Madison Medical Center

All Charges

Charge

Type

Setting

Price

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	9294760
Hospital Revenue Code	412
Rate for Payer: Cash Price	$40.50

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	9694760
Hospital Revenue Code	412
Rate for Payer: Cash Price	$40.50

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	3994760
Hospital Revenue Code	412
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	4494760
Hospital Revenue Code	412
Rate for Payer: Cash Price	$40.50

PULSE OXIMETRY

Facility

$45.00

Service Code	CPT 94760
Hospital Charge Code	9494760
Hospital Revenue Code	412
Rate for Payer: Cash Price	$40.50

PULSE OX-MULTI READINGS-EXERCISE

Facility

$126.00

Service Code	CPT 94761
Hospital Charge Code	4500490
Hospital Revenue Code	460
Rate for Payer: Cash Price	$113.40

PULSE OX-MULTI READINGS-EXERCISE

Facility

$126.00

Service Code	CPT 94761
Hospital Charge Code	4500490
Hospital Revenue Code	460
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$89.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: UnitedHealthcare Commercial	$84.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

PULSE OX - OVERNIGHT MONITORING

Facility

$383.00

Service Code	CPT 94762
Hospital Charge Code	4594762
Hospital Revenue Code	460
Min. Negotiated Rate	$116.00
Max. Negotiated Rate	$273.46
Rate for Payer: Aetna Better Health Medicaid/QHP	$116.00
Rate for Payer: Aetna Medicare Advantage	$131.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$226.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$273.46
Rate for Payer: Cash Price	$344.70
Rate for Payer: Cash Price	$344.70
Rate for Payer: Cash Price	$344.70
Rate for Payer: Cigna Commercial HMO & PPO	$131.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$116.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$124.12
Rate for Payer: Home State Health Plan Medicare Advantage	$131.46
Rate for Payer: Humana Commercial	$262.92
Rate for Payer: Humana Medicare Advantage	$131.46
Rate for Payer: UnitedHealthcare Commercial	$255.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$116.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$137.88

PULSE OX - OVERNIGHT MONITORING

Facility

$383.00

Service Code	CPT 94762
Hospital Charge Code	4594762
Hospital Revenue Code	460
Rate for Payer: Cash Price	$344.70

PUNCH BIOPSY OF SKIN LESIONS

Facility

$121.00

Service Code	CPT 11102
Hospital Charge Code	4411100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$108.90

PUNCH BIOPSY OF SKIN LESIONS

Facility

$121.00

Service Code	CPT 11102
Hospital Charge Code	4411100
Hospital Revenue Code	521
Min. Negotiated Rate	$71.63
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	$71.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$86.39
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
Rate for Payer: Cash Price	$108.90
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	$80.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PUNCH BIOPSY OF SKIN LESIONS EACH ADD'L

Facility

$70.00

Service Code	CPT 11103
Hospital Charge Code	4411101
Hospital Revenue Code	521
Rate for Payer: Cash Price	$63.00

PUNCH BIOPSY OF SKIN LESIONS EACH ADD'L

Facility

$70.00

Service Code	CPT 11103
Hospital Charge Code	4411101
Hospital Revenue Code	521
Min. Negotiated Rate	$41.44
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PUNCH BX SINGLE LESION

Facility

$240.00

Service Code	CPT 11104
Hospital Charge Code	5411104
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

PUNCH BX SINGLE LESION

Facility

$240.00

Service Code	CPT 11104
Hospital Charge Code	5411104
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA

Professional

Both

$103.00

Service Code	CPT 10160
Hospital Charge Code	4110160
Hospital Revenue Code	975
Min. Negotiated Rate	$36.05
Max. Negotiated Rate	$107.51
Rate for Payer: Aetna Commercial/Medicare Advantage	$85.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$97.74
Rate for Payer: Cash Price	$92.70
Rate for Payer: Cash Price	$92.70
Rate for Payer: Cigna Commercial HMO & PPO	$85.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$97.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$107.51
Rate for Payer: Home State Health Plan Medicare Advantage	$85.11
Rate for Payer: Optum Medicare Advantage	$36.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$97.74

PUNCTURE ASPIRATION OF BREAST CYST

Professional

Both

$142.00

Service Code	CPT 19000
Hospital Charge Code	4119000
Hospital Revenue Code	975
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$86.15
Rate for Payer: Aetna Commercial/Medicare Advantage	$35.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$78.32
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cigna Commercial HMO & PPO	$35.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$86.15
Rate for Payer: Home State Health Plan Medicare Advantage	$35.57
Rate for Payer: Optum Medicare Advantage	$49.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.32

PUNCTURE ASP OF ABS, HEMATOMA, BULLA CYS

Facility

$210.00

Service Code	CPT 10160
Hospital Charge Code	9810160
Hospital Revenue Code	521
Rate for Payer: Cash Price	$189.00

PUNCTURE ASP OF ABS, HEMATOMA, BULLA CYS

Facility

$210.00

Service Code	CPT 10160
Hospital Charge Code	9810160
Hospital Revenue Code	521
Min. Negotiated Rate	$124.32
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	$124.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
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	$140.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PUNCTURE DRAINAGE OF LESION

Professional

Both

$431.00

Service Code	CPT 10160
Hospital Charge Code	1810160
Hospital Revenue Code	981
Min. Negotiated Rate	$85.11
Max. Negotiated Rate	$150.85
Rate for Payer: Aetna Commercial/Medicare Advantage	$85.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$97.74
Rate for Payer: Cash Price	$387.90
Rate for Payer: Cash Price	$387.90
Rate for Payer: Cigna Commercial HMO & PPO	$85.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$97.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$107.51
Rate for Payer: Home State Health Plan Medicare Advantage	$85.11
Rate for Payer: Optum Medicare Advantage	$150.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$97.74

PURINES AND PYRIMIDINE PANEL

Facility

$472.00

Service Code	CPT 82542
Hospital Charge Code	2282542
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$337.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.68
Rate for Payer: Aetna Medicare Advantage	$24.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$279.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$337.01
Rate for Payer: Cash Price	$424.80
Rate for Payer: Cash Price	$424.80
Rate for Payer: Cash Price	$424.80
Rate for Payer: Cigna Commercial HMO & PPO	$24.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.68
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.20
Rate for Payer: Home State Health Plan Medicare Advantage	$24.09
Rate for Payer: Humana Commercial	$48.18
Rate for Payer: Humana Medicare Advantage	$24.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$169.92

PURINES AND PYRIMIDINE PANEL

Facility

$472.00

Service Code	CPT 82542
Hospital Charge Code	2282542
Hospital Revenue Code	301
Rate for Payer: Cash Price	$424.80

PUSH PEG

Facility

$685.00

Hospital Charge Code	127294
Hospital Revenue Code	271
Min. Negotiated Rate	$246.60
Max. Negotiated Rate	$489.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$405.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$489.09
Rate for Payer: Cash Price	$616.50
Rate for Payer: UnitedHealthcare Commercial	$456.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$246.60

PUSH PEG

Facility

$685.00

Hospital Charge Code	127294
Hospital Revenue Code	271
Rate for Payer: Cash Price	$616.50

PUSTULAR

Facility

$58.00

Service Code	CPT 10040
Hospital Charge Code	5210040
Hospital Revenue Code	521
Min. Negotiated Rate	$34.34
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	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
Rate for Payer: Cash Price	$52.20
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	$38.69
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