Madison Medical Center

All Charges

Charge

Type

Setting

Price

SHAVING LES .6 TO 1 CM TRUNK,ARMS,LEGS

Facility

$185.00

Service Code	CPT 11302
Hospital Charge Code	9811302
Hospital Revenue Code	521
Min. Negotiated Rate	$109.52
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	$109.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.09
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
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	$123.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING LES .6 TO 1 CM TRUNK,ARMS,LEGS

Facility

$185.00

Service Code	CPT 11302
Hospital Charge Code	9811302
Hospital Revenue Code	521
Rate for Payer: Cash Price	$166.50

SHAVING LES FACE,EARS <.5 CM

Facility

$140.00

Service Code	CPT 11310
Hospital Charge Code	9811310
Hospital Revenue Code	521
Rate for Payer: Cash Price	$126.00

SHAVING LES FACE,EARS <.5 CM

Facility

$140.00

Service Code	CPT 11310
Hospital Charge Code	9811310
Hospital Revenue Code	521
Min. Negotiated Rate	$82.88
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	$82.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$99.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
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	$93.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING LESION .6 TO 1.0 CM

Facility

$185.00

Service Code	CPT 11306
Hospital Charge Code	9811306
Hospital Revenue Code	521
Min. Negotiated Rate	$109.52
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	$109.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.09
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
Rate for Payer: Cash Price	$166.50
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	$123.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING LESION .6 TO 1.0 CM

Facility

$185.00

Service Code	CPT 11306
Hospital Charge Code	9811306
Hospital Revenue Code	521
Rate for Payer: Cash Price	$166.50

SHAVING LESION OVER 2.0 CM

Facility

$257.00

Service Code	CPT 11303
Hospital Charge Code	5411303
Hospital Revenue Code	521
Min. Negotiated Rate	$152.14
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	$152.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$183.50
Rate for Payer: Cash Price	$231.30
Rate for Payer: Cash Price	$231.30
Rate for Payer: Cash Price	$231.30
Rate for Payer: Cash Price	$231.30
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	$171.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING LESION OVER 2.0 CM

Facility

$257.00

Service Code	CPT 11303
Hospital Charge Code	5411303
Hospital Revenue Code	521
Rate for Payer: Cash Price	$231.30

SHAVING LES SCALP,NECK,HANDS,FEET,GENITA

Facility

$140.00

Service Code	CPT 11305
Hospital Charge Code	9811305
Hospital Revenue Code	521
Rate for Payer: Cash Price	$126.00

SHAVING LES SCALP,NECK,HANDS,FEET,GENITA

Facility

$140.00

Service Code	CPT 11305
Hospital Charge Code	9811305
Hospital Revenue Code	521
Min. Negotiated Rate	$82.88
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	$82.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$99.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
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	$93.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING LES SCALP,NECK,HANDS,FEET,GENITA

Facility

$140.00

Service Code	CPT 11305
Hospital Charge Code	98911305
Hospital Revenue Code	521
Rate for Payer: Cash Price	$126.00

SHAVING LES SCALP,NECK,HANDS,FEET,GENITA

Facility

$140.00

Service Code	CPT 11305
Hospital Charge Code	98911305
Hospital Revenue Code	521
Min. Negotiated Rate	$82.88
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	$82.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$99.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
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	$93.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING LES TRUNK .5 TO 1.0 CM

Facility

$170.00

Service Code	CPT 11301
Hospital Charge Code	9811301
Hospital Revenue Code	521
Min. Negotiated Rate	$100.64
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	$100.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$121.38
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
Rate for Payer: Cash Price	$153.00
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	$113.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING LES TRUNK .5 TO 1.0 CM

Facility

$170.00

Service Code	CPT 11301
Hospital Charge Code	9811301
Hospital Revenue Code	521
Rate for Payer: Cash Price	$153.00

SHAVING OF EPIDER/DERM LES <.5 EACH LESI

Facility

$140.00

Service Code	CPT 11300
Hospital Charge Code	9811300
Hospital Revenue Code	521
Rate for Payer: Cash Price	$126.00

SHAVING OF EPIDER/DERM LES <.5 EACH LESI

Facility

$140.00

Service Code	CPT 11300
Hospital Charge Code	9811300
Hospital Revenue Code	521
Min. Negotiated Rate	$82.88
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	$82.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$99.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
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	$93.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING OF EPIDERMAL/DERMAL LES SINGLE

Facility

$140.00

Service Code	CPT 11305
Hospital Charge Code	4211305
Hospital Revenue Code	521
Rate for Payer: Cash Price	$126.00

SHAVING OF EPIDERMAL/DERMAL LES SINGLE

Facility

$140.00

Service Code	CPT 11305
Hospital Charge Code	4211305
Hospital Revenue Code	521
Min. Negotiated Rate	$82.88
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	$82.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$99.96
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
Rate for Payer: Cash Price	$126.00
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	$93.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING OF EPIDERMAL LES 1.1 TO 2.0CM

Facility

$257.00

Service Code	CPT 11312
Hospital Charge Code	5411312
Hospital Revenue Code	521
Min. Negotiated Rate	$152.14
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	$152.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$183.50
Rate for Payer: Cash Price	$231.30
Rate for Payer: Cash Price	$231.30
Rate for Payer: Cash Price	$231.30
Rate for Payer: Cash Price	$231.30
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	$171.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING OF EPIDERMAL LES 1.1 TO 2.0CM

Facility

$257.00

Service Code	CPT 11312
Hospital Charge Code	5411312
Hospital Revenue Code	521
Rate for Payer: Cash Price	$231.30

SHAVING OF EPIDERMAL LES .5 TO 1.0CM

Facility

$242.00

Service Code	CPT 11311
Hospital Charge Code	5411311
Hospital Revenue Code	521
Rate for Payer: Cash Price	$217.80

SHAVING OF EPIDERMAL LES .5 TO 1.0CM

Facility

$242.00

Service Code	CPT 11311
Hospital Charge Code	5411311
Hospital Revenue Code	521
Min. Negotiated Rate	$143.26
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	$143.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$172.79
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cash Price	$217.80
Rate for Payer: Cash Price	$217.80
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	$161.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING OF EPIDERMAL LES FACE .5 OR LESS

Facility

$173.00

Service Code	CPT 11310
Hospital Charge Code	5411310
Hospital Revenue Code	521
Rate for Payer: Cash Price	$155.70

SHAVING OF EPIDERMAL LES FACE .5 OR LESS

Facility

$173.00

Service Code	CPT 11310
Hospital Charge Code	5411310
Hospital Revenue Code	521
Min. Negotiated Rate	$102.42
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	$102.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$123.52
Rate for Payer: Cash Price	$155.70
Rate for Payer: Cash Price	$155.70
Rate for Payer: Cash Price	$155.70
Rate for Payer: Cash Price	$155.70
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	$115.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING OF EPIDERMAL LES NECK .5 OR LESS

Facility

$137.00

Service Code	CPT 11305
Hospital Charge Code	5411305
Hospital Revenue Code	521
Rate for Payer: Cash Price	$123.30

Know your out-of-pocket cost for care.

All Charges