Madison Medical Center

All Charges

Charge

Type

Setting

Price

EXCISION LESION

Professional

Both

$479.00

Service Code	CPT 11622
Hospital Charge Code	4111622
Hospital Revenue Code	975
Min. Negotiated Rate	$135.90
Max. Negotiated Rate	$209.97
Rate for Payer: Aetna Commercial/Medicare Advantage	$135.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$190.88
Rate for Payer: Cash Price	$431.10
Rate for Payer: Cash Price	$431.10
Rate for Payer: Cigna Commercial HMO & PPO	$135.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$190.88
Rate for Payer: Home State Health Plan Medicaid Managed Care	$209.97
Rate for Payer: Home State Health Plan Medicare Advantage	$135.90
Rate for Payer: Optum Medicare Advantage	$167.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$190.88

EXCISION LESION

Professional

Both

$228.00

Service Code	CPT 11441
Hospital Charge Code	4111441
Hospital Revenue Code	975
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$145.45
Rate for Payer: Aetna Commercial/Medicare Advantage	$111.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$132.23
Rate for Payer: Cash Price	$205.20
Rate for Payer: Cash Price	$205.20
Rate for Payer: Cigna Commercial HMO & PPO	$111.23
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$132.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$145.45
Rate for Payer: Home State Health Plan Medicare Advantage	$111.23
Rate for Payer: Optum Medicare Advantage	$79.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$132.23

EXCISION LESION

Facility

$281.00

Service Code	CPT 11403
Hospital Charge Code	4111403
Hospital Revenue Code	521
Min. Negotiated Rate	$166.35
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	$166.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$200.63
Rate for Payer: Cash Price	$252.90
Rate for Payer: Cash Price	$252.90
Rate for Payer: Cash Price	$252.90
Rate for Payer: Cash Price	$252.90
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	$187.43
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXCISION LESION 1.1 TO 2.0 CM

Professional

Both

$242.00

Service Code	CPT 11422
Hospital Charge Code	4111422
Hospital Revenue Code	975
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$149.71
Rate for Payer: Aetna Commercial/Medicare Advantage	$115.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$136.10
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cigna Commercial HMO & PPO	$115.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$136.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$149.71
Rate for Payer: Home State Health Plan Medicare Advantage	$115.45
Rate for Payer: Optum Medicare Advantage	$84.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$136.10

EXCISION LESION 1.1 TO 2.0 CM FACE

Professional

Both

$242.00

Service Code	CPT 11442
Hospital Charge Code	4111442
Hospital Revenue Code	975
Min. Negotiated Rate	$84.70
Max. Negotiated Rate	$161.13
Rate for Payer: Aetna Commercial/Medicare Advantage	$122.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$146.48
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cigna Commercial HMO & PPO	$122.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$146.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$161.13
Rate for Payer: Home State Health Plan Medicare Advantage	$122.52
Rate for Payer: Optum Medicare Advantage	$84.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$146.48

EXCISION LESION-BENIGN/EXCEP,SK-NK-SCLP

Professional

Both

$135.00

Service Code	CPT 11600
Hospital Charge Code	4111420
Hospital Revenue Code	975
Min. Negotiated Rate	$47.25
Max. Negotiated Rate	$165.29
Rate for Payer: Aetna Commercial/Medicare Advantage	$101.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$150.26
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cash Price	$121.50
Rate for Payer: Cigna Commercial HMO & PPO	$101.69
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$150.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$165.29
Rate for Payer: Home State Health Plan Medicare Advantage	$101.69
Rate for Payer: Optum Medicare Advantage	$47.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$150.26

EXCISION LESION-BENIGN/NOSE,EYES,EARS

Professional

Both

$176.00

Service Code	CPT 11440
Hospital Charge Code	4111440
Hospital Revenue Code	975
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$119.71
Rate for Payer: Aetna Commercial/Medicare Advantage	$89.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$108.83
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cigna Commercial HMO & PPO	$89.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$108.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$119.71
Rate for Payer: Home State Health Plan Medicare Advantage	$89.47
Rate for Payer: Optum Medicare Advantage	$61.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$108.83

EXCISION LESION-MALIGN/FACE1.1 TO 2.0 CM

Professional

Both

$606.00

Service Code	CPT 11642
Hospital Charge Code	4111642
Hospital Revenue Code	975
Min. Negotiated Rate	$146.18
Max. Negotiated Rate	$222.81
Rate for Payer: Aetna Commercial/Medicare Advantage	$146.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$202.55
Rate for Payer: Cash Price	$545.40
Rate for Payer: Cash Price	$545.40
Rate for Payer: Cigna Commercial HMO & PPO	$146.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$202.55
Rate for Payer: Home State Health Plan Medicaid Managed Care	$222.81
Rate for Payer: Home State Health Plan Medicare Advantage	$146.18
Rate for Payer: Optum Medicare Advantage	$212.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$202.55

EXCISION LESION-MALIGN/FACE .6 TO 1.0 CM

Professional

Both

$434.00

Service Code	CPT 11641
Hospital Charge Code	4111641
Hospital Revenue Code	975
Min. Negotiated Rate	$126.77
Max. Negotiated Rate	$197.03
Rate for Payer: Aetna Commercial/Medicare Advantage	$126.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$179.12
Rate for Payer: Cash Price	$390.60
Rate for Payer: Cash Price	$390.60
Rate for Payer: Cigna Commercial HMO & PPO	$126.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$179.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$197.03
Rate for Payer: Home State Health Plan Medicare Advantage	$126.77
Rate for Payer: Optum Medicare Advantage	$151.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$179.12

EXCISION LESION-MALIGN/FACE,EARS 4.0 CM

Professional

Both

$1,080.00

Service Code	CPT 11646
Hospital Charge Code	4111646
Hospital Revenue Code	975
Min. Negotiated Rate	$318.72
Max. Negotiated Rate	$419.90
Rate for Payer: Aetna Commercial/Medicare Advantage	$318.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$381.73
Rate for Payer: Cash Price	$972.00
Rate for Payer: Cash Price	$972.00
Rate for Payer: Cigna Commercial HMO & PPO	$318.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$381.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$419.90
Rate for Payer: Home State Health Plan Medicare Advantage	$318.72
Rate for Payer: Optum Medicare Advantage	$378.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$381.73

EXCISION LESION-MALIGN/LIMB 0.6-1.0CM

Professional

Both

$285.00

Service Code	CPT 11601
Hospital Charge Code	4111601
Hospital Revenue Code	975
Min. Negotiated Rate	$99.75
Max. Negotiated Rate	$190.56
Rate for Payer: Aetna Commercial/Medicare Advantage	$120.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$173.24
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cash Price	$256.50
Rate for Payer: Cigna Commercial HMO & PPO	$120.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$173.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$190.56
Rate for Payer: Home State Health Plan Medicare Advantage	$120.77
Rate for Payer: Optum Medicare Advantage	$99.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$173.24

EXCISION LESION-MALIGN/NOSE,2.1 TO 3.0

Professional

Both

$416.00

Service Code	CPT 11443
Hospital Charge Code	4111443
Hospital Revenue Code	975
Min. Negotiated Rate	$145.60
Max. Negotiated Rate	$190.01
Rate for Payer: Aetna Commercial/Medicare Advantage	$148.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$172.74
Rate for Payer: Cash Price	$374.40
Rate for Payer: Cash Price	$374.40
Rate for Payer: Cigna Commercial HMO & PPO	$148.97
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$172.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$190.01
Rate for Payer: Home State Health Plan Medicare Advantage	$148.97
Rate for Payer: Optum Medicare Advantage	$145.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$172.74

EXCISION LESION-MALIGN/SC/NK/ND 2.1-3.0

Professional

Both

$276.00

Service Code	CPT 11623
Hospital Charge Code	4111623
Hospital Revenue Code	975
Min. Negotiated Rate	$96.60
Max. Negotiated Rate	$246.10
Rate for Payer: Aetna Commercial/Medicare Advantage	$168.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$223.73
Rate for Payer: Cash Price	$248.40
Rate for Payer: Cash Price	$248.40
Rate for Payer: Cigna Commercial HMO & PPO	$168.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$223.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$246.10
Rate for Payer: Home State Health Plan Medicare Advantage	$168.56
Rate for Payer: Optum Medicare Advantage	$96.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$223.73

EXCISION LESION-MALIGN/TRUNK LIMB -0.5

Professional

Both

$228.00

Service Code	CPT 11600
Hospital Charge Code	4111600
Hospital Revenue Code	975
Min. Negotiated Rate	$79.80
Max. Negotiated Rate	$165.29
Rate for Payer: Aetna Commercial/Medicare Advantage	$101.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$150.26
Rate for Payer: Cash Price	$205.20
Rate for Payer: Cash Price	$205.20
Rate for Payer: Cigna Commercial HMO & PPO	$101.69
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$150.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$165.29
Rate for Payer: Home State Health Plan Medicare Advantage	$101.69
Rate for Payer: Optum Medicare Advantage	$79.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$150.26

EXCISION LESION OF SPERMATIC CORD

Facility

$984.00

Service Code	CPT 55520
Hospital Charge Code	4155520
Hospital Revenue Code	521
Rate for Payer: Cash Price	$885.60

EXCISION LESION OF SPERMATIC CORD

Facility

$984.00

Service Code	CPT 55520
Hospital Charge Code	4155520
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$7,202.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$3,177.59
Rate for Payer: Aetna Medicare Advantage	$3,601.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$582.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$702.58
Rate for Payer: Cash Price	$885.60
Rate for Payer: Cash Price	$885.60
Rate for Payer: Cash Price	$885.60
Rate for Payer: Cash Price	$885.60
Rate for Payer: Cigna Commercial HMO & PPO	$3,601.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,859.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,400.02
Rate for Payer: Home State Health Plan Medicare Advantage	$3,601.33
Rate for Payer: Humana Commercial	$7,202.66
Rate for Payer: Humana Medicare Advantage	$3,601.33
Rate for Payer: UnitedHealthcare Commercial	$656.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3,177.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXCISION OF CYST BREAST

Professional

Both

$899.00

Service Code	CPT 19120
Hospital Charge Code	4119120
Hospital Revenue Code	975
Min. Negotiated Rate	$314.65
Max. Negotiated Rate	$433.53
Rate for Payer: Aetna Commercial/Medicare Advantage	$383.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$394.12
Rate for Payer: Cash Price	$809.10
Rate for Payer: Cash Price	$809.10
Rate for Payer: Cigna Commercial HMO & PPO	$383.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$394.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$433.53
Rate for Payer: Home State Health Plan Medicare Advantage	$383.57
Rate for Payer: Optum Medicare Advantage	$314.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$394.12

EXCISION OF DEEP CYST

Facility

$632.00

Service Code	CPT 27324
Hospital Charge Code	4127324
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$5,935.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,618.45
Rate for Payer: Aetna Medicare Advantage	$2,967.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$374.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$451.25
Rate for Payer: Cash Price	$568.80
Rate for Payer: Cash Price	$568.80
Rate for Payer: Cash Price	$568.80
Rate for Payer: Cash Price	$568.80
Rate for Payer: Cigna Commercial HMO & PPO	$2,967.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,356.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2,801.74
Rate for Payer: Home State Health Plan Medicare Advantage	$2,967.63
Rate for Payer: Humana Commercial	$5,935.26
Rate for Payer: Humana Medicare Advantage	$2,967.63
Rate for Payer: UnitedHealthcare Commercial	$421.54
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,618.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXCISION OF DEEP CYST

Facility

$632.00

Service Code	CPT 27324
Hospital Charge Code	4127324
Hospital Revenue Code	521
Rate for Payer: Cash Price	$568.80

EXCISION OF F/B FOOT, SUBCUTANEOUS

Facility

$232.00

Service Code	CPT 28190
Hospital Charge Code	4428190
Hospital Revenue Code	521
Rate for Payer: Cash Price	$208.80

EXCISION OF F/B FOOT, SUBCUTANEOUS

Facility

$232.00

Service Code	CPT 28190
Hospital Charge Code	4428190
Hospital Revenue Code	521
Min. Negotiated Rate	$137.34
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	$137.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$165.65
Rate for Payer: Cash Price	$208.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Cash Price	$208.80
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	$154.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXCISION OF GANGLION

Facility

$975.00

Service Code	CPT 25111
Hospital Charge Code	4125111
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
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	$577.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$696.15
Rate for Payer: Cash Price	$877.50
Rate for Payer: Cash Price	$877.50
Rate for Payer: Cash Price	$877.50
Rate for Payer: Cash Price	$877.50
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	$650.33
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,449.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXCISION OF GANGLION

Facility

$975.00

Service Code	CPT 25111
Hospital Charge Code	4125111
Hospital Revenue Code	521
Rate for Payer: Cash Price	$877.50

EXCISION OF HYDROCELE; UNILATERAL

Professional

Both

$1,575.00

Service Code	CPT 55040
Hospital Charge Code	5455040
Hospital Revenue Code	975
Min. Negotiated Rate	$253.91
Max. Negotiated Rate	$551.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$298.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$253.91
Rate for Payer: Cash Price	$1,417.50
Rate for Payer: Cash Price	$1,417.50
Rate for Payer: Cigna Commercial HMO & PPO	$298.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$253.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$279.30
Rate for Payer: Home State Health Plan Medicare Advantage	$298.64
Rate for Payer: Optum Medicare Advantage	$551.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$253.91

EXCISION OF HYDRO OF SPERM CORD.

Professional

Both

$1,024.00

Service Code	CPT 55500-51
Hospital Charge Code	4155500
Hospital Revenue Code	975
Min. Negotiated Rate	$358.40
Max. Negotiated Rate	$358.40
Rate for Payer: Cash Price	$921.60
Rate for Payer: Optum Medicare Advantage	$358.40

Know your out-of-pocket cost for care.

All Charges