Madison Medical Center

All Charges

Charge

Type

Setting

Price

EXC MAL LES .6 TO 1 CM TRUNK,ARMS,LEGS

Facility

$450.00

Service Code	CPT 11601
Hospital Charge Code	4211601
Hospital Revenue Code	521
Rate for Payer: Cash Price	$405.00

EXC MAL LES .6 TO 1 CM TRUNK,ARMS,LEGS

Facility

$450.00

Service Code	CPT 11601
Hospital Charge Code	4211601
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	$266.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$321.30
Rate for Payer: Cash Price	$405.00
Rate for Payer: Cash Price	$405.00
Rate for Payer: Cash Price	$405.00
Rate for Payer: Cash Price	$405.00
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	$300.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES ARM 1.1 TO 2.0 CM

Facility

$189.00

Service Code	CPT 11602
Hospital Charge Code	5211602
Hospital Revenue Code	521
Rate for Payer: Cash Price	$170.10

EXC MAL LES ARM 1.1 TO 2.0 CM

Facility

$189.00

Service Code	CPT 11602
Hospital Charge Code	5211602
Hospital Revenue Code	521
Min. Negotiated Rate	$111.89
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	$111.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$134.95
Rate for Payer: Cash Price	$170.10
Rate for Payer: Cash Price	$170.10
Rate for Payer: Cash Price	$170.10
Rate for Payer: Cash Price	$170.10
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	$126.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES ARM 4.0 CM OR LARGER

Facility

$315.00

Service Code	CPT 11606
Hospital Charge Code	5211606
Hospital Revenue Code	521
Rate for Payer: Cash Price	$283.50

EXC MAL LES ARM 4.0 CM OR LARGER

Facility

$315.00

Service Code	CPT 11606
Hospital Charge Code	5211606
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	$186.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$224.91
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
Rate for Payer: Cash Price	$283.50
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	$210.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES FACE 1.1 TO 2.0CM

Facility

$420.00

Service Code	CPT 11642
Hospital Charge Code	5211642
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	$248.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$299.88
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cash Price	$378.00
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	$280.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES FACE 1.1 TO 2.0CM

Facility

$420.00

Service Code	CPT 11642
Hospital Charge Code	5211642
Hospital Revenue Code	521
Rate for Payer: Cash Price	$378.00

EXC MAL LES FACE .5 TO 1.0 CM

Facility

$368.00

Service Code	CPT 11641
Hospital Charge Code	5211641
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	$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	$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	$245.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LES FACE .5 TO 1.0 CM

Facility

$368.00

Service Code	CPT 11641
Hospital Charge Code	5211641
Hospital Revenue Code	521
Rate for Payer: Cash Price	$331.20

EXC MAL LESION FACE 1.1 TO 2.0 CM

Facility

$498.00

Service Code	CPT 11641
Hospital Charge Code	4411642
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	$294.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$355.57
Rate for Payer: Cash Price	$448.20
Rate for Payer: Cash Price	$448.20
Rate for Payer: Cash Price	$448.20
Rate for Payer: Cash Price	$448.20
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	$332.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL LESION FACE 1.1 TO 2.0 CM

Facility

$498.00

Service Code	CPT 11641
Hospital Charge Code	4411642
Hospital Revenue Code	521
Rate for Payer: Cash Price	$448.20

EXC MAL LES TRUNK, ARMS, LEGS 2.1 TO 3.0

Facility

$590.00

Service Code	CPT 11603
Hospital Charge Code	9811603
Hospital Revenue Code	521
Rate for Payer: Cash Price	$531.00

EXC MAL LES TRUNK, ARMS, LEGS 2.1 TO 3.0

Facility

$590.00

Service Code	CPT 11603
Hospital Charge Code	9811603
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	$349.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$421.26
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cash Price	$531.00
Rate for Payer: Cash Price	$531.00
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	$393.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL NEO FACE 3.1 TO 4.0 CM

Facility

$1,000.00

Service Code	CPT 11644
Hospital Charge Code	9811644
Hospital Revenue Code	521
Rate for Payer: Cash Price	$900.00

EXC MAL NEO FACE 3.1 TO 4.0 CM

Facility

$1,000.00

Service Code	CPT 11644
Hospital Charge Code	9811644
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	$592.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$714.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
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	$667.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL TRUNK,ARMS, LEGS 1.1 CM

Facility

$446.00

Service Code	CPT 11602
Hospital Charge Code	5411602
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	$264.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$318.44
Rate for Payer: Cash Price	$401.40
Rate for Payer: Cash Price	$401.40
Rate for Payer: Cash Price	$401.40
Rate for Payer: Cash Price	$401.40
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	$297.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL TRUNK,ARMS, LEGS 1.1 CM

Facility

$446.00

Service Code	CPT 11602
Hospital Charge Code	5411602
Hospital Revenue Code	521
Rate for Payer: Cash Price	$401.40

EXC MAL TRUNK,ARMS, LEGS 2.1 TO 3.0 CM

Facility

$541.00

Service Code	CPT 11603
Hospital Charge Code	5411603
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	$320.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$386.27
Rate for Payer: Cash Price	$486.90
Rate for Payer: Cash Price	$486.90
Rate for Payer: Cash Price	$486.90
Rate for Payer: Cash Price	$486.90
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	$360.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC MAL TRUNK,ARMS, LEGS 2.1 TO 3.0 CM

Facility

$541.00

Service Code	CPT 11603
Hospital Charge Code	5411603
Hospital Revenue Code	521
Rate for Payer: Cash Price	$486.90

EXC MAL TRUNK,ARMS, LEGS .6 TO 1.0

Facility

$378.00

Service Code	CPT 11601
Hospital Charge Code	5411601
Hospital Revenue Code	521
Rate for Payer: Cash Price	$340.20

EXC MAL TRUNK,ARMS, LEGS .6 TO 1.0

Facility

$378.00

Service Code	CPT 11601
Hospital Charge Code	5411601
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	$223.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$269.89
Rate for Payer: Cash Price	$340.20
Rate for Payer: Cash Price	$340.20
Rate for Payer: Cash Price	$340.20
Rate for Payer: Cash Price	$340.20
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	$252.13
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC NAIL AND MATRIX

Facility

$145.00

Service Code	CPT 69210
Hospital Charge Code	9717000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$130.50

EXC NAIL AND MATRIX

Facility

$368.00

Service Code	CPT 11750
Hospital Charge Code	9711750
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 NAIL AND MATRIX

Facility

$368.00

Service Code	CPT 11750
Hospital Charge Code	9711750
Hospital Revenue Code	521
Rate for Payer: Cash Price	$331.20

Know your out-of-pocket cost for care.

All Charges