Madison Medical Center

All Charges

Charge

Type

Setting

Price

D&C THERAPUTIC

Facility

$813.00

Service Code	CPT 58120
Hospital Charge Code	5258120
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$6,614.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,918.10
Rate for Payer: Aetna Medicare Advantage	$3,307.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$481.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$580.48
Rate for Payer: Cash Price	$731.70
Rate for Payer: Cash Price	$731.70
Rate for Payer: Cash Price	$731.70
Rate for Payer: Cash Price	$731.70
Rate for Payer: Cigna Commercial HMO & PPO	$3,307.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,626.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,122.37
Rate for Payer: Home State Health Plan Medicare Advantage	$3,307.24
Rate for Payer: Humana Commercial	$6,614.48
Rate for Payer: Humana Medicare Advantage	$3,307.24
Rate for Payer: UnitedHealthcare Commercial	$542.27
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,918.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

D&C THERAPUTIC

Facility

$813.00

Service Code	CPT 58120
Hospital Charge Code	5258120
Hospital Revenue Code	521
Rate for Payer: Cash Price	$731.70

DDIMER PATHFAST

Facility

$180.00

Service Code	CPT 85379
Hospital Charge Code	2285380
Hospital Revenue Code	305
Rate for Payer: Cash Price	$162.00

DDIMER PATHFAST

Facility

$180.00

Service Code	CPT 85379
Hospital Charge Code	2285380
Hospital Revenue Code	305
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$128.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.16
Rate for Payer: Aetna Medicare Advantage	$10.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$106.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$128.52
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cigna Commercial HMO & PPO	$10.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.80
Rate for Payer: Home State Health Plan Medicare Advantage	$10.18
Rate for Payer: Humana Commercial	$20.36
Rate for Payer: Humana Medicare Advantage	$10.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.16
Rate for Payer: UnitedHealthcare Medicare Advantage	$64.80

DEBREDMENT OF WOUND

Professional

Both

$300.00

Service Code	CPT 11042
Hospital Charge Code	4111042
Hospital Revenue Code	975
Min. Negotiated Rate	$53.09
Max. Negotiated Rate	$108.23
Rate for Payer: Aetna Commercial/Medicare Advantage	$53.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$98.39
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cigna Commercial HMO & PPO	$53.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$98.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$108.23
Rate for Payer: Home State Health Plan Medicare Advantage	$53.09
Rate for Payer: Optum Medicare Advantage	$105.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$98.39

DEBRIDEMANT OF WOUND

Facility

$100.00

Service Code	CPT 97602
Hospital Charge Code	5497602
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

DEBRIDEMANT OF WOUND

Facility

$100.00

Service Code	CPT 97602
Hospital Charge Code	5497602
Hospital Revenue Code	521
Min. Negotiated Rate	$59.20
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	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
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	$66.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DEBRIDEMENT

Facility

$140.00

Service Code	CPT 11303
Hospital Charge Code	9811303
Hospital Revenue Code	521
Rate for Payer: Cash Price	$126.00

DEBRIDEMENT

Facility

$140.00

Service Code	CPT 11303
Hospital Charge Code	9811303
Hospital Revenue Code	521
Min. Negotiated Rate	$82.88
Max. Negotiated Rate	$830.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$366.45
Rate for Payer: Aetna Medicare Advantage	$415.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$82.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$99.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cigna Commercial HMO & PPO	$415.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$329.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$392.10
Rate for Payer: Home State Health Plan Medicare Advantage	$415.32
Rate for Payer: Humana Commercial	$830.64
Rate for Payer: Humana Medicare Advantage	$415.32
Rate for Payer: UnitedHealthcare Commercial	$93.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DEBRIDEMENT; 20 SQ CM OR LESS

Facility

$125.00

Service Code	CPT 97597
Hospital Charge Code	9811040
Hospital Revenue Code	521
Min. Negotiated Rate	$74.00
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	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
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	$83.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DEBRIDEMENT; 20 SQ CM OR LESS

Facility

$125.00

Service Code	CPT 97597
Hospital Charge Code	9811040
Hospital Revenue Code	521
Rate for Payer: Cash Price	$112.50

DEBRIDEMENT INC REM F/B SKIN

Facility

$101.00

Service Code	CPT 11010
Hospital Charge Code	5211010
Hospital Revenue Code	521
Min. Negotiated Rate	$59.79
Max. Negotiated Rate	$1,446.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$638.34
Rate for Payer: Aetna Medicare Advantage	$723.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cigna Commercial HMO & PPO	$723.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$574.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$683.02
Rate for Payer: Home State Health Plan Medicare Advantage	$723.47
Rate for Payer: Humana Commercial	$1,446.94
Rate for Payer: Humana Medicare Advantage	$723.47
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DEBRIDEMENT INC REM F/B SKIN

Facility

$101.00

Service Code	CPT 11010
Hospital Charge Code	5211010
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.90

DEBRIDEMENT OF ECZEMATOUS OR INFEC SKIN

Facility

$120.00

Service Code	CPT 11000
Hospital Charge Code	5411000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

DEBRIDEMENT OF ECZEMATOUS OR INFEC SKIN

Facility

$120.00

Service Code	CPT 11000
Hospital Charge Code	5411000
Hospital Revenue Code	521
Min. Negotiated Rate	$71.04
Max. Negotiated Rate	$830.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$366.45
Rate for Payer: Aetna Medicare Advantage	$415.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$71.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$85.68
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna Commercial HMO & PPO	$415.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$329.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$392.10
Rate for Payer: Home State Health Plan Medicare Advantage	$415.32
Rate for Payer: Humana Commercial	$830.64
Rate for Payer: Humana Medicare Advantage	$415.32
Rate for Payer: UnitedHealthcare Commercial	$80.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DEBRIDEMENT OF EXT ECZEM/INFEC SKIN 10%

Professional

Both

$100.00

Service Code	CPT 11000
Hospital Charge Code	4111000
Hospital Revenue Code	975
Min. Negotiated Rate	$23.92
Max. Negotiated Rate	$48.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$23.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$44.09
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cigna Commercial HMO & PPO	$23.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$44.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$48.50
Rate for Payer: Home State Health Plan Medicare Advantage	$23.92
Rate for Payer: Optum Medicare Advantage	$35.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$44.09

DEBRIDEMENT OF EXT ECZ/INF SKIN <10% OF

Facility

$120.00

Service Code	CPT 11000
Hospital Charge Code	9811000
Hospital Revenue Code	521
Min. Negotiated Rate	$71.04
Max. Negotiated Rate	$830.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$366.45
Rate for Payer: Aetna Medicare Advantage	$415.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$71.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$85.68
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cigna Commercial HMO & PPO	$415.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$329.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$392.10
Rate for Payer: Home State Health Plan Medicare Advantage	$415.32
Rate for Payer: Humana Commercial	$830.64
Rate for Payer: Humana Medicare Advantage	$415.32
Rate for Payer: UnitedHealthcare Commercial	$80.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DEBRIDEMENT OF EXT ECZ/INF SKIN <10% OF

Facility

$120.00

Service Code	CPT 11000
Hospital Charge Code	9811000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.00

DEBRIDEMENT OF NAILS

Professional

Both

$127.00

Service Code	CPT 11720
Hospital Charge Code	1811700
Hospital Revenue Code	981
Min. Negotiated Rate	$12.48
Max. Negotiated Rate	$44.45
Rate for Payer: Aetna Commercial/Medicare Advantage	$12.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$24.43
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cigna Commercial HMO & PPO	$12.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$24.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.87
Rate for Payer: Home State Health Plan Medicare Advantage	$12.48
Rate for Payer: Optum Medicare Advantage	$44.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24.43

DEBRIDEMENT OF NAILS 6 OR MORE

Facility

$95.00

Service Code	CPT 11721
Hospital Charge Code	9311721
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$67.83
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cash Price	$85.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$63.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DEBRIDEMENT OF NAILS 6 OR MORE

Facility

$95.00

Service Code	CPT 11721
Hospital Charge Code	9311721
Hospital Revenue Code	521
Rate for Payer: Cash Price	$85.50

DEBRIDEMENT OPEN WOUND

Facility

$125.00

Service Code	CPT 97597
Hospital Charge Code	4297597
Hospital Revenue Code	521
Min. Negotiated Rate	$74.00
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	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
Rate for Payer: Cash Price	$112.50
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	$83.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DEBRIDEMENT OPEN WOUND

Facility

$125.00

Service Code	CPT 97597
Hospital Charge Code	4297597
Hospital Revenue Code	521
Rate for Payer: Cash Price	$112.50

DEBRIDEMENT; OPEN WOUND EA ADDL 20 SQ CM

Facility

$160.00

Service Code	CPT 97598
Hospital Charge Code	9897598
Hospital Revenue Code	521
Min. Negotiated Rate	$94.72
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$94.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.24
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: UnitedHealthcare Commercial	$106.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DEBRIDEMENT; OPEN WOUND EA ADDL 20 SQ CM

Facility

$160.00

Service Code	CPT 97598
Hospital Charge Code	9897598
Hospital Revenue Code	521
Rate for Payer: Cash Price	$144.00

Know your out-of-pocket cost for care.

All Charges