Madison Medical Center

All Charges

Charge

Type

Setting

Price

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
Rate for Payer: Cash Price	$615.60

EXC MALIG LES NECK 1 TO 1.5 CM

Facility

$536.00

Service Code	CPT 11622
Hospital Charge Code	5411622
Hospital Revenue Code	521
Rate for Payer: Cash Price	$482.40

EXC MALIG LES NECK 1 TO 1.5 CM

Facility

$536.00

Service Code	CPT 11622
Hospital Charge Code	5411622
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	$317.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$382.70
Rate for Payer: Cash Price	$482.40
Rate for Payer: Cash Price	$482.40
Rate for Payer: Cash Price	$482.40
Rate for Payer: Cash Price	$482.40
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	$357.51
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MALIG LES TRUNK,ARMS LEGS 1.1 TO 2.0

Facility

$368.00

Service Code	CPT 11602
Hospital Charge Code	4411602
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	$217.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$262.75
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
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	$245.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MALIG LES TRUNK,ARMS LEGS 1.1 TO 2.0

Facility

$368.00

Service Code	CPT 11602
Hospital Charge Code	4411602
Hospital Revenue Code	521
Rate for Payer: Cash Price	$331.20

EXC MAL LES 1.1-2.0 CM SCALP, NECK,HANDS

Facility

$520.00

Service Code	CPT 11622
Hospital Charge Code	9711622
Hospital Revenue Code	521
Rate for Payer: Cash Price	$468.00

EXC MAL LES 1.1-2.0 CM SCALP, NECK,HANDS

Facility

$520.00

Service Code	CPT 11622
Hospital Charge Code	9711622
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	$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	$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	$346.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES 1.1 TO 2.0 CM FACE

Facility

$390.00

Service Code	CPT 17282
Hospital Charge Code	9817282
Hospital Revenue Code	521
Rate for Payer: Cash Price	$351.00

EXC MAL LES 1.1 TO 2.0 CM FACE

Facility

$390.00

Service Code	CPT 17282
Hospital Charge Code	9817282
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	$230.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$278.46
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
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	$260.13
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES 1.1 TO 2.0 CM FACE EARS EYEL

Facility

$650.00

Service Code	CPT 11642
Hospital Charge Code	9811642
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	$384.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$464.10
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cash Price	$585.00
Rate for Payer: Cash Price	$585.00
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	$433.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES 1.1 TO 2.0 CM FACE EARS EYEL

Facility

$650.00

Service Code	CPT 11642
Hospital Charge Code	9811642
Hospital Revenue Code	521
Rate for Payer: Cash Price	$585.00

EXC MAL LES 1.1 TO 2.0 CM SCALP NECK HAN

Facility

$520.00

Service Code	CPT 11622
Hospital Charge Code	9811622
Hospital Revenue Code	521
Rate for Payer: Cash Price	$468.00

EXC MAL LES 1.1 TO 2.0 CM SCALP NECK HAN

Facility

$520.00

Service Code	CPT 11622
Hospital Charge Code	9811622
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	$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	$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	$346.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES 2.1 TO 3.0 CM FACE EARS EYEL

Facility

$825.00

Service Code	CPT 11643
Hospital Charge Code	9811643
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	$488.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$589.05
Rate for Payer: Cash Price	$742.50
Rate for Payer: Cash Price	$742.50
Rate for Payer: Cash Price	$742.50
Rate for Payer: Cash Price	$742.50
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	$550.27
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES 2.1 TO 3.0 CM FACE EARS EYEL

Facility

$825.00

Service Code	CPT 11643
Hospital Charge Code	9811643
Hospital Revenue Code	521
Rate for Payer: Cash Price	$742.50

EXC MAL LES 2.1 TO 3.0 CM TRUNK,ARM/LEG

Facility

$600.00

Service Code	CPT 11603
Hospital Charge Code	4211603
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	$355.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$428.40
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cash Price	$540.00
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	$400.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES 2.1 TO 3.0 CM TRUNK,ARM/LEG

Facility

$600.00

Service Code	CPT 11603
Hospital Charge Code	4211603
Hospital Revenue Code	521
Rate for Payer: Cash Price	$540.00

EXC MAL LES 2.1 TO 3.0 SCALP,NECK,HANDS,

Facility

$641.00

Service Code	CPT 11623
Hospital Charge Code	5411623
Hospital Revenue Code	521
Rate for Payer: Cash Price	$576.90

EXC MAL LES 2.1 TO 3.0 SCALP,NECK,HANDS,

Facility

$641.00

Service Code	CPT 11623
Hospital Charge Code	5411623
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	$379.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$457.67
Rate for Payer: Cash Price	$576.90
Rate for Payer: Cash Price	$576.90
Rate for Payer: Cash Price	$576.90
Rate for Payer: Cash Price	$576.90
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	$427.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES 3.1-4.0CM TRUNK,ARMS,LEGS

Facility

$500.00

Service Code	CPT 11604
Hospital Charge Code	9811604
Hospital Revenue Code	521
Rate for Payer: Cash Price	$450.00

EXC MAL LES 3.1-4.0CM TRUNK,ARMS,LEGS

Facility

$500.00

Service Code	CPT 11604
Hospital Charge Code	9811604
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	$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	$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	$333.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES 4.0 AND > CM FACE

Facility

$540.00

Service Code	CPT 17286
Hospital Charge Code	9817286
Hospital Revenue Code	521
Rate for Payer: Cash Price	$486.00

EXC MAL LES 4.0 AND > CM FACE

Facility

$540.00

Service Code	CPT 17286
Hospital Charge Code	9817286
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	$319.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$385.56
Rate for Payer: Cash Price	$486.00
Rate for Payer: Cash Price	$486.00
Rate for Payer: Cash Price	$486.00
Rate for Payer: Cash Price	$486.00
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	$360.18
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$666.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES .5 CM OR< TRUNK,ARMS,LEGS

Facility

$400.00

Service Code	CPT 11600
Hospital Charge Code	4211600
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	$236.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$285.60
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
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	$266.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES .5 CM OR< TRUNK,ARMS,LEGS

Facility

$400.00

Service Code	CPT 11600
Hospital Charge Code	4211600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$360.00

Know your out-of-pocket cost for care.

All Charges