Madison Medical Center

All Charges

Charge

Type

Setting

Price

EXC BEN TRK,ARMS,LEGS 2.1 TO 3.0 CM

Facility

$300.00

Service Code	CPT 11403
Hospital Charge Code	9811403
Hospital Revenue Code	521
Rate for Payer: Cash Price	$270.00

EXC BEN TRUNK,ARMS, LEGS 1.1 TO 2.0 CM

Facility

$341.00

Service Code	CPT 11402
Hospital Charge Code	5411402
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	$201.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$243.47
Rate for Payer: Cash Price	$306.90
Rate for Payer: Cash Price	$306.90
Rate for Payer: Cash Price	$306.90
Rate for Payer: Cash Price	$306.90
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	$227.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC BEN TRUNK,ARMS, LEGS 1.1 TO 2.0 CM

Facility

$341.00

Service Code	CPT 11402
Hospital Charge Code	5411402
Hospital Revenue Code	521
Rate for Payer: Cash Price	$306.90

EXC BEN TRUNK,ARMS, LEGS 3.1 TO 4.0CM

Facility

$515.00

Service Code	CPT 11404
Hospital Charge Code	5411404
Hospital Revenue Code	521
Rate for Payer: Cash Price	$463.50

EXC BEN TRUNK,ARMS, LEGS 3.1 TO 4.0CM

Facility

$515.00

Service Code	CPT 11404
Hospital Charge Code	5411404
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	$304.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$367.71
Rate for Payer: Cash Price	$463.50
Rate for Payer: Cash Price	$463.50
Rate for Payer: Cash Price	$463.50
Rate for Payer: Cash Price	$463.50
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	$343.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC CYST HAND OR FINGER

Facility

$158.00

Service Code	CPT 26160
Hospital Charge Code	5226160
Hospital Revenue Code	521
Rate for Payer: Cash Price	$142.20

EXC CYST HAND OR FINGER

Facility

$158.00

Service Code	CPT 26160
Hospital Charge Code	5226160
Hospital Revenue Code	521
Min. Negotiated Rate	$93.54
Max. Negotiated Rate	$3,285.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,449.52
Rate for Payer: Aetna Medicare Advantage	$1,642.82
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	$1,642.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,304.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,550.99
Rate for Payer: Home State Health Plan Medicare Advantage	$1,642.82
Rate for Payer: Humana Commercial	$3,285.64
Rate for Payer: Humana Medicare Advantage	$1,642.82
Rate for Payer: UnitedHealthcare Commercial	$105.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,449.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC FACE, EARS, EYELIDS .6 TO 1.0 CM

Facility

$280.00

Service Code	CPT 11441
Hospital Charge Code	9711441
Hospital Revenue Code	521
Rate for Payer: Cash Price	$252.00

EXC FACE, EARS, EYELIDS .6 TO 1.0 CM

Facility

$280.00

Service Code	CPT 11441
Hospital Charge Code	9711441
Hospital Revenue Code	521
Min. Negotiated Rate	$165.76
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	$165.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$199.92
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
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	$186.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXCISION AURAL POLYP

Professional

Both

$560.00

Service Code	CPT 69540
Hospital Charge Code	9369540
Hospital Revenue Code	975
Min. Negotiated Rate	$109.95
Max. Negotiated Rate	$196.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$109.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$161.96
Rate for Payer: Cash Price	$504.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Cigna Commercial HMO & PPO	$109.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$161.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$178.16
Rate for Payer: Home State Health Plan Medicare Advantage	$109.95
Rate for Payer: Optum Medicare Advantage	$196.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$161.96

EXCISION BENIGN

Professional

Both

$184.00

Service Code	CPT 11421
Hospital Charge Code	4111421
Hospital Revenue Code	975
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$133.51
Rate for Payer: Aetna Commercial/Medicare Advantage	$92.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$121.37
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cigna Commercial HMO & PPO	$92.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$121.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$133.51
Rate for Payer: Home State Health Plan Medicare Advantage	$92.45
Rate for Payer: Optum Medicare Advantage	$64.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$121.37

EXCISION-BENIGN LESION 0.6 TO 1.0CM

Professional

Both

$164.00

Service Code	CPT 11401
Hospital Charge Code	4111401
Hospital Revenue Code	975
Min. Negotiated Rate	$57.40
Max. Negotiated Rate	$130.58
Rate for Payer: Aetna Commercial/Medicare Advantage	$87.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$118.71
Rate for Payer: Cash Price	$147.60
Rate for Payer: Cash Price	$147.60
Rate for Payer: Cigna Commercial HMO & PPO	$87.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$118.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$130.58
Rate for Payer: Home State Health Plan Medicare Advantage	$87.84
Rate for Payer: Optum Medicare Advantage	$57.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$118.71

EXCISION-BENIGN LESION 1.1 TO 2.0CM

Professional

Both

$213.00

Service Code	CPT 11402
Hospital Charge Code	4111402
Hospital Revenue Code	975
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$143.73
Rate for Payer: Aetna Commercial/Medicare Advantage	$95.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$130.66
Rate for Payer: Cash Price	$191.70
Rate for Payer: Cash Price	$191.70
Rate for Payer: Cigna Commercial HMO & PPO	$95.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$130.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$143.73
Rate for Payer: Home State Health Plan Medicare Advantage	$95.56
Rate for Payer: Optum Medicare Advantage	$74.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$130.66

EXCISION,BENIGN LES SXCEPT LEM TRK-0.5

Professional

Both

$131.00

Service Code	CPT 11400
Hospital Charge Code	4111400
Hospital Revenue Code	975
Min. Negotiated Rate	$45.85
Max. Negotiated Rate	$106.79
Rate for Payer: Aetna Commercial/Medicare Advantage	$70.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$97.08
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cigna Commercial HMO & PPO	$70.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$97.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$106.79
Rate for Payer: Home State Health Plan Medicare Advantage	$70.40
Rate for Payer: Optum Medicare Advantage	$45.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$97.08

EXCISION,BENIGN OVER 5 CM

Professional

Both

$718.00

Service Code	CPT 11426
Hospital Charge Code	4111426
Hospital Revenue Code	975
Min. Negotiated Rate	$231.83
Max. Negotiated Rate	$277.61
Rate for Payer: Aetna Commercial/Medicare Advantage	$231.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$252.37
Rate for Payer: Cash Price	$646.20
Rate for Payer: Cash Price	$646.20
Rate for Payer: Cigna Commercial HMO & PPO	$231.83
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$252.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$277.61
Rate for Payer: Home State Health Plan Medicare Advantage	$231.83
Rate for Payer: Optum Medicare Advantage	$251.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$252.37

EXCISION-BIO OF STOMACH-LAPAROTOMY

Professional

Both

$2,129.00

Service Code	CPT 43605
Hospital Charge Code	4143605
Hospital Revenue Code	975
Min. Negotiated Rate	$634.55
Max. Negotiated Rate	$765.20
Rate for Payer: Aetna Commercial/Medicare Advantage	$765.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$634.55
Rate for Payer: Cash Price	$1,916.10
Rate for Payer: Cash Price	$1,916.10
Rate for Payer: Cigna Commercial HMO & PPO	$765.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$634.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$698.00
Rate for Payer: Home State Health Plan Medicare Advantage	$765.20
Rate for Payer: Optum Medicare Advantage	$745.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$634.55

EXCISION BIOPSY

Professional

Both

$310.00

Service Code	CPT 21550
Hospital Charge Code	4121550
Hospital Revenue Code	975
Min. Negotiated Rate	$108.50
Max. Negotiated Rate	$224.20
Rate for Payer: Aetna Commercial/Medicare Advantage	$134.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$203.82
Rate for Payer: Cash Price	$279.00
Rate for Payer: Cash Price	$279.00
Rate for Payer: Cigna Commercial HMO & PPO	$134.42
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$203.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$224.20
Rate for Payer: Home State Health Plan Medicare Advantage	$134.42
Rate for Payer: Optum Medicare Advantage	$108.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$203.82

EXCISION/BREAST-SINGLE LEASION W/MARKER

Professional

Both

$1,032.00

Service Code	CPT 19125
Hospital Charge Code	4119125
Hospital Revenue Code	975
Min. Negotiated Rate	$361.20
Max. Negotiated Rate	$478.06
Rate for Payer: Aetna Commercial/Medicare Advantage	$426.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$434.60
Rate for Payer: Cash Price	$928.80
Rate for Payer: Cash Price	$928.80
Rate for Payer: Cigna Commercial HMO & PPO	$426.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$434.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$478.06
Rate for Payer: Home State Health Plan Medicare Advantage	$426.46
Rate for Payer: Optum Medicare Advantage	$361.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$434.60

EXCISION CYST

Facility

$495.00

Service Code	CPT 11444
Hospital Charge Code	4111444
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	$293.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$353.43
Rate for Payer: Cash Price	$445.50
Rate for Payer: Cash Price	$445.50
Rate for Payer: Cash Price	$445.50
Rate for Payer: Cash Price	$445.50
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	$330.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXCISION CYST

Facility

$495.00

Service Code	CPT 11444
Hospital Charge Code	4111444
Hospital Revenue Code	521
Rate for Payer: Cash Price	$445.50

EXCISION EXTERNAL EAR;PARTIAL SIMP REPAR

Professional

Both

$811.00

Service Code	CPT 69110
Hospital Charge Code	4169110
Hospital Revenue Code	975
Min. Negotiated Rate	$276.85
Max. Negotiated Rate	$395.73
Rate for Payer: Aetna Commercial/Medicare Advantage	$276.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$359.75
Rate for Payer: Cash Price	$729.90
Rate for Payer: Cash Price	$729.90
Rate for Payer: Cigna Commercial HMO & PPO	$276.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$359.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$395.73
Rate for Payer: Home State Health Plan Medicare Advantage	$276.85
Rate for Payer: Optum Medicare Advantage	$283.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$359.75

EXCISION LESION

Facility

$697.00

Service Code	CPT 11643
Hospital Charge Code	4111643
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	$412.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$497.66
Rate for Payer: Cash Price	$627.30
Rate for Payer: Cash Price	$627.30
Rate for Payer: Cash Price	$627.30
Rate for Payer: Cash Price	$627.30
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	$464.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXCISION LESION

Facility

$697.00

Service Code	CPT 11643
Hospital Charge Code	4111643
Hospital Revenue Code	521
Rate for Payer: Cash Price	$627.30

EXCISION LESION

Professional

Both

$435.00

Service Code	CPT 11603
Hospital Charge Code	4111603
Hospital Revenue Code	975
Min. Negotiated Rate	$152.25
Max. Negotiated Rate	$231.29
Rate for Payer: Aetna Commercial/Medicare Advantage	$154.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$210.26
Rate for Payer: Cash Price	$391.50
Rate for Payer: Cash Price	$391.50
Rate for Payer: Cigna Commercial HMO & PPO	$154.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$210.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$231.29
Rate for Payer: Home State Health Plan Medicare Advantage	$154.70
Rate for Payer: Optum Medicare Advantage	$152.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$210.26

EXCISION LESION

Facility

$281.00

Service Code	CPT 11403
Hospital Charge Code	4111403
Hospital Revenue Code	521
Rate for Payer: Cash Price	$252.90

Know your out-of-pocket cost for care.

All Charges