Madison Medical Center

All Charges

Charge

Type

Setting

Price

EXC OF FRENUM, LABIAL OR BUCCAL

Facility

$800.00

Service Code	CPT 40819
Hospital Charge Code	9840819
Hospital Revenue Code	521
Rate for Payer: Cash Price	$720.00

EXC OF GANGLION WRIST

Professional

Both

$1,500.00

Service Code	CPT 25111
Hospital Charge Code	9325111
Hospital Revenue Code	975
Min. Negotiated Rate	$245.92
Max. Negotiated Rate	$525.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$295.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$245.92
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Cigna Commercial HMO & PPO	$295.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$245.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$270.51
Rate for Payer: Home State Health Plan Medicare Advantage	$295.01
Rate for Payer: Optum Medicare Advantage	$525.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$245.92

EXC OF GANGLION, WRIST PRIMARY

Facility

$1,400.00

Service Code	CPT 25111
Hospital Charge Code	9125111
Hospital Revenue Code	525
Rate for Payer: Cash Price	$1,260.00

EXC OF GANGLION, WRIST PRIMARY

Facility

$1,400.00

Service Code	CPT 25111
Hospital Charge Code	9125111
Hospital Revenue Code	525
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	$828.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$999.60
Rate for Payer: Cash Price	$1,260.00
Rate for Payer: Cash Price	$1,260.00
Rate for Payer: Cash Price	$1,260.00
Rate for Payer: Cash Price	$1,260.00
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	$933.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,449.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF GANGLION, WRIST; PRIMARY

Professional

Both

$1,286.00

Service Code	CPT 25111
Hospital Charge Code	5425111
Hospital Revenue Code	975
Min. Negotiated Rate	$245.92
Max. Negotiated Rate	$450.10
Rate for Payer: Aetna Commercial/Medicare Advantage	$295.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$245.92
Rate for Payer: Cash Price	$1,157.40
Rate for Payer: Cash Price	$1,157.40
Rate for Payer: Cigna Commercial HMO & PPO	$295.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$245.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$270.51
Rate for Payer: Home State Health Plan Medicare Advantage	$295.01
Rate for Payer: Optum Medicare Advantage	$450.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$245.92

EXC OF GANG OF THE TENDEN SHEATH

Facility

$405.00

Service Code	CPT 26160
Hospital Charge Code	4126160
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	$239.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$289.17
Rate for Payer: Cash Price	$364.50
Rate for Payer: Cash Price	$364.50
Rate for Payer: Cash Price	$364.50
Rate for Payer: Cash Price	$364.50
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	$270.13
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,449.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF GANG OF THE TENDEN SHEATH

Facility

$405.00

Service Code	CPT 26160
Hospital Charge Code	4126160
Hospital Revenue Code	521
Rate for Payer: Cash Price	$364.50

EXC OF INGROWN NAIL AND MATRIX

Facility

$368.00

Service Code	CPT 11750
Hospital Charge Code	5211750
Hospital Revenue Code	521
Rate for Payer: Cash Price	$331.20

EXC OF INGROWN NAIL AND MATRIX

Facility

$368.00

Service Code	CPT 11750
Hospital Charge Code	5211750
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 OF LACTI DUCT FISTULA

Professional

Both

$868.00

Service Code	CPT 19112
Hospital Charge Code	4119112
Hospital Revenue Code	975
Min. Negotiated Rate	$303.80
Max. Negotiated Rate	$389.52
Rate for Payer: Aetna Commercial/Medicare Advantage	$306.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$354.11
Rate for Payer: Cash Price	$781.20
Rate for Payer: Cash Price	$781.20
Rate for Payer: Cigna Commercial HMO & PPO	$306.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$354.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$389.52
Rate for Payer: Home State Health Plan Medicare Advantage	$306.20
Rate for Payer: Optum Medicare Advantage	$303.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$354.11

EXC OF LESION 1 TO 2 CENTEMETERS

Facility

$371.00

Service Code	CPT 11602
Hospital Charge Code	4111602
Hospital Revenue Code	521
Rate for Payer: Cash Price	$333.90

EXC OF LESION 1 TO 2 CENTEMETERS

Facility

$371.00

Service Code	CPT 11602
Hospital Charge Code	4111602
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	$219.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$264.89
Rate for Payer: Cash Price	$333.90
Rate for Payer: Cash Price	$333.90
Rate for Payer: Cash Price	$333.90
Rate for Payer: Cash Price	$333.90
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	$247.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF LESION 3.1 TO 4.0 CENTIMETERS

Facility

$695.00

Service Code	CPT 11404
Hospital Charge Code	4411404
Hospital Revenue Code	521
Rate for Payer: Cash Price	$625.50

EXC OF LESION 3.1 TO 4.0 CENTIMETERS

Facility

$695.00

Service Code	CPT 11404
Hospital Charge Code	4411404
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	$411.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$496.23
Rate for Payer: Cash Price	$625.50
Rate for Payer: Cash Price	$625.50
Rate for Payer: Cash Price	$625.50
Rate for Payer: Cash Price	$625.50
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	$463.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF LESION-EYELID

Facility

$267.00

Service Code	CPT 67840
Hospital Charge Code	4467840
Hospital Revenue Code	521
Min. Negotiated Rate	$158.06
Max. Negotiated Rate	$2,036.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$898.64
Rate for Payer: Aetna Medicare Advantage	$1,018.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$158.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$190.64
Rate for Payer: Cash Price	$240.30
Rate for Payer: Cash Price	$240.30
Rate for Payer: Cash Price	$240.30
Rate for Payer: Cash Price	$240.30
Rate for Payer: Cigna Commercial HMO & PPO	$1,018.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$808.78
Rate for Payer: Home State Health Plan Medicaid Managed Care	$961.54
Rate for Payer: Home State Health Plan Medicare Advantage	$1,018.47
Rate for Payer: Humana Commercial	$2,036.94
Rate for Payer: Humana Medicare Advantage	$1,018.47
Rate for Payer: UnitedHealthcare Commercial	$178.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$898.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF LESION-EYELID

Facility

$267.00

Service Code	CPT 67840
Hospital Charge Code	4467840
Hospital Revenue Code	521
Rate for Payer: Cash Price	$240.30

EXC OF LESION MUCOSA W SIMPLE REPAIR

Facility

$578.00

Service Code	CPT 40812
Hospital Charge Code	5440812
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	$342.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$412.69
Rate for Payer: Cash Price	$520.20
Rate for Payer: Cash Price	$520.20
Rate for Payer: Cash Price	$520.20
Rate for Payer: Cash Price	$520.20
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	$385.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,398.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF LESION MUCOSA W SIMPLE REPAIR

Facility

$578.00

Service Code	CPT 40812
Hospital Charge Code	5440812
Hospital Revenue Code	521
Rate for Payer: Cash Price	$520.20

EXC OF LESION OF MESENTERY

Professional

Both

$2,067.00

Service Code	CPT 44800
Hospital Charge Code	4144820
Hospital Revenue Code	975
Min. Negotiated Rate	$583.72
Max. Negotiated Rate	$723.45
Rate for Payer: Aetna Commercial/Medicare Advantage	$702.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$583.72
Rate for Payer: Cash Price	$1,860.30
Rate for Payer: Cash Price	$1,860.30
Rate for Payer: Cigna Commercial HMO & PPO	$702.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$583.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$642.09
Rate for Payer: Home State Health Plan Medicare Advantage	$702.78
Rate for Payer: Optum Medicare Advantage	$723.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$583.72

EXC OF LESION OF SPERMATIC CORD

Professional

Both

$1,470.00

Service Code	CPT 55520
Hospital Charge Code	5455520
Hospital Revenue Code	975
Min. Negotiated Rate	$347.56
Max. Negotiated Rate	$514.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$423.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$347.56
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Cigna Commercial HMO & PPO	$423.58
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$347.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$382.32
Rate for Payer: Home State Health Plan Medicare Advantage	$423.58
Rate for Payer: Optum Medicare Advantage	$514.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$347.56

EXC OF LESION OF TONGUE W/CLOSURE ANT2/3

Professional

Both

$840.00

Service Code	CPT 41112
Hospital Charge Code	5441112
Hospital Revenue Code	975
Min. Negotiated Rate	$208.77
Max. Negotiated Rate	$294.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$208.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$257.86
Rate for Payer: Cash Price	$756.00
Rate for Payer: Cash Price	$756.00
Rate for Payer: Cigna Commercial HMO & PPO	$208.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$257.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$283.65
Rate for Payer: Home State Health Plan Medicare Advantage	$208.77
Rate for Payer: Optum Medicare Advantage	$294.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$257.86

EXC OF LESION(S) IN ANUS

Professional

Both

$463.00

Service Code	CPT 46922
Hospital Charge Code	4146922
Hospital Revenue Code	975
Min. Negotiated Rate	$125.66
Max. Negotiated Rate	$266.57
Rate for Payer: Aetna Commercial/Medicare Advantage	$125.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$242.34
Rate for Payer: Cash Price	$416.70
Rate for Payer: Cash Price	$416.70
Rate for Payer: Cigna Commercial HMO & PPO	$125.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$242.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$266.57
Rate for Payer: Home State Health Plan Medicare Advantage	$125.66
Rate for Payer: Optum Medicare Advantage	$162.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$242.34

EXC OF LESION TENDON SHEATH OR JOINT HAN

Professional

Both

$1,900.00

Service Code	CPT 26160
Hospital Charge Code	9326160
Hospital Revenue Code	975
Min. Negotiated Rate	$284.54
Max. Negotiated Rate	$665.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$284.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$473.68
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Cash Price	$1,710.00
Rate for Payer: Cigna Commercial HMO & PPO	$284.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$473.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$521.05
Rate for Payer: Home State Health Plan Medicare Advantage	$284.54
Rate for Payer: Optum Medicare Advantage	$665.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$473.68

EXC OF LES MUCOSA/SUBMUCOSA VEST OF MOUT

Professional

Both

$420.00

Service Code	CPT 40810
Hospital Charge Code	5440810
Hospital Revenue Code	975
Min. Negotiated Rate	$105.85
Max. Negotiated Rate	$181.63
Rate for Payer: Aetna Commercial/Medicare Advantage	$105.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$165.12
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cigna Commercial HMO & PPO	$105.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$165.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$181.63
Rate for Payer: Home State Health Plan Medicare Advantage	$105.85
Rate for Payer: Optum Medicare Advantage	$147.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$165.12

EXC OF LES MUCOSA VEST OF MOUTH W/O REPA

Facility

$450.00

Service Code	CPT 40810
Hospital Charge Code	9840810
Hospital Revenue Code	521
Rate for Payer: Cash Price	$405.00

Know your out-of-pocket cost for care.

All Charges