Madison Medical Center

All Charges

Charge

Type

Setting

Price

EXC SOFT TISSUE SHOULDER AREA, SUBCUTAN

Facility

$432.00

Service Code	CPT 23075
Hospital Charge Code	4123075
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	$255.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$308.45
Rate for Payer: Cash Price	$388.80
Rate for Payer: Cash Price	$388.80
Rate for Payer: Cash Price	$388.80
Rate for Payer: Cash Price	$388.80
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	$288.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC, TUMOR, NECK/THORAX DEEP,SUBFAS,INTR

Professional

Both

$1,470.00

Service Code	CPT 21556
Hospital Charge Code	5421556
Hospital Revenue Code	975
Min. Negotiated Rate	$401.67
Max. Negotiated Rate	$514.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$463.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$401.67
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Cigna Commercial HMO & PPO	$463.49
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$401.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$441.84
Rate for Payer: Home State Health Plan Medicare Advantage	$463.49
Rate for Payer: Optum Medicare Advantage	$514.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$401.67

EXC TUMOR SOFT TISSUE FOREARM/WRIST SUBC

Facility

$1,050.00

Service Code	CPT 25075
Hospital Charge Code	5425075
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	$621.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$749.70
Rate for Payer: Cash Price	$945.00
Rate for Payer: Cash Price	$945.00
Rate for Payer: Cash Price	$945.00
Rate for Payer: Cash Price	$945.00
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	$700.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC TUMOR SOFT TISSUE FOREARM/WRIST SUBC

Facility

$1,470.00

Service Code	CPT 24076
Hospital Charge Code	5424076
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,323.00

EXC TUMOR SOFT TISSUE FOREARM/WRIST SUBC

Facility

$1,470.00

Service Code	CPT 24076
Hospital Charge Code	5424076
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	$870.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,049.58
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Cash Price	$1,323.00
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	$980.49
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,618.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC TUMOR SOFT TISSUE FOREARM/WRIST SUBC

Facility

$1,050.00

Service Code	CPT 25075
Hospital Charge Code	5425075
Hospital Revenue Code	521
Rate for Payer: Cash Price	$945.00

EXC TUMOR SOFT TISSUE NECK SUBCUTANEOUS

Facility

$998.00

Service Code	CPT 21555
Hospital Charge Code	5421555
Hospital Revenue Code	521
Rate for Payer: Cash Price	$898.20

EXC TUMOR SOFT TISSUE NECK SUBCUTANEOUS

Facility

$998.00

Service Code	CPT 21555
Hospital Charge Code	5421555
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	$590.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$712.57
Rate for Payer: Cash Price	$898.20
Rate for Payer: Cash Price	$898.20
Rate for Payer: Cash Price	$898.20
Rate for Payer: Cash Price	$898.20
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	$665.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXC, TUMOR, SOFT TISSUE OF BACK/FLANK

Professional

Both

$1,575.00

Service Code	CPT 21930
Hospital Charge Code	5421930
Hospital Revenue Code	975
Min. Negotiated Rate	$329.11
Max. Negotiated Rate	$551.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$329.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$383.75
Rate for Payer: Cash Price	$1,417.50
Rate for Payer: Cash Price	$1,417.50
Rate for Payer: Cigna Commercial HMO & PPO	$329.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$383.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$422.12
Rate for Payer: Home State Health Plan Medicare Advantage	$329.11
Rate for Payer: Optum Medicare Advantage	$551.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$383.75

EXCUSION LIPOMA

Professional

Both

$370.00

Service Code	CPT 11404
Hospital Charge Code	4111404
Hospital Revenue Code	975
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$187.30
Rate for Payer: Aetna Commercial/Medicare Advantage	$141.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$170.27
Rate for Payer: Cash Price	$333.00
Rate for Payer: Cash Price	$333.00
Rate for Payer: Cigna Commercial HMO & PPO	$141.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$170.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$187.30
Rate for Payer: Home State Health Plan Medicare Advantage	$141.84
Rate for Payer: Optum Medicare Advantage	$129.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$170.27

EXP LAP, EXP CELIOTOMY W OR W/O BX

Professional

Both

$2,625.00

Service Code	CPT 49000
Hospital Charge Code	5449000
Hospital Revenue Code	975
Min. Negotiated Rate	$581.80
Max. Negotiated Rate	$918.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$695.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$581.80
Rate for Payer: Cash Price	$2,362.50
Rate for Payer: Cash Price	$2,362.50
Rate for Payer: Cigna Commercial HMO & PPO	$695.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$581.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$639.98
Rate for Payer: Home State Health Plan Medicare Advantage	$695.86
Rate for Payer: Optum Medicare Advantage	$918.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$581.80

EXP. LAPRO W/R SALPINGCOPHORECTOMY

Facility

$1,662.00

Service Code	CPT 58940
Hospital Charge Code	4258940
Rate for Payer: Cash Price	$1,495.80

EXPLORATION OF ABDOMEN

Professional

Both

$2,096.00

Service Code	CPT 49000
Hospital Charge Code	4149000
Hospital Revenue Code	975
Min. Negotiated Rate	$581.80
Max. Negotiated Rate	$733.60
Rate for Payer: Aetna Commercial/Medicare Advantage	$695.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$581.80
Rate for Payer: Cash Price	$1,886.40
Rate for Payer: Cash Price	$1,886.40
Rate for Payer: Cigna Commercial HMO & PPO	$695.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$581.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$639.98
Rate for Payer: Home State Health Plan Medicare Advantage	$695.86
Rate for Payer: Optum Medicare Advantage	$733.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$581.80

EXPLORATION OF F/B DEEP ARM

Facility

$1,470.00

Service Code	CPT 25248
Hospital Charge Code	5425248
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,323.00

EXPLORATION OF F/B DEEP ARM

Facility

$1,470.00

Service Code	CPT 25248
Hospital Charge Code	5425248
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	$870.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,049.58
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Cash Price	$1,323.00
Rate for Payer: Cash Price	$1,323.00
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	$980.49
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,449.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXPLORATION OF PENETRATING WOUND ABD/BAC

Professional

Both

$290.00

Service Code	CPT 20102
Hospital Charge Code	4120102
Hospital Revenue Code	975
Min. Negotiated Rate	$101.50
Max. Negotiated Rate	$525.09
Rate for Payer: Aetna Commercial/Medicare Advantage	$232.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$477.35
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cash Price	$261.00
Rate for Payer: Cigna Commercial HMO & PPO	$232.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$477.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$525.09
Rate for Payer: Home State Health Plan Medicare Advantage	$232.92
Rate for Payer: Optum Medicare Advantage	$101.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$477.35

EXPLORATION OF PENETRATING WOUND EXTREME

Facility

$1,680.00

Service Code	CPT 20103
Hospital Charge Code	5420103
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	$994.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,199.52
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Cash Price	$1,512.00
Rate for Payer: Cash Price	$1,512.00
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	$1,120.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXPLORATION OF PENETRATING WOUND EXTREME

Facility

$1,680.00

Service Code	CPT 20103
Hospital Charge Code	5420103
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,512.00

EXPLORATION OF PENETRATING WOUND EXTREMI

Facility

$764.00

Service Code	CPT 20103
Hospital Charge Code	4120103
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	$452.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$545.50
Rate for Payer: Cash Price	$687.60
Rate for Payer: Cash Price	$687.60
Rate for Payer: Cash Price	$687.60
Rate for Payer: Cash Price	$687.60
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	$509.59
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

EXPLORATION OF PENETRATING WOUND EXTREMI

Facility

$764.00

Service Code	CPT 20103
Hospital Charge Code	4120103
Hospital Revenue Code	521
Rate for Payer: Cash Price	$687.60

EXTENDED CONSULT INPAT

Facility

$300.00

Service Code	CPT 99253
Hospital Charge Code	4299253
Rate for Payer: Cash Price	$270.00

EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$87,964.28

Service Code	APR-DRG 9114
Min. Negotiated Rate	$87,964.28
Max. Negotiated Rate	$87,964.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$87,964.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$87,964.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$87,964.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$87,964.28

EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$37,562.28

Service Code	APR-DRG 9113
Min. Negotiated Rate	$37,562.28
Max. Negotiated Rate	$37,562.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$37,562.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$37,562.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$37,562.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$37,562.28

EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$21,513.56

Service Code	APR-DRG 9111
Min. Negotiated Rate	$21,513.56
Max. Negotiated Rate	$21,513.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$21,513.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21,513.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21,513.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21,513.56

EXTENSIVE ABDOMINAL OR THORACIC PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$29,585.53

Service Code	APR-DRG 9112
Min. Negotiated Rate	$29,585.53
Max. Negotiated Rate	$29,585.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,585.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,585.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,585.53
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,585.53

Know your out-of-pocket cost for care.

All Charges