Madison Medical Center

All Charges

Charge

Type

Setting

Price

REPAIR WOUND,SIMPLE

Facility

$77.00

Service Code	CPT 17000
Hospital Charge Code	4117100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$69.30

REPAIR WOUND,SIMPLE

Facility

$77.00

Service Code	CPT 17000
Hospital Charge Code	4117100
Hospital Revenue Code	521
Min. Negotiated Rate	$45.58
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	$45.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.98
Rate for Payer: Cash Price	$69.30
Rate for Payer: Cash Price	$69.30
Rate for Payer: Cash Price	$69.30
Rate for Payer: Cash Price	$69.30
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	$51.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REPAIR-WOUNDS SIMPLE 0 TO 2.5C

Professional

Both

$565.00

Service Code	CPT 12001
Hospital Charge Code	1812001
Hospital Revenue Code	981
Min. Negotiated Rate	$42.46
Max. Negotiated Rate	$197.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$42.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$86.94
Rate for Payer: Cash Price	$508.50
Rate for Payer: Cash Price	$508.50
Rate for Payer: Cigna Commercial HMO & PPO	$42.46
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$86.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$95.63
Rate for Payer: Home State Health Plan Medicare Advantage	$42.46
Rate for Payer: Optum Medicare Advantage	$197.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$86.94

REPAIR WOUNDS-SIMPLE,2.6-7.5CM

Professional

Both

$620.00

Service Code	CPT 12002
Hospital Charge Code	1812002
Hospital Revenue Code	981
Min. Negotiated Rate	$55.54
Max. Negotiated Rate	$217.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$55.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$92.71
Rate for Payer: Cash Price	$558.00
Rate for Payer: Cash Price	$558.00
Rate for Payer: Cigna Commercial HMO & PPO	$55.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$92.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$101.98
Rate for Payer: Home State Health Plan Medicare Advantage	$55.54
Rate for Payer: Optum Medicare Advantage	$217.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$92.71

REPAIR WOUNDS-SIMPLE 7.6-12.5C

Professional

Both

$742.00

Service Code	CPT 12004
Hospital Charge Code	1812004
Hospital Revenue Code	981
Min. Negotiated Rate	$69.88
Max. Negotiated Rate	$259.70
Rate for Payer: Aetna Commercial/Medicare Advantage	$69.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$108.87
Rate for Payer: Cash Price	$667.80
Rate for Payer: Cash Price	$667.80
Rate for Payer: Cigna Commercial HMO & PPO	$69.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$108.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$119.76
Rate for Payer: Home State Health Plan Medicare Advantage	$69.88
Rate for Payer: Optum Medicare Advantage	$259.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$108.87

REP INTERMED 2.5 CMOR> NECK HANDS FEET

Facility

$415.00

Service Code	CPT 12041
Hospital Charge Code	9812041
Hospital Revenue Code	521
Rate for Payer: Cash Price	$373.50

REP INTERMED 2.5 CMOR> NECK HANDS FEET

Facility

$415.00

Service Code	CPT 12041
Hospital Charge Code	9812041
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	$245.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$296.31
Rate for Payer: Cash Price	$373.50
Rate for Payer: Cash Price	$373.50
Rate for Payer: Cash Price	$373.50
Rate for Payer: Cash Price	$373.50
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	$276.81
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REP INTERMED 2.6-7.5 CM SCALP, AXILLAE,

Facility

$460.00

Service Code	CPT 12032
Hospital Charge Code	9812032
Hospital Revenue Code	521
Rate for Payer: Cash Price	$414.00

REP INTERMED 2.6-7.5 CM SCALP, AXILLAE,

Facility

$460.00

Service Code	CPT 12032
Hospital Charge Code	9812032
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	$272.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$328.44
Rate for Payer: Cash Price	$414.00
Rate for Payer: Cash Price	$414.00
Rate for Payer: Cash Price	$414.00
Rate for Payer: Cash Price	$414.00
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	$306.82
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REP WOUND FACE 2.0 - 5.0

Facility

$252.00

Service Code	CPT 12013
Hospital Charge Code	9612013
Hospital Revenue Code	521
Min. Negotiated Rate	$149.18
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	$149.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$179.93
Rate for Payer: Cash Price	$226.80
Rate for Payer: Cash Price	$226.80
Rate for Payer: Cash Price	$226.80
Rate for Payer: Cash Price	$226.80
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	$168.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

REP WOUND FACE 2.0 - 5.0

Facility

$252.00

Service Code	CPT 12013
Hospital Charge Code	9612013
Hospital Revenue Code	521
Rate for Payer: Cash Price	$226.80

RESECTION OF FATTY TUMOR

Professional

Both

$1,575.00

Service Code	CPT 22900
Hospital Charge Code	5422900
Hospital Revenue Code	975
Min. Negotiated Rate	$427.99
Max. Negotiated Rate	$551.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$516.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$427.99
Rate for Payer: Cash Price	$1,417.50
Rate for Payer: Cash Price	$1,417.50
Rate for Payer: Cigna Commercial HMO & PPO	$516.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$427.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$470.79
Rate for Payer: Home State Health Plan Medicare Advantage	$516.68
Rate for Payer: Optum Medicare Advantage	$551.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$427.99

RESECTION OF LIP, MORE THAN 1/4 W/O RECO

Professional

Both

$1,323.00

Service Code	CPT 40530
Hospital Charge Code	4140530
Hospital Revenue Code	975
Min. Negotiated Rate	$344.53
Max. Negotiated Rate	$467.84
Rate for Payer: Aetna Commercial/Medicare Advantage	$344.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$425.31
Rate for Payer: Cash Price	$1,190.70
Rate for Payer: Cash Price	$1,190.70
Rate for Payer: Cigna Commercial HMO & PPO	$344.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$425.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$467.84
Rate for Payer: Home State Health Plan Medicare Advantage	$344.53
Rate for Payer: Optum Medicare Advantage	$463.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$425.31

RESECTOCOPE TRAY

Facility

$1,419.00

Hospital Charge Code	129119
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,277.10

RESECTOCOPE TRAY

Facility

$1,419.00

Hospital Charge Code	129119
Hospital Revenue Code	360
Min. Negotiated Rate	$510.84
Max. Negotiated Rate	$946.47
Rate for Payer: Cash Price	$1,277.10
Rate for Payer: UnitedHealthcare Commercial	$946.47
Rate for Payer: UnitedHealthcare Medicare Advantage	$510.84

RESET DISLOCATED JAW

Professional

Both

$895.00

Service Code	CPT 21480
Hospital Charge Code	1821480
Hospital Revenue Code	981
Min. Negotiated Rate	$29.41
Max. Negotiated Rate	$313.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$29.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$107.03
Rate for Payer: Cash Price	$805.50
Rate for Payer: Cash Price	$805.50
Rate for Payer: Cigna Commercial HMO & PPO	$29.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$107.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$117.73
Rate for Payer: Home State Health Plan Medicare Advantage	$29.41
Rate for Payer: Optum Medicare Advantage	$313.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$107.03

RESOL CLIP

Facility

$942.00

Hospital Charge Code	125354
Hospital Revenue Code	271
Min. Negotiated Rate	$339.12
Max. Negotiated Rate	$672.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$557.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$672.59
Rate for Payer: Cash Price	$847.80
Rate for Payer: UnitedHealthcare Commercial	$628.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$339.12

RESOL CLIP

Facility

$942.00

Hospital Charge Code	125354
Hospital Revenue Code	271
Rate for Payer: Cash Price	$847.80

RESPIRATORY FAILURE

Facility

$6,308.72

Service Code	APR-DRG 1331
Min. Negotiated Rate	$6,308.72
Max. Negotiated Rate	$6,308.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,308.72
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,308.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,308.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,308.72

RESPIRATORY FAILURE

Facility

$22,108.99

Service Code	APR-DRG 1333
Min. Negotiated Rate	$22,108.99
Max. Negotiated Rate	$22,108.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$22,108.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$22,108.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$22,108.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$22,108.99

RESPIRATORY FAILURE

Facility

$9,966.31

Service Code	APR-DRG 1332
Min. Negotiated Rate	$9,966.31
Max. Negotiated Rate	$9,966.31
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,966.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,966.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,966.31
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,966.31

RESPIRATORY FAILURE

Facility

$38,060.65

Service Code	APR-DRG 1334
Min. Negotiated Rate	$38,060.65
Max. Negotiated Rate	$38,060.65
Rate for Payer: Aetna Better Health Medicaid/QHP	$38,060.65
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$38,060.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$38,060.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$38,060.65

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC

Facility

$18,918.28

Service Code	MSDRG 178
Min. Negotiated Rate	$9,459.14
Max. Negotiated Rate	$18,918.28
Rate for Payer: Aetna Medicare Advantage	$9,459.14
Rate for Payer: Cigna Commercial HMO & PPO	$9,459.14
Rate for Payer: Home State Health Plan Medicare Advantage	$9,459.14
Rate for Payer: Humana Commercial	$18,918.28
Rate for Payer: Humana Medicare Advantage	$9,459.14

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC

Facility

$28,110.28

Service Code	MSDRG 177
Min. Negotiated Rate	$14,055.14
Max. Negotiated Rate	$28,110.28
Rate for Payer: Aetna Medicare Advantage	$14,055.14
Rate for Payer: Cigna Commercial HMO & PPO	$14,055.14
Rate for Payer: Home State Health Plan Medicare Advantage	$14,055.14
Rate for Payer: Humana Commercial	$28,110.28
Rate for Payer: Humana Medicare Advantage	$14,055.14

RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC

Facility

$15,459.80

Service Code	MSDRG 179
Min. Negotiated Rate	$7,729.90
Max. Negotiated Rate	$15,459.80
Rate for Payer: Aetna Medicare Advantage	$7,729.90
Rate for Payer: Cigna Commercial HMO & PPO	$7,729.90
Rate for Payer: Home State Health Plan Medicare Advantage	$7,729.90
Rate for Payer: Humana Commercial	$15,459.80
Rate for Payer: Humana Medicare Advantage	$7,729.90

Know your out-of-pocket cost for care.

All Charges