Madison Medical Center

All Charges

Charge

Type

Setting

Price

EXC BEN LES .6 TO 1.0 FACE, EARS, EYELI

Facility

$200.00

Service Code	CPT 11441
Hospital Charge Code	9811441
Hospital Revenue Code	521
Rate for Payer: Cash Price	$180.00

EXC BEN LES .6 TO 1.0 FACE, EARS, EYELI

Facility

$200.00

Service Code	CPT 11441
Hospital Charge Code	9811441
Hospital Revenue Code	521
Min. Negotiated Rate	$118.40
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	$118.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.80
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
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	$133.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN LES .6 TO 1.0 FACE,EARS,NOSE,EYE

Facility

$347.00

Service Code	CPT 11441
Hospital Charge Code	5411441
Hospital Revenue Code	521
Rate for Payer: Cash Price	$312.30

EXC BEN LES .6 TO 1.0 FACE,EARS,NOSE,EYE

Facility

$347.00

Service Code	CPT 11441
Hospital Charge Code	5411441
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
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	$205.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$247.76
Rate for Payer: Cash Price	$312.30
Rate for Payer: Cash Price	$312.30
Rate for Payer: Cash Price	$312.30
Rate for Payer: Cash Price	$312.30
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	$231.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN LES .6 TO 1.0 TRUNK,ARMS,LEGS

Facility

$273.00

Service Code	CPT 11401
Hospital Charge Code	5411401
Hospital Revenue Code	521
Min. Negotiated Rate	$161.62
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	$161.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$194.92
Rate for Payer: Cash Price	$245.70
Rate for Payer: Cash Price	$245.70
Rate for Payer: Cash Price	$245.70
Rate for Payer: Cash Price	$245.70
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	$182.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN LES .6 TO 1.0 TRUNK,ARMS,LEGS

Facility

$273.00

Service Code	CPT 11401
Hospital Charge Code	5411401
Hospital Revenue Code	521
Rate for Payer: Cash Price	$245.70

EXC BEN LES FAC 1.1 TO 2.0 CM

Facility

$410.00

Service Code	CPT 11442
Hospital Charge Code	5411442
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
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	$242.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$292.74
Rate for Payer: Cash Price	$369.00
Rate for Payer: Cash Price	$369.00
Rate for Payer: Cash Price	$369.00
Rate for Payer: Cash Price	$369.00
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	$273.47
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN LES FAC 1.1 TO 2.0 CM

Facility

$410.00

Service Code	CPT 11442
Hospital Charge Code	5411442
Hospital Revenue Code	521
Rate for Payer: Cash Price	$369.00

EXC BEN LES FAC 2.1 TO 3.0 CM

Facility

$504.00

Service Code	CPT 11443
Hospital Charge Code	5411443
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$3,374.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,488.83
Rate for Payer: Aetna Medicare Advantage	$1,687.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$298.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$359.86
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cigna Commercial HMO & PPO	$1,687.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,339.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,593.05
Rate for Payer: Home State Health Plan Medicare Advantage	$1,687.37
Rate for Payer: Humana Commercial	$3,374.74
Rate for Payer: Humana Medicare Advantage	$1,687.37
Rate for Payer: UnitedHealthcare Commercial	$336.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN LES FAC 2.1 TO 3.0 CM

Facility

$504.00

Service Code	CPT 11443
Hospital Charge Code	5411443
Hospital Revenue Code	521
Rate for Payer: Cash Price	$453.60

EXC BEN LES FACE .6 TO 1.0

Facility

$263.00

Service Code	CPT 11441
Hospital Charge Code	4411441
Hospital Revenue Code	521
Rate for Payer: Cash Price	$236.70

EXC BEN LES FACE .6 TO 1.0

Facility

$263.00

Service Code	CPT 11441
Hospital Charge Code	4411441
Hospital Revenue Code	521
Min. Negotiated Rate	$155.70
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	$155.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$187.78
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
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	$175.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN LES FACE, .6 TO 1.0 CM

Facility

$365.00

Service Code	CPT 11441
Hospital Charge Code	4211441
Hospital Revenue Code	521
Rate for Payer: Cash Price	$328.50

EXC BEN LES FACE, .6 TO 1.0 CM

Facility

$365.00

Service Code	CPT 11441
Hospital Charge Code	4211441
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
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	$216.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$260.61
Rate for Payer: Cash Price	$328.50
Rate for Payer: Cash Price	$328.50
Rate for Payer: Cash Price	$328.50
Rate for Payer: Cash Price	$328.50
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	$243.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN LES FACE LESS THAN .5

Facility

$125.00

Service Code	CPT 11440
Hospital Charge Code	9811440
Hospital Revenue Code	521
Min. Negotiated Rate	$74.00
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	$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	$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	$83.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN LES FACE LESS THAN .5

Facility

$125.00

Service Code	CPT 11440
Hospital Charge Code	9811440
Hospital Revenue Code	521
Rate for Payer: Cash Price	$112.50

EXC BEN LESION 2.1 TO 3.0 CM SCALP,NECK,

Facility

$530.00

Service Code	CPT 17000
Hospital Charge Code	9811423
Hospital Revenue Code	521
Rate for Payer: Cash Price	$477.00

EXC BEN LESION 2.1 TO 3.0 CM SCALP,NECK,

Facility

$530.00

Service Code	CPT 17000
Hospital Charge Code	9811423
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	$313.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$378.42
Rate for Payer: Cash Price	$477.00
Rate for Payer: Cash Price	$477.00
Rate for Payer: Cash Price	$477.00
Rate for Payer: Cash Price	$477.00
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	$353.51
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN LES OVER 4.0 CM TRUNK,ARMS,LEGS

Facility

$735.00

Service Code	CPT 11406
Hospital Charge Code	5411406
Hospital Revenue Code	521
Rate for Payer: Cash Price	$661.50

EXC BEN LES OVER 4.0 CM TRUNK,ARMS,LEGS

Facility

$735.00

Service Code	CPT 11406
Hospital Charge Code	5411406
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$3,374.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,488.83
Rate for Payer: Aetna Medicare Advantage	$1,687.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$435.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$524.79
Rate for Payer: Cash Price	$661.50
Rate for Payer: Cash Price	$661.50
Rate for Payer: Cash Price	$661.50
Rate for Payer: Cash Price	$661.50
Rate for Payer: Cigna Commercial HMO & PPO	$1,687.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,339.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,593.05
Rate for Payer: Home State Health Plan Medicare Advantage	$1,687.37
Rate for Payer: Humana Commercial	$3,374.74
Rate for Payer: Humana Medicare Advantage	$1,687.37
Rate for Payer: UnitedHealthcare Commercial	$490.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN LES SCALP, GENITALIA .6 TO 1.0CM

Facility

$263.00

Service Code	CPT 11421
Hospital Charge Code	4411421
Hospital Revenue Code	521
Rate for Payer: Cash Price	$236.70

EXC BEN LES SCALP, GENITALIA .6 TO 1.0CM

Facility

$263.00

Service Code	CPT 11421
Hospital Charge Code	4411421
Hospital Revenue Code	521
Min. Negotiated Rate	$155.70
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	$155.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$187.78
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
Rate for Payer: Cash Price	$236.70
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	$175.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN LES SCALP NECK .5 CM OR LESS

Facility

$230.00

Service Code	CPT 11420
Hospital Charge Code	4211420
Hospital Revenue Code	521
Min. Negotiated Rate	$136.16
Max. Negotiated Rate	$3,374.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,488.83
Rate for Payer: Aetna Medicare Advantage	$1,687.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$136.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$164.22
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cash Price	$207.00
Rate for Payer: Cigna Commercial HMO & PPO	$1,687.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,339.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,593.05
Rate for Payer: Home State Health Plan Medicare Advantage	$1,687.37
Rate for Payer: Humana Commercial	$3,374.74
Rate for Payer: Humana Medicare Advantage	$1,687.37
Rate for Payer: UnitedHealthcare Commercial	$153.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN LES SCALP NECK .5 CM OR LESS

Facility

$230.00

Service Code	CPT 11420
Hospital Charge Code	4211420
Hospital Revenue Code	521
Rate for Payer: Cash Price	$207.00

EXC BEN LES SCALP,NECK,HANDS <0.6

Facility

$215.00

Service Code	CPT 11420
Hospital Charge Code	5411420
Hospital Revenue Code	521
Min. Negotiated Rate	$127.28
Max. Negotiated Rate	$3,374.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,488.83
Rate for Payer: Aetna Medicare Advantage	$1,687.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$127.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$153.51
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cigna Commercial HMO & PPO	$1,687.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,339.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,593.05
Rate for Payer: Home State Health Plan Medicare Advantage	$1,687.37
Rate for Payer: Humana Commercial	$3,374.74
Rate for Payer: Humana Medicare Advantage	$1,687.37
Rate for Payer: UnitedHealthcare Commercial	$143.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges