Madison Medical Center

All Charges

Charge

Type

Setting

Price

DEBRIDEMENT; OPEN WOUND FIRST 20 SQ CM

Facility

$150.00

Service Code	CPT 97597
Hospital Charge Code	9897597
Hospital Revenue Code	521
Rate for Payer: Cash Price	$135.00

DEBRIDEMENT; OPEN WOUND FIRST 20 SQ CM

Facility

$150.00

Service Code	CPT 97597
Hospital Charge Code	9897597
Hospital Revenue Code	521
Min. Negotiated Rate	$88.80
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	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
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	$100.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DEBRIDEMENT; PARTIAL THICKNESS SKIN&SUBC

Facility

$289.00

Service Code	CPT 11042
Hospital Charge Code	9811042
Hospital Revenue Code	521
Rate for Payer: Cash Price	$260.10

DEBRIDEMENT; PARTIAL THICKNESS SKIN&SUBC

Facility

$289.00

Service Code	CPT 11042
Hospital Charge Code	9811042
Hospital Revenue Code	521
Min. Negotiated Rate	$171.09
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	$171.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$206.35
Rate for Payer: Cash Price	$260.10
Rate for Payer: Cash Price	$260.10
Rate for Payer: Cash Price	$260.10
Rate for Payer: Cash Price	$260.10
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	$192.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DEBRIDEMENT SKIN & SUBCUTANEOUS TISSUE

Professional

Both

$372.00

Service Code	CPT 16020
Hospital Charge Code	1816022
Hospital Revenue Code	981
Min. Negotiated Rate	$50.56
Max. Negotiated Rate	$130.20
Rate for Payer: Aetna Commercial/Medicare Advantage	$50.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$63.78
Rate for Payer: Cash Price	$334.80
Rate for Payer: Cash Price	$334.80
Rate for Payer: Cigna Commercial HMO & PPO	$50.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$63.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$70.16
Rate for Payer: Home State Health Plan Medicare Advantage	$50.56
Rate for Payer: Optum Medicare Advantage	$130.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$63.78

DEBRIDEMENT SKIN, TISS, MUSC & BONE

Professional

Both

$882.00

Service Code	CPT 11044
Hospital Charge Code	4111044
Hospital Revenue Code	975
Min. Negotiated Rate	$194.16
Max. Negotiated Rate	$308.70
Rate for Payer: Aetna Commercial/Medicare Advantage	$194.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$233.89
Rate for Payer: Cash Price	$793.80
Rate for Payer: Cash Price	$793.80
Rate for Payer: Cigna Commercial HMO & PPO	$194.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$233.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$257.28
Rate for Payer: Home State Health Plan Medicare Advantage	$194.16
Rate for Payer: Optum Medicare Advantage	$308.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$233.89

DEBRIDEMENT SUB TISSUE FIRST 20 SQ CM

Facility

$300.00

Service Code	CPT 11042
Hospital Charge Code	4211042
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$830.64
Rate for Payer: Humana Commercial	$830.64
Rate for Payer: Humana Medicare Advantage	$415.32
Rate for Payer: UnitedHealthcare Commercial	$200.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53
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	$177.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$214.20
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
Rate for Payer: Cash Price	$270.00
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

DEBRIDEMENT SUB TISSUE FIRST 20 SQ CM

Facility

$300.00

Service Code	CPT 11042
Hospital Charge Code	4211042
Hospital Revenue Code	521
Rate for Payer: Cash Price	$270.00

DEBRIDEMENT W/REM OF F/B SKIN

Facility

$158.00

Service Code	CPT 11010
Hospital Charge Code	4411010
Hospital Revenue Code	521
Min. Negotiated Rate	$93.54
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	$93.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$112.81
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
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	$105.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DEBRIDEMENT W/REM OF F/B SKIN

Facility

$158.00

Service Code	CPT 11010
Hospital Charge Code	4411010
Hospital Revenue Code	521
Rate for Payer: Cash Price	$142.20

DEBRID OF SKIN SUBCUT TISS AND MUSCLE

Professional

Both

$165.00

Service Code	CPT 11043
Hospital Charge Code	4111043
Hospital Revenue Code	975
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$193.67
Rate for Payer: Aetna Commercial/Medicare Advantage	$132.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$176.06
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cigna Commercial HMO & PPO	$132.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$176.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.67
Rate for Payer: Home State Health Plan Medicare Advantage	$132.89
Rate for Payer: Optum Medicare Advantage	$57.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$176.06

DEBRID; SKIN, PART TKNS SKIN & SUBQ TISS

Facility

$289.00

Service Code	CPT 11042
Hospital Charge Code	5411042
Hospital Revenue Code	521
Rate for Payer: Cash Price	$260.10

DEBRID; SKIN, PART TKNS SKIN & SUBQ TISS

Facility

$289.00

Service Code	CPT 11042
Hospital Charge Code	5411042
Hospital Revenue Code	521
Min. Negotiated Rate	$171.09
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	$171.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$206.35
Rate for Payer: Cash Price	$260.10
Rate for Payer: Cash Price	$260.10
Rate for Payer: Cash Price	$260.10
Rate for Payer: Cash Price	$260.10
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	$192.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DECADRON

Facility

$26.00

Service Code	CPT J1100
Hospital Charge Code	4101100
Hospital Revenue Code	636
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$17.34
Rate for Payer: Cash Price	$23.40
Rate for Payer: UnitedHealthcare Commercial	$17.34

DECADRON

Facility

$26.00

Service Code	CPT J1100
Hospital Charge Code	4101100
Hospital Revenue Code	636
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$18.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$15.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$18.56
Rate for Payer: Cash Price	$23.40
Rate for Payer: UnitedHealthcare Commercial	$17.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.36

DECLOT/ THROMBOLITIC AGENT/IMPLNTED DEV

Facility

$319.00

Service Code	CPT 36593
Hospital Charge Code	536593
Hospital Revenue Code	510
Min. Negotiated Rate	$114.84
Max. Negotiated Rate	$674.92
Rate for Payer: Aetna Better Health Medicaid/QHP	$297.75
Rate for Payer: Aetna Medicare Advantage	$337.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$188.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$227.77
Rate for Payer: Cash Price	$287.10
Rate for Payer: Cash Price	$287.10
Rate for Payer: Cash Price	$287.10
Rate for Payer: Cigna Commercial HMO & PPO	$337.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$297.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$318.59
Rate for Payer: Home State Health Plan Medicare Advantage	$337.46
Rate for Payer: Humana Commercial	$674.92
Rate for Payer: Humana Medicare Advantage	$337.46
Rate for Payer: UnitedHealthcare Commercial	$212.77
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$297.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$114.84

DECLOT/ THROMBOLITIC AGENT/IMPLNTED DEV

Facility

$319.00

Service Code	CPT 36593
Hospital Charge Code	536593
Hospital Revenue Code	510
Rate for Payer: Cash Price	$287.10

DEFIBRILLATOR IMPLANTS

Facility

$32,821.35

Service Code	APR-DRG 1792
Min. Negotiated Rate	$32,821.35
Max. Negotiated Rate	$32,821.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$32,821.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$32,821.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32,821.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$32,821.35

DEFIBRILLATOR IMPLANTS

Facility

$32,821.35

Service Code	APR-DRG 1791
Min. Negotiated Rate	$32,821.35
Max. Negotiated Rate	$32,821.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$32,821.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$32,821.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$32,821.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$32,821.35

DEFIBRILLATOR IMPLANTS

Facility

$73,599.11

Service Code	APR-DRG 1794
Min. Negotiated Rate	$73,599.11
Max. Negotiated Rate	$73,599.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$73,599.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$73,599.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$73,599.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$73,599.11

DEFIBRILLATOR IMPLANTS

Facility

$54,382.98

Service Code	APR-DRG 1793
Min. Negotiated Rate	$54,382.98
Max. Negotiated Rate	$54,382.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$54,382.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$54,382.98
Rate for Payer: Home State Health Plan Medicaid Managed Care	$54,382.98
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$54,382.98

DEFRAN GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9482962
Hospital Revenue Code	301
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$21.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.95
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$3.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.16
Rate for Payer: Home State Health Plan Medicare Advantage	$3.28
Rate for Payer: Humana Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.28
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

DEFRAN GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9482962
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

DEFRAN INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	9487804
Hospital Revenue Code	301
Rate for Payer: Cash Price	$63.90

DEFRAN INFLUENZA A & B CLIA WAVED

Facility

$71.00

Service Code	CPT 87804
Hospital Charge Code	9487804
Hospital Revenue Code	301
Min. Negotiated Rate	$14.90
Max. Negotiated Rate	$50.69
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.90
Rate for Payer: Aetna Medicare Advantage	$16.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$42.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$50.69
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cash Price	$63.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.94
Rate for Payer: Home State Health Plan Medicare Advantage	$16.55
Rate for Payer: Humana Commercial	$33.10
Rate for Payer: Humana Medicare Advantage	$16.55
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.56

Know your out-of-pocket cost for care.

All Charges