Madison Medical Center

All Charges

Charge

Type

Setting

Price

I & D OF ABSCESS

Professional

Both

$352.00

Service Code	CPT 54700
Hospital Charge Code	4154700
Hospital Revenue Code	975
Min. Negotiated Rate	$123.20
Max. Negotiated Rate	$189.84
Rate for Payer: Aetna Commercial/Medicare Advantage	$189.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$159.47
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cigna Commercial HMO & PPO	$189.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$159.47
Rate for Payer: Home State Health Plan Medicaid Managed Care	$175.42
Rate for Payer: Home State Health Plan Medicare Advantage	$189.84
Rate for Payer: Optum Medicare Advantage	$123.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$159.47

I&D OF ABSCESS

Facility

$104.00

Service Code	CPT 10060
Hospital Charge Code	4410060
Hospital Revenue Code	521
Rate for Payer: Cash Price	$93.60

I&D OF ABSCESS

Facility

$104.00

Service Code	CPT 10060
Hospital Charge Code	4410060
Hospital Revenue Code	521
Min. Negotiated Rate	$61.57
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$61.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.26
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$69.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I&D OF ABSCESS

Facility

$1,662.00

Service Code	CPT 44900
Hospital Charge Code	4144900
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,495.80

I&D OF ABSCESS

Facility

$1,662.00

Service Code	CPT 44900
Hospital Charge Code	4144900
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,186.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$983.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,186.67
Rate for Payer: Cash Price	$1,495.80
Rate for Payer: Cash Price	$1,495.80
Rate for Payer: UnitedHealthcare Commercial	$1,108.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I & D OF ABSCESS, COMPLICATED OR MULTIPL

Facility

$394.00

Service Code	CPT 10061
Hospital Charge Code	5410061
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	$233.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$281.32
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cash Price	$354.60
Rate for Payer: Cash Price	$354.60
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	$262.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I & D OF ABSCESS, COMPLICATED OR MULTIPL

Facility

$394.00

Service Code	CPT 10061
Hospital Charge Code	5410061
Hospital Revenue Code	521
Rate for Payer: Cash Price	$354.60

I & D OF ABSCESS COMPLICATED OR MULTIPLE

Facility

$425.00

Service Code	CPT 10061
Hospital Charge Code	9810061
Hospital Revenue Code	521
Rate for Payer: Cash Price	$382.50

I & D OF ABSCESS COMPLICATED OR MULTIPLE

Facility

$425.00

Service Code	CPT 10061
Hospital Charge Code	9810061
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	$251.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$303.45
Rate for Payer: Cash Price	$382.50
Rate for Payer: Cash Price	$382.50
Rate for Payer: Cash Price	$382.50
Rate for Payer: Cash Price	$382.50
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	$283.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I & D OF ABSCESS SIMPLE

Facility

$180.00

Service Code	CPT 10060
Hospital Charge Code	5210060
Hospital Revenue Code	521
Min. Negotiated Rate	$106.56
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$106.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$128.52
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cash Price	$162.00
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$120.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I & D OF ABSCESS SIMPLE

Facility

$180.00

Service Code	CPT 10060
Hospital Charge Code	5210060
Hospital Revenue Code	521
Rate for Payer: Cash Price	$162.00

I&D OF DEEP ABSCESS

Professional

Both

$945.00

Service Code	CPT 23930
Hospital Charge Code	5423930
Hospital Revenue Code	975
Min. Negotiated Rate	$192.52
Max. Negotiated Rate	$330.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$192.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$276.83
Rate for Payer: Cash Price	$850.50
Rate for Payer: Cash Price	$850.50
Rate for Payer: Cigna Commercial HMO & PPO	$192.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$276.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$304.51
Rate for Payer: Home State Health Plan Medicare Advantage	$192.52
Rate for Payer: Optum Medicare Advantage	$330.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.83

I & D OF HEMATOMA

Professional

Both

$479.00

Service Code	CPT 10140
Hospital Charge Code	1811247
Hospital Revenue Code	981
Min. Negotiated Rate	$107.50
Max. Negotiated Rate	$167.65
Rate for Payer: Aetna Commercial/Medicare Advantage	$107.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$128.94
Rate for Payer: Cash Price	$431.10
Rate for Payer: Cash Price	$431.10
Rate for Payer: Cigna Commercial HMO & PPO	$107.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$128.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$141.83
Rate for Payer: Home State Health Plan Medicare Advantage	$107.50
Rate for Payer: Optum Medicare Advantage	$167.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$128.94

I & D OF HEMATOMA SEROMA OR FLUID COLLEC

Facility

$250.00

Service Code	CPT 10140
Hospital Charge Code	9810140
Hospital Revenue Code	521
Min. Negotiated Rate	$148.00
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	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
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	$166.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I & D OF HEMATOMA SEROMA OR FLUID COLLEC

Facility

$250.00

Service Code	CPT 10140
Hospital Charge Code	9810140
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

I & D OF PILONIDAL CYST COMPLICATED

Professional

Both

$420.00

Service Code	CPT 10081
Hospital Charge Code	5410081
Hospital Revenue Code	975
Min. Negotiated Rate	$147.00
Max. Negotiated Rate	$292.44
Rate for Payer: Aetna Commercial/Medicare Advantage	$158.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$265.85
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cigna Commercial HMO & PPO	$158.44
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$265.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$292.44
Rate for Payer: Home State Health Plan Medicare Advantage	$158.44
Rate for Payer: Optum Medicare Advantage	$147.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$265.85

I & D OF SINMPLE ABCESS

Facility

$200.00

Service Code	CPT 10060
Hospital Charge Code	5410060
Hospital Revenue Code	521
Min. Negotiated Rate	$118.40
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$118.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$142.80
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cash Price	$180.00
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$133.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I & D OF SINMPLE ABCESS

Facility

$200.00

Service Code	CPT 10060
Hospital Charge Code	5410060
Hospital Revenue Code	521
Rate for Payer: Cash Price	$180.00

I & D PERIRECTAL ABSCESS

Facility

$1,050.00

Service Code	CPT 46040
Hospital Charge Code	5446040
Hospital Revenue Code	521
Rate for Payer: Cash Price	$945.00

I & D PERIRECTAL ABSCESS

Facility

$1,050.00

Service Code	CPT 46040
Hospital Charge Code	5446040
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$2,445.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,078.71
Rate for Payer: Aetna Medicare Advantage	$1,222.56
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	$1,222.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$970.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,154.22
Rate for Payer: Home State Health Plan Medicare Advantage	$1,222.56
Rate for Payer: Humana Commercial	$2,445.12
Rate for Payer: Humana Medicare Advantage	$1,222.56
Rate for Payer: UnitedHealthcare Commercial	$700.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,078.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

I&D POST/OP WOUND

Professional

Both

$423.00

Service Code	CPT 10180
Hospital Charge Code	4110180
Hospital Revenue Code	975
Min. Negotiated Rate	$148.05
Max. Negotiated Rate	$219.91
Rate for Payer: Aetna Commercial/Medicare Advantage	$163.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$199.92
Rate for Payer: Cash Price	$380.70
Rate for Payer: Cash Price	$380.70
Rate for Payer: Cigna Commercial HMO & PPO	$163.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$199.92
Rate for Payer: Home State Health Plan Medicaid Managed Care	$219.91
Rate for Payer: Home State Health Plan Medicare Advantage	$163.64
Rate for Payer: Optum Medicare Advantage	$148.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$199.92

I & D SIMPLE

Facility

$104.00

Service Code	CPT 10060
Hospital Charge Code	9210060
Hospital Revenue Code	521
Rate for Payer: Cash Price	$93.60

I & D SIMPLE

Professional

Both

$448.00

Service Code	CPT 10060
Hospital Charge Code	1810060
Hospital Revenue Code	981
Min. Negotiated Rate	$92.63
Max. Negotiated Rate	$156.80
Rate for Payer: Aetna Commercial/Medicare Advantage	$92.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$93.96
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cigna Commercial HMO & PPO	$92.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$93.96
Rate for Payer: Home State Health Plan Medicaid Managed Care	$103.36
Rate for Payer: Home State Health Plan Medicare Advantage	$92.63
Rate for Payer: Optum Medicare Advantage	$156.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$93.96

I & D SIMPLE

Facility

$104.00

Service Code	CPT 10060
Hospital Charge Code	9410060
Hospital Revenue Code	521
Rate for Payer: Cash Price	$93.60

I & D SIMPLE

Facility

$104.00

Service Code	CPT 10060
Hospital Charge Code	9210060
Hospital Revenue Code	521
Min. Negotiated Rate	$61.57
Max. Negotiated Rate	$409.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$180.86
Rate for Payer: Aetna Medicare Advantage	$204.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$61.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.26
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cigna Commercial HMO & PPO	$204.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$162.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$193.52
Rate for Payer: Home State Health Plan Medicare Advantage	$204.98
Rate for Payer: Humana Commercial	$409.96
Rate for Payer: Humana Medicare Advantage	$204.98
Rate for Payer: UnitedHealthcare Commercial	$69.37
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges