Madison Medical Center

All Charges

Charge

Type

Setting

Price

DESTRUCTION MALIG LESION 2.1 TO 3.0 CM

Facility

$210.00

Service Code	CPT 17283
Hospital Charge Code	9817273
Hospital Revenue Code	521
Rate for Payer: Cash Price	$189.00

DESTRUCTION MALIG LESION 2.1 TO 3.0 CM

Facility

$210.00

Service Code	CPT 17283
Hospital Charge Code	9817273
Hospital Revenue Code	521
Min. Negotiated Rate	$124.32
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	$124.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
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	$140.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DESTRUCTION MALIG LESION 3.1 TO 4.0 CM

Facility

$520.00

Service Code	CPT 17284
Hospital Charge Code	9817284
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,510.16
Rate for Payer: Aetna Better Health Medicaid/QHP	$666.23
Rate for Payer: Aetna Medicare Advantage	$755.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$307.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$371.28
Rate for Payer: Cash Price	$468.00
Rate for Payer: Cash Price	$468.00
Rate for Payer: Cash Price	$468.00
Rate for Payer: Cash Price	$468.00
Rate for Payer: Cigna Commercial HMO & PPO	$755.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$599.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$712.87
Rate for Payer: Home State Health Plan Medicare Advantage	$755.08
Rate for Payer: Humana Commercial	$1,510.16
Rate for Payer: Humana Medicare Advantage	$755.08
Rate for Payer: UnitedHealthcare Commercial	$346.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$666.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DESTRUCTION MALIG LESION 3.1 TO 4.0 CM

Facility

$235.00

Service Code	CPT 17266
Hospital Charge Code	9817266
Hospital Revenue Code	521
Rate for Payer: Cash Price	$211.50

DESTRUCTION MALIG LESION 3.1 TO 4.0 CM

Facility

$520.00

Service Code	CPT 17284
Hospital Charge Code	9817284
Hospital Revenue Code	521
Rate for Payer: Cash Price	$468.00

DESTRUCTION MALIG LESION 3.1 TO 4.0 CM

Facility

$235.00

Service Code	CPT 17266
Hospital Charge Code	9817266
Hospital Revenue Code	521
Min. Negotiated Rate	$139.12
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	$139.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.79
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
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	$156.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DESTRUCTION MALIG LESION CRYO, SURGICAL

Facility

$255.00

Service Code	CPT 17260
Hospital Charge Code	9817260
Hospital Revenue Code	521
Min. Negotiated Rate	$150.96
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	$150.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.07
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
Rate for Payer: Cash Price	$229.50
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	$170.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DESTRUCTION MALIG LESION CRYO, SURGICAL

Facility

$255.00

Service Code	CPT 17260
Hospital Charge Code	9817260
Hospital Revenue Code	521
Rate for Payer: Cash Price	$229.50

DESTRUCTION MAL LES .6 TO 1CM SCALP,NECK

Facility

$340.00

Service Code	CPT 17271
Hospital Charge Code	4217271
Hospital Revenue Code	521
Rate for Payer: Cash Price	$306.00

DESTRUCTION MAL LES .6 TO 1CM SCALP,NECK

Facility

$340.00

Service Code	CPT 17271
Hospital Charge Code	4217271
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	$201.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$242.76
Rate for Payer: Cash Price	$306.00
Rate for Payer: Cash Price	$306.00
Rate for Payer: Cash Price	$306.00
Rate for Payer: Cash Price	$306.00
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	$226.78
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DESTRUCTION OF 15 OR MORE BEN LESIONS

Facility

$110.00

Service Code	CPT 17111
Hospital Charge Code	9817111
Hospital Revenue Code	521
Rate for Payer: Cash Price	$99.00

DESTRUCTION OF 15 OR MORE BEN LESIONS

Facility

$110.00

Service Code	CPT 17111
Hospital Charge Code	9817111
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

DESTRUCTION OF BEN LESION UP TO 14 LESIO

Professional

Both

$200.00

Service Code	CPT 17110
Hospital Charge Code	9317110
Hospital Revenue Code	975
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$94.18
Rate for Payer: Aetna Commercial/Medicare Advantage	$57.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$85.62
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna Commercial HMO & PPO	$57.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$85.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$94.18
Rate for Payer: Home State Health Plan Medicare Advantage	$57.24
Rate for Payer: Optum Medicare Advantage	$70.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$85.62

DESTRUCTION OF BEN LES UP TO 14 LESIONS

Facility

$180.00

Service Code	CPT 17110
Hospital Charge Code	9417110
Hospital Revenue Code	521
Rate for Payer: Cash Price	$162.00

DESTRUCTION OF BEN LES UP TO 14 LESIONS

Facility

$180.00

Service Code	CPT 17110
Hospital Charge Code	9417110
Hospital Revenue Code	521
Min. Negotiated Rate	$106.56
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	$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: Cash Price	$162.00
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	$120.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DESTRUCTION OF LESION BY ANY METHOD

Facility

$142.00

Service Code	CPT 17110
Hospital Charge Code	5417110
Hospital Revenue Code	521
Min. Negotiated Rate	$84.06
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	$84.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$101.39
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cash Price	$127.80
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	$94.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DESTRUCTION OF LESION BY ANY METHOD

Facility

$142.00

Service Code	CPT 17110
Hospital Charge Code	5417110
Hospital Revenue Code	521
Rate for Payer: Cash Price	$127.80

DESTRUCTION OF LESION MOUTH BY CRYO, CHE

Facility

$590.00

Service Code	CPT 40820
Hospital Charge Code	9840820
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$6,774.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,988.72
Rate for Payer: Aetna Medicare Advantage	$3,387.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$349.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$421.26
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cigna Commercial HMO & PPO	$3,387.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,689.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,197.93
Rate for Payer: Home State Health Plan Medicare Advantage	$3,387.27
Rate for Payer: Humana Commercial	$6,774.54
Rate for Payer: Humana Medicare Advantage	$3,387.27
Rate for Payer: UnitedHealthcare Commercial	$393.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,988.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DESTRUCTION OF LESION MOUTH BY CRYO, CHE

Facility

$590.00

Service Code	CPT 40820
Hospital Charge Code	9840820
Hospital Revenue Code	521
Rate for Payer: Cash Price	$531.00

DESTRUCTION OF LES PENIS CRYOSURGERY

Facility

$380.00

Service Code	CPT 54056
Hospital Charge Code	4254056
Hospital Revenue Code	521
Rate for Payer: Cash Price	$342.00

DESTRUCTION OF LES PENIS CRYOSURGERY

Facility

$380.00

Service Code	CPT 54056
Hospital Charge Code	4254056
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	$224.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$271.32
Rate for Payer: Cash Price	$342.00
Rate for Payer: Cash Price	$342.00
Rate for Payer: Cash Price	$342.00
Rate for Payer: Cash Price	$342.00
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	$253.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DESTRUCTION OF MALIGNANT LESION 0.5 CM

Facility

$275.00

Service Code	CPT 17270
Hospital Charge Code	4217270
Hospital Revenue Code	521
Rate for Payer: Cash Price	$247.50

DESTRUCTION OF MALIGNANT LESION 0.5 CM

Facility

$275.00

Service Code	CPT 17270
Hospital Charge Code	4217270
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	$162.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$196.35
Rate for Payer: Cash Price	$247.50
Rate for Payer: Cash Price	$247.50
Rate for Payer: Cash Price	$247.50
Rate for Payer: Cash Price	$247.50
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	$183.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DESTRUCTION OF TOENAIL

Facility

$350.00

Service Code	CPT 11750
Hospital Charge Code	9311750
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
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	$207.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$249.90
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
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	$233.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

DESTRUCTION OF TOENAIL

Facility

$350.00

Service Code	CPT 11750
Hospital Charge Code	9311750
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

Know your out-of-pocket cost for care.

All Charges