Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

SHAVING OF EPIDERMAL LES SCALP >2.0 CM

Facility

$268.00

Service Code	CPT 11308
Hospital Charge Code	5411308
Hospital Revenue Code	521
Min. Negotiated Rate	$158.66
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	$158.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$191.35
Rate for Payer: Cash Price	$241.20
Rate for Payer: Cash Price	$241.20
Rate for Payer: Cash Price	$241.20
Rate for Payer: Cash Price	$241.20
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	$178.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING OF EPIDERMAL LES SCALP >2.0 CM

Facility

$268.00

Service Code	CPT 11308
Hospital Charge Code	5411308
Hospital Revenue Code	521
Rate for Payer: Cash Price	$241.20

SHAVING OF EPIDERMAL LES TRUNK .5 OR LES

Facility

$142.00

Service Code	CPT 11200
Hospital Charge Code	5411200
Hospital Revenue Code	521
Rate for Payer: Cash Price	$127.80

SHAVING OF EPIDERMAL LES TRUNK .5 OR LES

Facility

$131.00

Service Code	CPT 11300
Hospital Charge Code	5411300
Hospital Revenue Code	521
Min. Negotiated Rate	$77.55
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	$77.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$93.53
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
Rate for Payer: Cash Price	$117.90
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	$87.38
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING OF EPIDERMAL LES TRUNK .5 OR LES

Facility

$142.00

Service Code	CPT 11200
Hospital Charge Code	5411200
Hospital Revenue Code	521
Min. Negotiated Rate	$84.06
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	$84.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$101.39
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cash Price	$127.80
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	$94.71
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING OF EPIDERMAL LES TRUNK .5 OR LES

Facility

$131.00

Service Code	CPT 11300
Hospital Charge Code	5411300
Hospital Revenue Code	521
Rate for Payer: Cash Price	$117.90

SHAVING OF EPIDERMAL LES TRUNK .6 TO 1.0

Facility

$173.00

Service Code	CPT 11301
Hospital Charge Code	5411301
Hospital Revenue Code	521
Rate for Payer: Cash Price	$155.70

SHAVING OF EPIDERMAL LES TRUNK .6 TO 1.0

Facility

$173.00

Service Code	CPT 11301
Hospital Charge Code	5411301
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 EPID LESION 1.1 TO 2.0 FACE

Facility

$236.00

Service Code	CPT 11312
Hospital Charge Code	4411312
Hospital Revenue Code	521
Rate for Payer: Cash Price	$212.40

SHAVING OF EPID LESION 1.1 TO 2.0 FACE

Facility

$236.00

Service Code	CPT 11312
Hospital Charge Code	4411312
Hospital Revenue Code	521
Min. Negotiated Rate	$139.71
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	$139.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$168.50
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cash Price	$212.40
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	$157.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING OF LESION .5 CM OR LESS

Facility

$130.00

Service Code	CPT 113000
Hospital Charge Code	98113000
Hospital Revenue Code	521
Rate for Payer: Cash Price	$117.00

SHAVING OF LESION .5 CM OR LESS

Facility

$130.00

Service Code	CPT 113000
Hospital Charge Code	98113000
Hospital Revenue Code	521
Min. Negotiated Rate	$76.96
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.82
Rate for Payer: Cash Price	$117.00
Rate for Payer: Cash Price	$117.00
Rate for Payer: UnitedHealthcare Commercial	$86.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING OF LES TRUNK,ARMS LEGS 1.1TO 2.0

Facility

$215.00

Service Code	CPT 11302
Hospital Charge Code	5411302
Hospital Revenue Code	521
Min. Negotiated Rate	$127.28
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	$127.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$153.51
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
Rate for Payer: Cash Price	$193.50
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	$143.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHAVING OF LES TRUNK,ARMS LEGS 1.1TO 2.0

Facility

$215.00

Service Code	CPT 11302
Hospital Charge Code	5411302
Hospital Revenue Code	521
Rate for Payer: Cash Price	$193.50

SHAV OF EPIDERMAL LESION .5 CM OR LESS

Professional

Both

$110.00

Service Code	CPT 11300
Hospital Charge Code	4111300
Hospital Revenue Code	975
Min. Negotiated Rate	$26.84
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$26.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$77.73
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$26.84
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$77.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$85.50
Rate for Payer: Home State Health Plan Medicare Advantage	$26.84
Rate for Payer: Optum Medicare Advantage	$38.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$77.73

SHAV OF EPIDERML/DERML LES .6 TO 1.CM

Facility

$190.00

Service Code	CPT 11307
Hospital Charge Code	4211307
Hospital Revenue Code	521
Rate for Payer: Cash Price	$171.00

SHAV OF EPIDERML/DERML LES .6 TO 1.CM

Facility

$190.00

Service Code	CPT 11307
Hospital Charge Code	4211307
Hospital Revenue Code	521
Min. Negotiated Rate	$112.48
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	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
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	$126.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SHEATH O'CONNOR

Facility

$385.00

Hospital Charge Code	2819019
Hospital Revenue Code	271
Min. Negotiated Rate	$138.60
Max. Negotiated Rate	$274.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$227.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$274.89
Rate for Payer: Cash Price	$346.50
Rate for Payer: UnitedHealthcare Commercial	$256.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$138.60

SHEATH O'CONNOR

Facility

$385.00

Hospital Charge Code	2819019
Hospital Revenue Code	271
Rate for Payer: Cash Price	$346.50

SHEETS 1/4 1/2

Facility

$16.00

Hospital Charge Code	2819793
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

SHEETS 1/4 1/2

Facility

$16.00

Hospital Charge Code	2819793
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

SHOE COVERS

Facility

$250.00

Hospital Charge Code	283850
Hospital Revenue Code	271
Min. Negotiated Rate	$90.00
Max. Negotiated Rate	$178.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.00

SHOE COVERS

Facility

$250.00

Hospital Charge Code	283850
Hospital Revenue Code	271
Rate for Payer: Cash Price	$225.00

SHORT MEDIUM BLADE 18.5 X 9.0

Facility

$244.00

Hospital Charge Code	127780
Hospital Revenue Code	271
Min. Negotiated Rate	$87.84
Max. Negotiated Rate	$174.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$144.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.22
Rate for Payer: Cash Price	$219.60
Rate for Payer: UnitedHealthcare Commercial	$162.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$87.84

Know your out-of-pocket cost for care.

All Charges