Madison Medical Center

All Charges

Charge

Type

Setting

Price

EXC NAIL AND MATRIX

Facility

$145.00

Service Code	CPT 69210
Hospital Charge Code	9717000
Hospital Revenue Code	521
Min. Negotiated Rate	$47.86
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$85.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$103.53
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cash Price	$130.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$96.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF BEN LES 1 - 2 CM

Facility

$242.00

Service Code	CPT 11422
Hospital Charge Code	4411422
Hospital Revenue Code	521
Rate for Payer: Cash Price	$217.80

EXC OF BEN LES 1 - 2 CM

Facility

$242.00

Service Code	CPT 11422
Hospital Charge Code	4411422
Hospital Revenue Code	521
Min. Negotiated Rate	$143.26
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	$143.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$172.79
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cash Price	$217.80
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	$161.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF BEN LES GENITALIA LESS THAN .5CM

Facility

$132.00

Service Code	CPT 11420
Hospital Charge Code	4411420
Hospital Revenue Code	521
Rate for Payer: Cash Price	$118.80

EXC OF BEN LES GENITALIA LESS THAN .5CM

Facility

$132.00

Service Code	CPT 11420
Hospital Charge Code	4411420
Hospital Revenue Code	521
Min. Negotiated Rate	$78.14
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	$78.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$94.25
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cash Price	$118.80
Rate for Payer: Cash Price	$118.80
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	$88.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF BEN LESION 1.1-2.0CM - FACE

Facility

$264.00

Service Code	CPT 11442
Hospital Charge Code	4411442
Hospital Revenue Code	521
Rate for Payer: Cash Price	$237.60

EXC OF BEN LESION 1.1-2.0CM - FACE

Facility

$264.00

Service Code	CPT 11442
Hospital Charge Code	4411442
Hospital Revenue Code	521
Min. Negotiated Rate	$156.29
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	$156.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$188.50
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
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	$176.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF BEN LESION 1.1 TO 2.0 CM

Facility

$210.00

Service Code	CPT 11402
Hospital Charge Code	4411402
Hospital Revenue Code	521
Min. Negotiated Rate	$124.32
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	$124.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
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	$140.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF BEN LESION 1.1 TO 2.0 CM

Facility

$210.00

Service Code	CPT 11402
Hospital Charge Code	4411402
Hospital Revenue Code	521
Rate for Payer: Cash Price	$189.00

EXC OF BEN LESION 2.1 TO 3.0 CM FACE,EAR

Facility

$441.00

Service Code	CPT 11443
Hospital Charge Code	4411443
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	$261.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$314.87
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cash Price	$396.90
Rate for Payer: Cash Price	$396.90
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	$294.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF BEN LESION 2.1 TO 3.0 CM FACE,EAR

Facility

$441.00

Service Code	CPT 11443
Hospital Charge Code	4411443
Hospital Revenue Code	521
Rate for Payer: Cash Price	$396.90

EXC OF BEN LESION 3.1 TO 4.0 CM FACE,EAR

Facility

$401.00

Service Code	CPT 11444
Hospital Charge Code	4411444
Hospital Revenue Code	521
Rate for Payer: Cash Price	$360.90

EXC OF BEN LESION 3.1 TO 4.0 CM FACE,EAR

Facility

$401.00

Service Code	CPT 11444
Hospital Charge Code	4411444
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	$237.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$286.31
Rate for Payer: Cash Price	$360.90
Rate for Payer: Cash Price	$360.90
Rate for Payer: Cash Price	$360.90
Rate for Payer: Cash Price	$360.90
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	$267.47
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF BEN LESION >4.0 CM NECK

Facility

$368.00

Service Code	CPT 11426
Hospital Charge Code	4411426
Hospital Revenue Code	521
Rate for Payer: Cash Price	$331.20

EXC OF BEN LESION >4.0 CM NECK

Facility

$368.00

Service Code	CPT 11426
Hospital Charge Code	4411426
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	$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	$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	$245.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,618.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF BEN LESION >4.0 CM TRUNK,ARMS,LEG

Facility

$368.00

Service Code	CPT 11406
Hospital Charge Code	4411406
Hospital Revenue Code	521
Rate for Payer: Cash Price	$331.20

EXC OF BEN LESION >4.0 CM TRUNK,ARMS,LEG

Facility

$368.00

Service Code	CPT 11406
Hospital Charge Code	4411406
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	$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	$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	$245.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF BEN LESION .5 CM OR LESS

Facility

$131.00

Service Code	CPT 11400
Hospital Charge Code	4411400
Hospital Revenue Code	521
Min. Negotiated Rate	$77.55
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	$77.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$93.53
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
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	$87.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF BEN LESION .5 CM OR LESS

Facility

$131.00

Service Code	CPT 11400
Hospital Charge Code	4411400
Hospital Revenue Code	521
Rate for Payer: Cash Price	$117.90

EXC OF BEN LESION .5 CM OR LESS FACE

Facility

$131.00

Service Code	CPT 11440
Hospital Charge Code	4411440
Hospital Revenue Code	521
Rate for Payer: Cash Price	$117.90

EXC OF BEN LESION .5 CM OR LESS FACE

Facility

$131.00

Service Code	CPT 11440
Hospital Charge Code	4411440
Hospital Revenue Code	521
Min. Negotiated Rate	$77.55
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	$77.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$93.53
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
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	$87.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF BREAST LES BY RADIOL MARK OPEN

Professional

Both

$1,470.00

Service Code	CPT 19125
Hospital Charge Code	5419125
Hospital Revenue Code	975
Min. Negotiated Rate	$426.46
Max. Negotiated Rate	$514.50
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	$1,323.00
Rate for Payer: Cash Price	$1,323.00
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	$514.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$434.60

EXC OF CYST/ADENOMA THYROID;RESEC ISTHMU

Professional

Both

$2,205.00

Service Code	CPT 60200
Hospital Charge Code	5460200
Hospital Revenue Code	975
Min. Negotiated Rate	$504.93
Max. Negotiated Rate	$771.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$588.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$504.93
Rate for Payer: Cash Price	$1,984.50
Rate for Payer: Cash Price	$1,984.50
Rate for Payer: Cigna Commercial HMO & PPO	$588.48
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$504.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$555.42
Rate for Payer: Home State Health Plan Medicare Advantage	$588.48
Rate for Payer: Optum Medicare Advantage	$771.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$504.93

EXC OF CYST,FIBRO OR BEN/MAL BREAST LESI

Professional

Both

$1,365.00

Service Code	CPT 19120
Hospital Charge Code	5419120
Hospital Revenue Code	975
Min. Negotiated Rate	$383.57
Max. Negotiated Rate	$477.75
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	$1,228.50
Rate for Payer: Cash Price	$1,228.50
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	$477.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$394.12

EXC OF FRENUM, LABIAL OR BUCCAL

Facility

$800.00

Service Code	CPT 40819
Hospital Charge Code	9840819
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$3,170.38
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,398.67
Rate for Payer: Aetna Medicare Advantage	$1,585.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$473.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$571.20
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cigna Commercial HMO & PPO	$1,585.19
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,258.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,496.58
Rate for Payer: Home State Health Plan Medicare Advantage	$1,585.19
Rate for Payer: Humana Commercial	$3,170.38
Rate for Payer: Humana Medicare Advantage	$1,585.19
Rate for Payer: UnitedHealthcare Commercial	$533.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,398.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges