 17000
Hospital Charge Code	9417000
Hospital Revenue Code	521
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$85.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$103.53
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$96.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE FIRST LESION

Facility

$145.00

Service Code	CPT 17000
Hospital Charge Code	9817000
Hospital Revenue Code	521
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$85.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$103.53
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$96.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE FIRST LEX

Facility

$145.00

Service Code	CPT 17000
Hospital Charge Code	5217000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$130.50

CRYOFREEZE FIRST LEX

Facility

$145.00

Service Code	CPT 17000
Hospital Charge Code	5217000
Hospital Revenue Code	521
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$85.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$103.53
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$96.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE LESION 2 - 14

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	9617003
Hospital Revenue Code	521
Min. Negotiated Rate	$32.56
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE LESION 2 - 14

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	9617003
Hospital Revenue Code	521
Rate for Payer: Cash Price	$49.50

CRYOFREEZE LESION 2-14

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	3917003
Hospital Revenue Code	521
Min. Negotiated Rate	$32.56
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE LESION 2-14

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	3917003
Hospital Revenue Code	521
Rate for Payer: Cash Price	$49.50

CRYOFREEZE LESION ON PENIS

Facility

$425.00

Service Code	CPT 54056
Hospital Charge Code	9854056
Hospital Revenue Code	521
Min. Negotiated Rate	$162.77
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$251.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$303.45
Rate for Payer: Cash Price	$382.50
Rate for Payer: Cash Price	$382.50
Rate for Payer: Cash Price	$382.50
Rate for Payer: Cash Price	$382.50
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$283.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE LESION ON PENIS

Facility

$425.00

Service Code	CPT 54056
Hospital Charge Code	9854056
Hospital Revenue Code	521
Rate for Payer: Cash Price	$382.50

CRYOFREEZE SECOND THROUGH 14 LESIONS

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	4417003
Hospital Revenue Code	521
Rate for Payer: Cash Price	$49.50

CRYOFREEZE SECOND THROUGH 14 LESIONS

Facility

$55.00

Service Code	CPT 17003
Hospital Charge Code	4417003
Hospital Revenue Code	521
Min. Negotiated Rate	$32.56
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE UP TO 14 LESIONS BENIGN

Facility

$110.00

Service Code	CPT 17110
Hospital Charge Code	98171000
Hospital Revenue Code	521
Min. Negotiated Rate	$65.12
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$73.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

CRYOFREEZE UP TO 14 LESIONS BENIGN

Facility

$110.00

Service Code	CPT 17110
Hospital Charge Code	98171000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$99.00

CRYOGLOBULIN QUALI

Facility

$55.00

Service Code	CPT 82595
Hospital Charge Code	223255
Hospital Revenue Code	301
Rate for Payer: Cash Price	$49.50

CRYOGLOBULIN QUALI

Facility

$55.00

Service Code	CPT 82595
Hospital Charge Code	223255
Hospital Revenue Code	301
Min. Negotiated Rate	$5.82
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.82
Rate for Payer: Aetna Medicare Advantage	$6.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$6.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.23
Rate for Payer: Home State Health Plan Medicare Advantage	$6.47
Rate for Payer: Humana Commercial	$12.94
Rate for Payer: Humana Medicare Advantage	$6.47
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

CRYPTOSPORIDIUM ANTIGEN

Facility

$61.00

Service Code	CPT 87015
Hospital Charge Code	3086318
Hospital Revenue Code	306
Rate for Payer: Cash Price	$54.90

CRYPTOSPORIDIUM ANTIGEN

Facility

$61.00

Service Code	CPT 87015
Hospital Charge Code	3086318
Hospital Revenue Code	306
Min. Negotiated Rate	$6.01
Max. Negotiated Rate	$43.55
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.01
Rate for Payer: Aetna Medicare Advantage	$6.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$43.55
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cash Price	$54.90
Rate for Payer: Cigna Commercial HMO & PPO	$6.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.43
Rate for Payer: Home State Health Plan Medicare Advantage	$6.68
Rate for Payer: Humana Commercial	$13.36
Rate for Payer: Humana Medicare Advantage	$6.68
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.96

CRYSELLE 6X28 TAB EMP

Facility

$113.00

Service Code	NDC 5.1285E+10
Hospital Charge Code	2625891
Hospital Revenue Code	250
Rate for Payer: Cash Price	$101.70

CRYSELLE 6X28 TAB EMP

Facility

$113.00

Service Code	NDC 5.1285E+10
Hospital Charge Code	2625891
Hospital Revenue Code	250
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$80.68
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: UnitedHealthcare Commercial	$75.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

CRYSTAL FLUID

Facility

$70.00

Service Code	CPT 89060
Hospital Charge Code	2289060
Hospital Revenue Code	301
Min. Negotiated Rate	$6.60
Max. Negotiated Rate	$49.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.60
Rate for Payer: Aetna Medicare Advantage	$7.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cigna Commercial HMO & PPO	$7.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.06
Rate for Payer: Home State Health Plan Medicare Advantage	$7.33
Rate for Payer: Humana Commercial	$14.66
Rate for Payer: Humana Medicare Advantage	$7.33
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.60
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

CRYSTAL FLUID

Facility

$70.00

Service Code	CPT 89060
Hospital Charge Code	2289060
Hospital Revenue Code	301
Rate for Payer: Cash Price	$63.00

Know your out-of-pocket cost for care.

All Charges