Madison Medical Center

All Charges

Charge

Type

Setting

Price

EXCISION OF LESION/MOUTH

Professional

Both

$347.00

Service Code	CPT 40812
Hospital Charge Code	4140812
Hospital Revenue Code	975
Min. Negotiated Rate	$121.45
Max. Negotiated Rate	$239.54
Rate for Payer: Aetna Commercial/Medicare Advantage	$156.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$217.76
Rate for Payer: Cash Price	$312.30
Rate for Payer: Cash Price	$312.30
Rate for Payer: Cigna Commercial HMO & PPO	$156.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$217.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$239.54
Rate for Payer: Home State Health Plan Medicare Advantage	$156.84
Rate for Payer: Optum Medicare Advantage	$121.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$217.76

EXCISION OF LYMPH NODES OF NECK, DEEP

Professional

Both

$1,158.00

Service Code	CPT 38510
Hospital Charge Code	4138510
Hospital Revenue Code	975
Min. Negotiated Rate	$360.95
Max. Negotiated Rate	$442.52
Rate for Payer: Aetna Commercial/Medicare Advantage	$360.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$402.29
Rate for Payer: Cash Price	$1,042.20
Rate for Payer: Cash Price	$1,042.20
Rate for Payer: Cigna Commercial HMO & PPO	$360.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$402.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$442.52
Rate for Payer: Home State Health Plan Medicare Advantage	$360.95
Rate for Payer: Optum Medicare Advantage	$405.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$402.29

EXCISION OF NAIL

Facility

$152.00

Service Code	CPT 11765
Hospital Charge Code	4111765
Hospital Revenue Code	521
Rate for Payer: Cash Price	$136.80

EXCISION OF NAIL

Facility

$152.00

Service Code	CPT 11765
Hospital Charge Code	4111765
Hospital Revenue Code	521
Min. Negotiated Rate	$89.98
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	$89.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$108.53
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
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	$101.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXCISION OF PILONIDAL SINUS

Facility

$478.00

Service Code	CPT 11770
Hospital Charge Code	4111770
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	$282.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$341.29
Rate for Payer: Cash Price	$430.20
Rate for Payer: Cash Price	$430.20
Rate for Payer: Cash Price	$430.20
Rate for Payer: Cash Price	$430.20
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	$318.83
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,618.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXCISION OF PILONIDAL SINUS

Facility

$478.00

Service Code	CPT 11770
Hospital Charge Code	4111770
Hospital Revenue Code	521
Rate for Payer: Cash Price	$430.20

EXCISION OF RECTAL TUMOR, TRANSANAL APPR

Professional

Both

$2,205.00

Service Code	CPT 45171
Hospital Charge Code	5445170
Hospital Revenue Code	975
Min. Negotiated Rate	$469.25
Max. Negotiated Rate	$771.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$569.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$469.25
Rate for Payer: Cash Price	$1,984.50
Rate for Payer: Cash Price	$1,984.50
Rate for Payer: Cigna Commercial HMO & PPO	$569.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$469.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$516.17
Rate for Payer: Home State Health Plan Medicare Advantage	$569.85
Rate for Payer: Optum Medicare Advantage	$771.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$469.25

EXCISION OF THYROGLOSSAL DUCT CYST

Professional

Both

$1,854.00

Service Code	CPT 60280
Hospital Charge Code	4160280
Hospital Revenue Code	975
Min. Negotiated Rate	$343.42
Max. Negotiated Rate	$648.90
Rate for Payer: Aetna Commercial/Medicare Advantage	$384.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$343.42
Rate for Payer: Cash Price	$1,668.60
Rate for Payer: Cash Price	$1,668.60
Rate for Payer: Cigna Commercial HMO & PPO	$384.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$343.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$377.76
Rate for Payer: Home State Health Plan Medicare Advantage	$384.45
Rate for Payer: Optum Medicare Advantage	$648.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$343.42

EXCISION OF TONSIL TAGS

Professional

Both

$770.00

Service Code	CPT 42860
Hospital Charge Code	9342860
Hospital Revenue Code	975
Min. Negotiated Rate	$145.34
Max. Negotiated Rate	$269.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$166.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$145.34
Rate for Payer: Cash Price	$693.00
Rate for Payer: Cash Price	$693.00
Rate for Payer: Cigna Commercial HMO & PPO	$166.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$145.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$159.87
Rate for Payer: Home State Health Plan Medicare Advantage	$166.50
Rate for Payer: Optum Medicare Advantage	$269.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$145.34

EXCISION PRESSURE ULCER, UNLISTED

Facility

$1,654.00

Service Code	CPT 15999
Hospital Charge Code	4115999
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	$979.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,180.96
Rate for Payer: Cash Price	$1,488.60
Rate for Payer: Cash Price	$1,488.60
Rate for Payer: Cash Price	$1,488.60
Rate for Payer: Cash Price	$1,488.60
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	$1,103.22
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXCISION PRESSURE ULCER, UNLISTED

Facility

$1,654.00

Service Code	CPT 15999
Hospital Charge Code	4115999
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,488.60

EXCISION SKIN LESION

Facility

$87.00

Service Code	CPT 11200
Hospital Charge Code	4211200
Hospital Revenue Code	521
Min. Negotiated Rate	$51.50
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	$51.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.12
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
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	$58.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXCISION SKIN LESION

Facility

$87.00

Service Code	CPT 11200
Hospital Charge Code	4211200
Hospital Revenue Code	521
Rate for Payer: Cash Price	$78.30

EXCISION, SOFT TISSUE TUMOR,SHOULDER SUB

Professional

Both

$840.00

Service Code	CPT 23075
Hospital Charge Code	5423075
Hospital Revenue Code	975
Min. Negotiated Rate	$294.00
Max. Negotiated Rate	$437.86
Rate for Payer: Aetna Commercial/Medicare Advantage	$299.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$398.05
Rate for Payer: Cash Price	$756.00
Rate for Payer: Cash Price	$756.00
Rate for Payer: Cigna Commercial HMO & PPO	$299.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$398.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$437.86
Rate for Payer: Home State Health Plan Medicare Advantage	$299.31
Rate for Payer: Optum Medicare Advantage	$294.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$398.05

EXCISION TUMOR SUBQ PELVIS & HIP REGION

Facility

$1,575.00

Service Code	CPT 27047
Hospital Charge Code	5427047
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	$932.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,124.55
Rate for Payer: Cash Price	$1,417.50
Rate for Payer: Cash Price	$1,417.50
Rate for Payer: Cash Price	$1,417.50
Rate for Payer: Cash Price	$1,417.50
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	$1,050.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,618.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXCISION TUMOR SUBQ PELVIS & HIP REGION

Facility

$1,575.00

Service Code	CPT 27047
Hospital Charge Code	5427047
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,417.50

EXCIS. OF NAIL FOLD

Professional

Both

$441.00

Service Code	CPT 11765
Hospital Charge Code	1811765
Hospital Revenue Code	981
Min. Negotiated Rate	$82.70
Max. Negotiated Rate	$154.35
Rate for Payer: Aetna Commercial/Medicare Advantage	$82.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$125.93
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cigna Commercial HMO & PPO	$82.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$125.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$138.52
Rate for Payer: Home State Health Plan Medicare Advantage	$82.70
Rate for Payer: Optum Medicare Advantage	$154.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$125.93

EXCIS.OF NAIL % MATRIX

Professional

Both

$989.00

Service Code	CPT 11750
Hospital Charge Code	1819014
Hospital Revenue Code	981
Min. Negotiated Rate	$88.81
Max. Negotiated Rate	$346.15
Rate for Payer: Aetna Commercial/Medicare Advantage	$88.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$121.29
Rate for Payer: Cash Price	$890.10
Rate for Payer: Cash Price	$890.10
Rate for Payer: Cigna Commercial HMO & PPO	$88.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$121.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$133.42
Rate for Payer: Home State Health Plan Medicare Advantage	$88.81
Rate for Payer: Optum Medicare Advantage	$346.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$121.29

EXC LESION OF PALATE, UVULA W/SIMP CLOSU

Professional

Both

$578.00

Service Code	CPT 42104
Hospital Charge Code	5442104
Hospital Revenue Code	975
Min. Negotiated Rate	$114.09
Max. Negotiated Rate	$202.30
Rate for Payer: Aetna Commercial/Medicare Advantage	$114.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$164.96
Rate for Payer: Cash Price	$520.20
Rate for Payer: Cash Price	$520.20
Rate for Payer: Cigna Commercial HMO & PPO	$114.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$164.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$181.46
Rate for Payer: Home State Health Plan Medicare Advantage	$114.09
Rate for Payer: Optum Medicare Advantage	$202.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$164.96

EXC LESION OF PALATE, UVULA W/SIMP CLOSU

Professional

Both

$709.00

Service Code	CPT 42106
Hospital Charge Code	5442106
Hospital Revenue Code	975
Min. Negotiated Rate	$139.96
Max. Negotiated Rate	$248.15
Rate for Payer: Aetna Commercial/Medicare Advantage	$139.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$196.61
Rate for Payer: Cash Price	$638.10
Rate for Payer: Cash Price	$638.10
Rate for Payer: Cigna Commercial HMO & PPO	$139.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$196.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$216.27
Rate for Payer: Home State Health Plan Medicare Advantage	$139.96
Rate for Payer: Optum Medicare Advantage	$248.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$196.61

EXC MALIG LES 1.1 TO 2.0 CM TRUNK,ARMS,L

Facility

$500.00

Service Code	CPT 11602
Hospital Charge Code	9811602
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	$296.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$357.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
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	$333.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MALIG LES 1.1 TO 2.0 CM TRUNK,ARMS,L

Facility

$500.00

Service Code	CPT 11602
Hospital Charge Code	9811602
Hospital Revenue Code	521
Rate for Payer: Cash Price	$450.00

EXC MALIG LES 1.1 TO 2.0 FACE EARS EYELI

Facility

$646.00

Service Code	CPT 11642
Hospital Charge Code	5411642
Hospital Revenue Code	521
Rate for Payer: Cash Price	$581.40

EXC MALIG LES 1.1 TO 2.0 FACE EARS EYELI

Facility

$646.00

Service Code	CPT 11642
Hospital Charge Code	5411642
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	$382.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$461.24
Rate for Payer: Cash Price	$581.40
Rate for Payer: Cash Price	$581.40
Rate for Payer: Cash Price	$581.40
Rate for Payer: Cash Price	$581.40
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	$430.88
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MALIG LESION/FACE 2.1 TO 3.0 CM

Facility

$684.00

Service Code	CPT 11643
Hospital Charge Code	4411643
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	$404.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$488.38
Rate for Payer: Cash Price	$615.60
Rate for Payer: Cash Price	$615.60
Rate for Payer: Cash Price	$615.60
Rate for Payer: Cash Price	$615.60
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	$456.23
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