Madison Medical Center

All Charges

Charge

Type

Setting

Price

INCISION AND DRAINAGE, PERIANAL ABSCESS,

Facility

$550.00

Service Code	CPT 46050
Hospital Charge Code	5446050
Hospital Revenue Code	521
Rate for Payer: Cash Price	$495.00

INCISION/DRAIN-ABSCESS SINGLE/SIMPLE

Professional

Both

$104.00

Service Code	CPT 10060
Hospital Charge Code	4110060
Hospital Revenue Code	975
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$103.36
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	$93.60
Rate for Payer: Cash Price	$93.60
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	$36.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$93.96

INCISION & DRAINAGE ABCESS VULVA/PERINEA

Professional

Both

$840.00

Service Code	CPT 56405
Hospital Charge Code	1856405
Hospital Revenue Code	981
Min. Negotiated Rate	$108.43
Max. Negotiated Rate	$294.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$108.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$113.60
Rate for Payer: Cash Price	$756.00
Rate for Payer: Cash Price	$756.00
Rate for Payer: Cigna Commercial HMO & PPO	$108.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$113.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$124.96
Rate for Payer: Home State Health Plan Medicare Advantage	$108.43
Rate for Payer: Optum Medicare Advantage	$294.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$113.60

INCISION/DRAIN OF ISCHIO/PERIRCTAL ABSC

Professional

Both

$570.00

Service Code	CPT 46040
Hospital Charge Code	4146040
Hospital Revenue Code	975
Min. Negotiated Rate	$199.50
Max. Negotiated Rate	$468.65
Rate for Payer: Aetna Commercial/Medicare Advantage	$403.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$426.05
Rate for Payer: Cash Price	$513.00
Rate for Payer: Cash Price	$513.00
Rate for Payer: Cigna Commercial HMO & PPO	$403.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$426.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$468.65
Rate for Payer: Home State Health Plan Medicare Advantage	$403.51
Rate for Payer: Optum Medicare Advantage	$199.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$426.05

INCISION/DRAIN PERIANAL ABSCESS SUPERFIC

Professional

Both

$195.00

Service Code	CPT 46050
Hospital Charge Code	4146050
Hospital Revenue Code	975
Min. Negotiated Rate	$68.25
Max. Negotiated Rate	$200.60
Rate for Payer: Aetna Commercial/Medicare Advantage	$95.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$182.36
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cash Price	$175.50
Rate for Payer: Cigna Commercial HMO & PPO	$95.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$182.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$200.60
Rate for Payer: Home State Health Plan Medicare Advantage	$95.73
Rate for Payer: Optum Medicare Advantage	$68.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$182.36

INCISION OF ANAL ABSCESS

Professional

Both

$951.00

Service Code	CPT 46050
Hospital Charge Code	1846050
Hospital Revenue Code	981
Min. Negotiated Rate	$95.73
Max. Negotiated Rate	$332.85
Rate for Payer: Aetna Commercial/Medicare Advantage	$95.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$182.36
Rate for Payer: Cash Price	$855.90
Rate for Payer: Cash Price	$855.90
Rate for Payer: Cigna Commercial HMO & PPO	$95.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$182.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$200.60
Rate for Payer: Home State Health Plan Medicare Advantage	$95.73
Rate for Payer: Optum Medicare Advantage	$332.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$182.36

INCISION OF BARTHOLINS GLAND

Professional

Both

$920.00

Service Code	CPT 56420
Hospital Charge Code	1856420
Hospital Revenue Code	981
Min. Negotiated Rate	$93.73
Max. Negotiated Rate	$322.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$93.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$143.21
Rate for Payer: Cash Price	$828.00
Rate for Payer: Cash Price	$828.00
Rate for Payer: Cigna Commercial HMO & PPO	$93.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$143.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$157.53
Rate for Payer: Home State Health Plan Medicare Advantage	$93.73
Rate for Payer: Optum Medicare Advantage	$322.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$143.21

INCISION OF THROMBOSED HEMORRHOID, EXT

Professional

Both

$165.00

Service Code	CPT 46083
Hospital Charge Code	4146083
Hospital Revenue Code	975
Min. Negotiated Rate	$57.75
Max. Negotiated Rate	$177.54
Rate for Payer: Aetna Commercial/Medicare Advantage	$100.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$161.40
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cigna Commercial HMO & PPO	$100.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$161.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$177.54
Rate for Payer: Home State Health Plan Medicare Advantage	$100.26
Rate for Payer: Optum Medicare Advantage	$57.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$161.40

INCISION OF THROMBOSED HEMORRHOID, EXTER

Facility

$440.00

Service Code	CPT 46083
Hospital Charge Code	9846083
Hospital Revenue Code	521
Rate for Payer: Cash Price	$396.00

INCISION OF THROMBOSED HEMORRHOID, EXTER

Facility

$440.00

Service Code	CPT 46083
Hospital Charge Code	9846083
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$510.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$225.22
Rate for Payer: Aetna Medicare Advantage	$255.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$260.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$314.16
Rate for Payer: Cash Price	$396.00
Rate for Payer: Cash Price	$396.00
Rate for Payer: Cash Price	$396.00
Rate for Payer: Cash Price	$396.00
Rate for Payer: Cigna Commercial HMO & PPO	$255.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$202.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$240.99
Rate for Payer: Home State Health Plan Medicare Advantage	$255.26
Rate for Payer: Humana Commercial	$510.52
Rate for Payer: Humana Medicare Advantage	$255.26
Rate for Payer: UnitedHealthcare Commercial	$293.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$225.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INCISION OF THROMBOSED HEMORRHOID EXTERN

Facility

$420.00

Service Code	CPT 46083
Hospital Charge Code	5446083
Hospital Revenue Code	521
Rate for Payer: Cash Price	$378.00

INCISION OF THROMBOSED HEMORRHOID EXTERN

Facility

$420.00

Service Code	CPT 46083
Hospital Charge Code	5446083
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$510.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$225.22
Rate for Payer: Aetna Medicare Advantage	$255.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$248.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$299.88
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cash Price	$378.00
Rate for Payer: Cigna Commercial HMO & PPO	$255.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$202.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$240.99
Rate for Payer: Home State Health Plan Medicare Advantage	$255.26
Rate for Payer: Humana Commercial	$510.52
Rate for Payer: Humana Medicare Advantage	$255.26
Rate for Payer: UnitedHealthcare Commercial	$280.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$225.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INCISION OF THROMBOSED HEMORRHOID,EXTERN

Professional

Both

$863.00

Service Code	CPT 46083
Hospital Charge Code	1846083
Hospital Revenue Code	981
Min. Negotiated Rate	$100.26
Max. Negotiated Rate	$302.05
Rate for Payer: Aetna Commercial/Medicare Advantage	$100.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$161.40
Rate for Payer: Cash Price	$776.70
Rate for Payer: Cash Price	$776.70
Rate for Payer: Cigna Commercial HMO & PPO	$100.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$161.40
Rate for Payer: Home State Health Plan Medicaid Managed Care	$177.54
Rate for Payer: Home State Health Plan Medicare Advantage	$100.26
Rate for Payer: Optum Medicare Advantage	$302.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$161.40

INCISION & REM OF F/B SIMPLE

Facility

$158.00

Service Code	CPT 10120
Hospital Charge Code	5210120
Hospital Revenue Code	521
Min. Negotiated Rate	$93.54
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	$93.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$112.81
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
Rate for Payer: Cash Price	$142.20
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	$105.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INCISION & REM OF F/B SIMPLE

Facility

$158.00

Service Code	CPT 10120
Hospital Charge Code	5210120
Hospital Revenue Code	521
Rate for Payer: Cash Price	$142.20

INCISION & REMOV OF F/B COMPLICATED

Professional

Both

$373.00

Service Code	CPT 10121
Hospital Charge Code	4110121
Hospital Revenue Code	975
Min. Negotiated Rate	$130.55
Max. Negotiated Rate	$220.76
Rate for Payer: Aetna Commercial/Medicare Advantage	$161.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$200.69
Rate for Payer: Cash Price	$335.70
Rate for Payer: Cash Price	$335.70
Rate for Payer: Cigna Commercial HMO & PPO	$161.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$220.76
Rate for Payer: Home State Health Plan Medicare Advantage	$161.72
Rate for Payer: Optum Medicare Advantage	$130.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$200.69

INC OF LABIAL FRENUM FRENOTOMY

Facility

$850.00

Service Code	CPT 40806
Hospital Charge Code	9840806
Hospital Revenue Code	521
Rate for Payer: Cash Price	$765.00

INC OF LABIAL FRENUM FRENOTOMY

Facility

$850.00

Service Code	CPT 40806
Hospital Charge Code	9840806
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,102.02
Rate for Payer: Aetna Better Health Medicaid/QHP	$486.18
Rate for Payer: Aetna Medicare Advantage	$551.01
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$503.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$606.90
Rate for Payer: Cash Price	$765.00
Rate for Payer: Cash Price	$765.00
Rate for Payer: Cash Price	$765.00
Rate for Payer: Cash Price	$765.00
Rate for Payer: Cigna Commercial HMO & PPO	$551.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$437.56
Rate for Payer: Home State Health Plan Medicaid Managed Care	$520.21
Rate for Payer: Home State Health Plan Medicare Advantage	$551.01
Rate for Payer: Humana Commercial	$1,102.02
Rate for Payer: Humana Medicare Advantage	$551.01
Rate for Payer: UnitedHealthcare Commercial	$566.95
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$486.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INCOMPLETE ABORTION D&C

Facility

$676.00

Service Code	CPT 59812
Hospital Charge Code	4259812
Rate for Payer: Cash Price	$608.40

INC & REM OF F/B SIMPLE

Facility

$149.00

Service Code	CPT 10120
Hospital Charge Code	4410120
Hospital Revenue Code	521
Rate for Payer: Cash Price	$134.10

INC & REM OF F/B SIMPLE

Facility

$149.00

Service Code	CPT 10120
Hospital Charge Code	4410120
Hospital Revenue Code	521
Min. Negotiated Rate	$88.21
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	$88.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$106.39
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cash Price	$134.10
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	$99.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INC & REM OF FOR BODY SUBCUT TIS COMPLIC

Facility

$500.00

Service Code	CPT 10121
Hospital Charge Code	9810121
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	$296.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$357.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
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	$333.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

INC & REM OF FOR BODY SUBCUT TIS COMPLIC

Facility

$500.00

Service Code	CPT 10121
Hospital Charge Code	9810121
Hospital Revenue Code	521
Rate for Payer: Cash Price	$450.00

INC & REM OF FOR BODY SUBCUT TIS SIMPLE

Facility

$240.00

Service Code	CPT 10120
Hospital Charge Code	9810120
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

INC & REM OF FOR BODY SUBCUT TIS SIMPLE

Facility

$240.00

Service Code	CPT 10120
Hospital Charge Code	9810120
Hospital Revenue Code	521
Min. Negotiated Rate	$142.08
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	$142.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$171.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
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	$160.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges