Madison Medical Center

All Charges

Charge

Type

Setting

Price

REPAIR INTERMED CLOS >2.5 FACE,EYES,NOSE

Facility

$420.00

Service Code	CPT 12051
Hospital Charge Code	5412051
Hospital Revenue Code	521
Rate for Payer: Cash Price	$378.00

REPAIR INTERMED CLOS >2.5 FACE,EYES,NOSE

Facility

$420.00

Service Code	CPT 12051
Hospital Charge Code	5412051
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	$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	$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	$280.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REPAIR INTERMED CLOS 2.6TO5.0 FACE,EARS,

Facility

$525.00

Service Code	CPT 12052
Hospital Charge Code	5412052
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	$310.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$374.85
Rate for Payer: Cash Price	$472.50
Rate for Payer: Cash Price	$472.50
Rate for Payer: Cash Price	$472.50
Rate for Payer: Cash Price	$472.50
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	$350.18
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REPAIR INTERMED CLOS 2.6TO5.0 FACE,EARS,

Facility

$525.00

Service Code	CPT 12052
Hospital Charge Code	5412052
Hospital Revenue Code	521
Rate for Payer: Cash Price	$472.50

REPAIR INTERMED CLOS >5.1 CM

Facility

$630.00

Service Code	CPT 12053
Hospital Charge Code	5412053
Hospital Revenue Code	521
Rate for Payer: Cash Price	$567.00

REPAIR INTERMED CLOS >5.1 CM

Facility

$630.00

Service Code	CPT 12053
Hospital Charge Code	5412053
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	$372.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$449.82
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cash Price	$567.00
Rate for Payer: Cash Price	$567.00
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	$420.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REPAIR INTERMEDIATE LAYER CLOS 2.6-7.5CM

Facility

$313.00

Service Code	CPT 12032
Hospital Charge Code	4112032
Hospital Revenue Code	521
Rate for Payer: Cash Price	$281.70

REPAIR INTERMEDIATE LAYER CLOS 2.6-7.5CM

Facility

$313.00

Service Code	CPT 12032
Hospital Charge Code	4112032
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	$185.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$223.48
Rate for Payer: Cash Price	$281.70
Rate for Payer: Cash Price	$281.70
Rate for Payer: Cash Price	$281.70
Rate for Payer: Cash Price	$281.70
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	$208.77
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REPAIR INTERMEDIATE LAYER CLOSURE 2.5CM

Professional

Both

$213.00

Service Code	CPT 12031
Hospital Charge Code	4112031
Hospital Revenue Code	975
Min. Negotiated Rate	$74.55
Max. Negotiated Rate	$220.89
Rate for Payer: Aetna Commercial/Medicare Advantage	$124.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$200.81
Rate for Payer: Cash Price	$191.70
Rate for Payer: Cash Price	$191.70
Rate for Payer: Cigna Commercial HMO & PPO	$124.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$200.81
Rate for Payer: Home State Health Plan Medicaid Managed Care	$220.89
Rate for Payer: Home State Health Plan Medicare Advantage	$124.73
Rate for Payer: Optum Medicare Advantage	$74.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$200.81

REPAIR INTERMED LAYER CLOSURE 2.5 OR LES

Facility

$336.00

Service Code	CPT 12031
Hospital Charge Code	5412031
Hospital Revenue Code	521
Rate for Payer: Cash Price	$302.40

REPAIR INTERMED LAYER CLOSURE 2.5 OR LES

Facility

$336.00

Service Code	CPT 12031
Hospital Charge Code	5412031
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	$198.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$239.90
Rate for Payer: Cash Price	$302.40
Rate for Payer: Cash Price	$302.40
Rate for Payer: Cash Price	$302.40
Rate for Payer: Cash Price	$302.40
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	$224.11
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REPAIR INTERMED LAYER CLOSURE 2.6 TO 7.5

Facility

$550.00

Service Code	CPT 12032
Hospital Charge Code	5412032
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	$325.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$392.70
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cash Price	$495.00
Rate for Payer: Cash Price	$495.00
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	$366.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REPAIR INTERMED LAYER CLOSURE 2.6 TO 7.5

Facility

$550.00

Service Code	CPT 12032
Hospital Charge Code	5412032
Hospital Revenue Code	521
Rate for Payer: Cash Price	$495.00

REPAIR INTERMED LAYER CLOSURE >7.5

Facility

$525.00

Service Code	CPT 12034
Hospital Charge Code	5412034
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	$310.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$374.85
Rate for Payer: Cash Price	$472.50
Rate for Payer: Cash Price	$472.50
Rate for Payer: Cash Price	$472.50
Rate for Payer: Cash Price	$472.50
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	$350.18
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REPAIR INTERMED LAYER CLOSURE >7.5

Facility

$525.00

Service Code	CPT 12034
Hospital Charge Code	5412034
Hospital Revenue Code	521
Rate for Payer: Cash Price	$472.50

REPAIR INTERMED TRUNK EXTREM <2.5 CM

Facility

$360.00

Service Code	CPT 12031
Hospital Charge Code	4212031
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	$213.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$257.04
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
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	$240.12
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REPAIR INTERMED TRUNK EXTREM <2.5 CM

Facility

$360.00

Service Code	CPT 12031
Hospital Charge Code	4212031
Hospital Revenue Code	521
Rate for Payer: Cash Price	$324.00

REPAIR INTERMED WOUND FACE 2.6-5.0CM

Facility

$390.00

Service Code	CPT 12052
Hospital Charge Code	4112052
Hospital Revenue Code	521
Rate for Payer: Cash Price	$351.00

REPAIR INTERMED WOUND FACE 2.6-5.0CM

Facility

$390.00

Service Code	CPT 12052
Hospital Charge Code	4112052
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	$230.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$278.46
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
Rate for Payer: Cash Price	$351.00
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	$260.13
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REPAIR LAPAROSCOPY INITIAL INGUINAL HERN

Professional

Both

$1,654.00

Service Code	CPT 49650
Hospital Charge Code	4149650
Hospital Revenue Code	975
Min. Negotiated Rate	$328.46
Max. Negotiated Rate	$578.90
Rate for Payer: Aetna Commercial/Medicare Advantage	$400.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$328.46
Rate for Payer: Cash Price	$1,488.60
Rate for Payer: Cash Price	$1,488.60
Rate for Payer: Cigna Commercial HMO & PPO	$400.33
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$328.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$361.31
Rate for Payer: Home State Health Plan Medicare Advantage	$400.33
Rate for Payer: Optum Medicare Advantage	$578.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$328.46

REPAIR LAYER CLOSURE FACE 2.6-5.0 CM

Facility

$400.00

Service Code	CPT 12052
Hospital Charge Code	4412052
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	$236.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$285.60
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Cash Price	$360.00
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	$266.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REPAIR LAYER CLOSURE FACE 2.6-5.0 CM

Facility

$400.00

Service Code	CPT 12052
Hospital Charge Code	4412052
Hospital Revenue Code	521
Rate for Payer: Cash Price	$360.00

REPAIR LIVER WOUND

Professional

Both

$2,641.00

Service Code	CPT 47350
Hospital Charge Code	4147350
Hospital Revenue Code	975
Min. Negotiated Rate	$924.35
Max. Negotiated Rate	$1,229.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,229.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,035.77
Rate for Payer: Cash Price	$2,376.90
Rate for Payer: Cash Price	$2,376.90
Rate for Payer: Cigna Commercial HMO & PPO	$1,229.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,035.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,139.35
Rate for Payer: Home State Health Plan Medicare Advantage	$1,229.25
Rate for Payer: Optum Medicare Advantage	$924.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,035.77

REPAIR OF COMPLEX WOUND HEAD, HANDS,FEET

Facility

$368.00

Service Code	CPT 13131
Hospital Charge Code	4413131
Hospital Revenue Code	250
Min. Negotiated Rate	$132.48
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	$217.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$262.75
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cigna Commercial HMO & PPO	$415.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$366.45
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	$245.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$132.48

REPAIR OF COMPLEX WOUND HEAD, HANDS,FEET

Facility

$368.00

Service Code	CPT 13131
Hospital Charge Code	4413131
Hospital Revenue Code	250
Rate for Payer: Cash Price	$331.20

Know your out-of-pocket cost for care.

All Charges