Madison Medical Center

All Charges

Charge

Type

Setting

Price

REMOVAL OF F/B SUPERFICIAL EYE

Facility

$105.00

Service Code	CPT 65205
Hospital Charge Code	4465205
Hospital Revenue Code	521
Rate for Payer: Cash Price	$94.50

REMOVAL OF FOREIGN BODY

Professional

Both

$212.00

Service Code	CPT 28190
Hospital Charge Code	4128190
Hospital Revenue Code	975
Min. Negotiated Rate	$74.20
Max. Negotiated Rate	$202.34
Rate for Payer: Aetna Commercial/Medicare Advantage	$119.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$183.95
Rate for Payer: Cash Price	$190.80
Rate for Payer: Cash Price	$190.80
Rate for Payer: Cigna Commercial HMO & PPO	$119.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$183.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$202.34
Rate for Payer: Home State Health Plan Medicare Advantage	$119.80
Rate for Payer: Optum Medicare Advantage	$74.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$183.95

REMOVAL OF FOREIGN BODY CONJUNCTIVAL EMB

Facility

$240.00

Service Code	CPT 65210
Hospital Charge Code	9865210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

REMOVAL OF FOREIGN BODY CONJUNCTIVAL EMB

Facility

$240.00

Service Code	CPT 65210
Hospital Charge Code	9865210
Hospital Revenue Code	521
Min. Negotiated Rate	$142.08
Max. Negotiated Rate	$912.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$402.70
Rate for Payer: Aetna Medicare Advantage	$456.40
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	$456.40
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$362.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$430.89
Rate for Payer: Home State Health Plan Medicare Advantage	$456.40
Rate for Payer: Humana Commercial	$912.80
Rate for Payer: Humana Medicare Advantage	$456.40
Rate for Payer: UnitedHealthcare Commercial	$160.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$402.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REMOVAL OF FOREIGN BODY, FOOT; SUBQ

Facility

$570.00

Service Code	CPT 28190
Hospital Charge Code	9728190
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
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	$337.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$406.98
Rate for Payer: Cash Price	$513.00
Rate for Payer: Cash Price	$513.00
Rate for Payer: Cash Price	$513.00
Rate for Payer: Cash Price	$513.00
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	$380.19
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REMOVAL OF FOREIGN BODY, FOOT; SUBQ

Facility

$570.00

Service Code	CPT 28190
Hospital Charge Code	9728190
Hospital Revenue Code	521
Rate for Payer: Cash Price	$513.00

REMOVAL OF FOREIGN BODY NOSE OFFICE

Facility

$450.00

Service Code	CPT 30300
Hospital Charge Code	9330300
Hospital Revenue Code	521
Min. Negotiated Rate	$107.95
Max. Negotiated Rate	$321.30
Rate for Payer: Aetna Better Health Medicaid/QHP	$119.94
Rate for Payer: Aetna Medicare Advantage	$135.93
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	$135.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$128.34
Rate for Payer: Home State Health Plan Medicare Advantage	$135.93
Rate for Payer: Humana Commercial	$271.86
Rate for Payer: Humana Medicare Advantage	$135.93
Rate for Payer: UnitedHealthcare Commercial	$300.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REMOVAL OF FOREIGN BODY NOSE OFFICE

Facility

$450.00

Service Code	CPT 30300
Hospital Charge Code	9330300
Hospital Revenue Code	521
Rate for Payer: Cash Price	$405.00

REMOVAL OF HYDROCELE

Professional

Both

$1,216.00

Service Code	CPT 55040
Hospital Charge Code	4155040
Hospital Revenue Code	975
Min. Negotiated Rate	$253.91
Max. Negotiated Rate	$425.60
Rate for Payer: Aetna Commercial/Medicare Advantage	$298.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$253.91
Rate for Payer: Cash Price	$1,094.40
Rate for Payer: Cash Price	$1,094.40
Rate for Payer: Cigna Commercial HMO & PPO	$298.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$253.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$279.30
Rate for Payer: Home State Health Plan Medicare Advantage	$298.64
Rate for Payer: Optum Medicare Advantage	$425.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$253.91

REMOVAL OF IMPLANT

Professional

Both

$731.00

Service Code	CPT 20680
Hospital Charge Code	4120680
Hospital Revenue Code	975
Min. Negotiated Rate	$255.85
Max. Negotiated Rate	$502.51
Rate for Payer: Aetna Commercial/Medicare Advantage	$370.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$456.83
Rate for Payer: Cash Price	$657.90
Rate for Payer: Cash Price	$657.90
Rate for Payer: Cigna Commercial HMO & PPO	$370.77
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$456.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$502.51
Rate for Payer: Home State Health Plan Medicare Advantage	$370.77
Rate for Payer: Optum Medicare Advantage	$255.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$456.83

REMOVAL OF IUD

Facility

$330.00

Service Code	CPT 58301
Hospital Charge Code	9258301
Hospital Revenue Code	521
Rate for Payer: Cash Price	$297.00

REMOVAL OF IUD

Facility

$330.00

Service Code	CPT 58301
Hospital Charge Code	9258301
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$622.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$274.70
Rate for Payer: Aetna Medicare Advantage	$311.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$195.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$235.62
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cash Price	$297.00
Rate for Payer: Cigna Commercial HMO & PPO	$311.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$247.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$293.93
Rate for Payer: Home State Health Plan Medicare Advantage	$311.33
Rate for Payer: Humana Commercial	$622.66
Rate for Payer: Humana Medicare Advantage	$311.33
Rate for Payer: UnitedHealthcare Commercial	$220.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$274.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REMOVAL OF LESION

Professional

Both

$362.00

Service Code	CPT 11640
Hospital Charge Code	4111640
Hospital Revenue Code	975
Min. Negotiated Rate	$103.85
Max. Negotiated Rate	$169.76
Rate for Payer: Aetna Commercial/Medicare Advantage	$103.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$154.33
Rate for Payer: Cash Price	$325.80
Rate for Payer: Cash Price	$325.80
Rate for Payer: Cigna Commercial HMO & PPO	$103.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$154.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$169.76
Rate for Payer: Home State Health Plan Medicare Advantage	$103.85
Rate for Payer: Optum Medicare Advantage	$126.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$154.33

REMOVAL OF NAIL(S)

Professional

Both

$951.00

Service Code	CPT 11750
Hospital Charge Code	1811750
Hospital Revenue Code	981
Min. Negotiated Rate	$88.81
Max. Negotiated Rate	$332.85
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	$855.90
Rate for Payer: Cash Price	$855.90
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	$332.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$121.29

REMOVAL OF OBJECT IN MUSCLE

Professional

Both

$951.00

Service Code	CPT 20520
Hospital Charge Code	1820520
Hospital Revenue Code	981
Min. Negotiated Rate	$131.90
Max. Negotiated Rate	$332.85
Rate for Payer: Aetna Commercial/Medicare Advantage	$131.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$165.23
Rate for Payer: Cash Price	$855.90
Rate for Payer: Cash Price	$855.90
Rate for Payer: Cigna Commercial HMO & PPO	$131.90
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$165.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$181.75
Rate for Payer: Home State Health Plan Medicare Advantage	$131.90
Rate for Payer: Optum Medicare Advantage	$332.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$165.23

REMOVAL OF PACEMAKER

Professional

Both

$584.00

Service Code	CPT 33233
Hospital Charge Code	4133233
Hospital Revenue Code	975
Min. Negotiated Rate	$199.91
Max. Negotiated Rate	$251.11
Rate for Payer: Aetna Commercial/Medicare Advantage	$199.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$228.28
Rate for Payer: Cash Price	$525.60
Rate for Payer: Cash Price	$525.60
Rate for Payer: Cigna Commercial HMO & PPO	$199.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$228.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$251.11
Rate for Payer: Home State Health Plan Medicare Advantage	$199.91
Rate for Payer: Optum Medicare Advantage	$204.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$228.28

REMOVAL OF PICC LINE

Professional

Both

$1,373.00

Service Code	CPT 36589
Hospital Charge Code	1836589
Hospital Revenue Code	981
Min. Negotiated Rate	$119.51
Max. Negotiated Rate	$480.55
Rate for Payer: Aetna Commercial/Medicare Advantage	$119.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$126.07
Rate for Payer: Cash Price	$1,235.70
Rate for Payer: Cash Price	$1,235.70
Rate for Payer: Cigna Commercial HMO & PPO	$119.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$126.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$138.68
Rate for Payer: Home State Health Plan Medicare Advantage	$119.51
Rate for Payer: Optum Medicare Advantage	$480.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$126.07

REMOVAL OF PICC LINE

Professional

Both

$1,373.00

Service Code	CPT 36589
Hospital Charge Code	536589
Hospital Revenue Code	982
Min. Negotiated Rate	$119.51
Max. Negotiated Rate	$480.55
Rate for Payer: Aetna Commercial/Medicare Advantage	$119.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$126.07
Rate for Payer: Cash Price	$1,235.70
Rate for Payer: Cash Price	$1,235.70
Rate for Payer: Cigna Commercial HMO & PPO	$119.51
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$126.07
Rate for Payer: Home State Health Plan Medicaid Managed Care	$138.68
Rate for Payer: Home State Health Plan Medicare Advantage	$119.51
Rate for Payer: Optum Medicare Advantage	$480.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$126.07

REMOVAL OF PIC LINE

Facility

$620.00

Service Code	CPT 36589
Hospital Charge Code	9836589
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,281.78
Rate for Payer: Aetna Better Health Medicaid/QHP	$565.48
Rate for Payer: Aetna Medicare Advantage	$640.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$367.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$442.68
Rate for Payer: Cash Price	$558.00
Rate for Payer: Cash Price	$558.00
Rate for Payer: Cash Price	$558.00
Rate for Payer: Cash Price	$558.00
Rate for Payer: Cigna Commercial HMO & PPO	$640.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$508.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$605.06
Rate for Payer: Home State Health Plan Medicare Advantage	$640.89
Rate for Payer: Humana Commercial	$1,281.78
Rate for Payer: Humana Medicare Advantage	$640.89
Rate for Payer: UnitedHealthcare Commercial	$413.54
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$565.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REMOVAL OF PIC LINE

Facility

$620.00

Service Code	CPT 36589
Hospital Charge Code	9836589
Hospital Revenue Code	521
Rate for Payer: Cash Price	$558.00

REMOVAL OF SKIN LESION

Professional

Both

$1,007.00

Service Code	CPT 11423
Hospital Charge Code	1811423
Hospital Revenue Code	981
Min. Negotiated Rate	$134.08
Max. Negotiated Rate	$352.45
Rate for Payer: Aetna Commercial/Medicare Advantage	$134.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$155.20
Rate for Payer: Cash Price	$906.30
Rate for Payer: Cash Price	$906.30
Rate for Payer: Cigna Commercial HMO & PPO	$134.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$155.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$170.72
Rate for Payer: Home State Health Plan Medicare Advantage	$134.08
Rate for Payer: Optum Medicare Advantage	$352.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$155.20

REMOVAL OF SKIN LESION

Professional

Both

$529.00

Service Code	CPT 11406
Hospital Charge Code	4111406
Hospital Revenue Code	975
Min. Negotiated Rate	$185.15
Max. Negotiated Rate	$265.79
Rate for Payer: Aetna Commercial/Medicare Advantage	$214.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$241.63
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cash Price	$476.10
Rate for Payer: Cigna Commercial HMO & PPO	$214.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$241.63
Rate for Payer: Home State Health Plan Medicaid Managed Care	$265.79
Rate for Payer: Home State Health Plan Medicare Advantage	$214.56
Rate for Payer: Optum Medicare Advantage	$185.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$241.63

REMOVAL OF SKIN LIESON

Professional

Both

$329.00

Service Code	CPT 11423
Hospital Charge Code	4111423
Hospital Revenue Code	975
Min. Negotiated Rate	$115.15
Max. Negotiated Rate	$170.72
Rate for Payer: Aetna Commercial/Medicare Advantage	$134.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$155.20
Rate for Payer: Cash Price	$296.10
Rate for Payer: Cash Price	$296.10
Rate for Payer: Cigna Commercial HMO & PPO	$134.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$155.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$170.72
Rate for Payer: Home State Health Plan Medicare Advantage	$134.08
Rate for Payer: Optum Medicare Advantage	$115.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$155.20

REMOVAL OF SKIN TAG

Facility

$115.00

Service Code	CPT 11200
Hospital Charge Code	4411200
Hospital Revenue Code	521
Min. Negotiated Rate	$68.08
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	$68.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$82.11
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
Rate for Payer: Cash Price	$103.50
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	$76.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REMOVAL OF SKIN TAG

Facility

$115.00

Service Code	CPT 11200
Hospital Charge Code	4411200
Hospital Revenue Code	521
Rate for Payer: Cash Price	$103.50

Know your out-of-pocket cost for care.

All Charges