Madison Medical Center

All Charges

Charge

Type

Setting

Price

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
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$6,774.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,988.72
Rate for Payer: Aetna Medicare Advantage	$3,387.27
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	$3,387.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,689.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,197.93
Rate for Payer: Home State Health Plan Medicare Advantage	$3,387.27
Rate for Payer: Humana Commercial	$6,774.54
Rate for Payer: Humana Medicare Advantage	$3,387.27
Rate for Payer: UnitedHealthcare Commercial	$300.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,988.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF MALIG LESION OVER 4.0 CM TRNK ARM

Facility

$695.00

Service Code	CPT 11606
Hospital Charge Code	4411606
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 MALIG LESION OVER 4.0 CM TRNK ARM

Facility

$695.00

Service Code	CPT 11606
Hospital Charge Code	4411606
Hospital Revenue Code	521
Rate for Payer: Cash Price	$625.50

EXC OF MAL LES FACE .5CM TO 1.0

Facility

$221.00

Service Code	CPT 11621
Hospital Charge Code	4411621
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.90

EXC OF MAL LES FACE .5CM TO 1.0

Facility

$221.00

Service Code	CPT 11621
Hospital Charge Code	4411621
Hospital Revenue Code	521
Min. Negotiated Rate	$130.83
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	$130.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.79
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
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	$147.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF MAL LES FACE .6 TO 1.0CM

Facility

$221.00

Service Code	CPT 11641
Hospital Charge Code	4411641
Hospital Revenue Code	521
Min. Negotiated Rate	$130.83
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	$130.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.79
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
Rate for Payer: Cash Price	$198.90
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	$147.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF MAL LES FACE .6 TO 1.0CM

Facility

$221.00

Service Code	CPT 11641
Hospital Charge Code	4411641
Hospital Revenue Code	521
Rate for Payer: Cash Price	$198.90

EXC OF MAL LES SCALP .5CM OR LESS

Facility

$131.00

Service Code	CPT 11620
Hospital Charge Code	4411620
Hospital Revenue Code	521
Rate for Payer: Cash Price	$117.90

EXC OF MAL LES SCALP .5CM OR LESS

Facility

$131.00

Service Code	CPT 11620
Hospital Charge Code	4411620
Hospital Revenue Code	521
Min. Negotiated Rate	$77.55
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	$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	$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	$87.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF MAL LES SCALP,NECK HANDS 2.1 TO 3

Facility

$350.00

Service Code	CPT 11623
Hospital Charge Code	4411623
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	$207.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$249.90
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
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	$233.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF MAL LES SCALP,NECK HANDS 2.1 TO 3

Facility

$350.00

Service Code	CPT 11623
Hospital Charge Code	4411623
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

EXC OF MAL LES SCALP OVER 4.0 CM

Facility

$893.00

Service Code	CPT 11626
Hospital Charge Code	4411626
Hospital Revenue Code	521
Rate for Payer: Cash Price	$803.70

EXC OF MAL LES SCALP OVER 4.0 CM

Facility

$893.00

Service Code	CPT 11626
Hospital Charge Code	4411626
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	$528.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$637.60
Rate for Payer: Cash Price	$803.70
Rate for Payer: Cash Price	$803.70
Rate for Payer: Cash Price	$803.70
Rate for Payer: Cash Price	$803.70
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	$595.63
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,618.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF MECKELS DIVERTICULUM

Professional

Both

$2,171.00

Service Code	CPT 44800
Hospital Charge Code	4144800
Hospital Revenue Code	975
Min. Negotiated Rate	$583.72
Max. Negotiated Rate	$759.85
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	$1,953.90
Rate for Payer: Cash Price	$1,953.90
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	$759.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$583.72

EXC OF NAIL AND MATRIX PART OR COMPLETE

Facility

$368.00

Service Code	CPT 11750
Hospital Charge Code	4411750
Hospital Revenue Code	521
Rate for Payer: Cash Price	$331.20

EXC OF NAIL AND MATRIX PART OR COMPLETE

Facility

$368.00

Service Code	CPT 11750
Hospital Charge Code	4411750
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 NAIL & NAIL MATRIX, PART/COMPLETE

Professional

Both

$440.00

Service Code	CPT 11750
Hospital Charge Code	4111750
Hospital Revenue Code	975
Min. Negotiated Rate	$88.81
Max. Negotiated Rate	$154.00
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	$396.00
Rate for Payer: Cash Price	$396.00
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	$154.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$121.29

EXC OF NAIL PART OR COMPLETE

Facility

$400.00

Service Code	CPT 11750
Hospital Charge Code	9811750
Hospital Revenue Code	521
Rate for Payer: Cash Price	$360.00

EXC OF NAIL PART OR COMPLETE

Facility

$400.00

Service Code	CPT 11750
Hospital Charge Code	9811750
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	$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	$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	$266.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC OF ONE OR MORE LES OF INTESTINES NOT

Facility

$2,730.00

Service Code	CPT 44110
Hospital Charge Code	5444110
Rate for Payer: Cash Price	$2,457.00

EXC OF PILONIDAL CYST EXTENSIVE

Professional

Both

$1,260.00

Service Code	CPT 11771
Hospital Charge Code	5411771
Hospital Revenue Code	975
Min. Negotiated Rate	$413.64
Max. Negotiated Rate	$530.70
Rate for Payer: Aetna Commercial/Medicare Advantage	$413.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$482.45
Rate for Payer: Cash Price	$1,134.00
Rate for Payer: Cash Price	$1,134.00
Rate for Payer: Cigna Commercial HMO & PPO	$413.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$482.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$530.70
Rate for Payer: Home State Health Plan Medicare Advantage	$413.64
Rate for Payer: Optum Medicare Advantage	$441.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$482.45

EXC OR DESTR INTRANASAL LESION INTERNAL

Professional

Both

$1,250.00

Service Code	CPT 30117
Hospital Charge Code	9330117
Hospital Revenue Code	975
Min. Negotiated Rate	$342.37
Max. Negotiated Rate	$826.51
Rate for Payer: Aetna Commercial/Medicare Advantage	$342.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$751.37
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Cash Price	$1,125.00
Rate for Payer: Cigna Commercial HMO & PPO	$342.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$751.37
Rate for Payer: Home State Health Plan Medicaid Managed Care	$826.51
Rate for Payer: Home State Health Plan Medicare Advantage	$342.37
Rate for Payer: Optum Medicare Advantage	$437.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$751.37

EXC PILONIDAL CYST

Facility

$368.00

Service Code	CPT 11770
Hospital Charge Code	4411770
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 PILONIDAL CYST

Facility

$368.00

Service Code	CPT 11770
Hospital Charge Code	4411770
Hospital Revenue Code	521
Rate for Payer: Cash Price	$331.20

EXC SOFT TISSUE SHOULDER AREA, SUBCUTAN

Facility

$432.00

Service Code	CPT 23075
Hospital Charge Code	4123075
Hospital Revenue Code	521
Rate for Payer: Cash Price	$388.80

Know your out-of-pocket cost for care.

All Charges