Madison Medical Center

All Charges

Charge

Type

Setting

Price

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$21,405.39

Service Code	APR-DRG 3612
Min. Negotiated Rate	$21,405.39
Max. Negotiated Rate	$21,405.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$21,405.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21,405.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21,405.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21,405.39

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$29,375.67

Service Code	APR-DRG 3613
Min. Negotiated Rate	$29,375.67
Max. Negotiated Rate	$29,375.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,375.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,375.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,375.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,375.67

SKIN GRAFT FOR SKIN AND SUBCUTANEOUS TISSUE DIAGNOSES

Facility

$56,639.73

Service Code	APR-DRG 3614
Min. Negotiated Rate	$56,639.73
Max. Negotiated Rate	$56,639.73
Rate for Payer: Aetna Better Health Medicaid/QHP	$56,639.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$56,639.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56,639.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$56,639.73

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC

Facility

$58,251.64

Service Code	MSDRG 574
Min. Negotiated Rate	$29,125.82
Max. Negotiated Rate	$58,251.64
Rate for Payer: Aetna Medicare Advantage	$29,125.82
Rate for Payer: Cigna Commercial HMO & PPO	$29,125.82
Rate for Payer: Home State Health Plan Medicare Advantage	$29,125.82
Rate for Payer: Humana Commercial	$58,251.64
Rate for Payer: Humana Medicare Advantage	$29,125.82

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC

Facility

$107,135.72

Service Code	MSDRG 573
Min. Negotiated Rate	$53,567.86
Max. Negotiated Rate	$107,135.72
Rate for Payer: Aetna Medicare Advantage	$53,567.86
Rate for Payer: Cigna Commercial HMO & PPO	$53,567.86
Rate for Payer: Home State Health Plan Medicare Advantage	$53,567.86
Rate for Payer: Humana Commercial	$107,135.72
Rate for Payer: Humana Medicare Advantage	$53,567.86

SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC

Facility

$31,801.40

Service Code	MSDRG 575
Min. Negotiated Rate	$15,900.70
Max. Negotiated Rate	$31,801.40
Rate for Payer: Aetna Medicare Advantage	$15,900.70
Rate for Payer: Cigna Commercial HMO & PPO	$15,900.70
Rate for Payer: Home State Health Plan Medicare Advantage	$15,900.70
Rate for Payer: Humana Commercial	$31,801.40
Rate for Payer: Humana Medicare Advantage	$15,900.70

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC

Facility

$31,752.56

Service Code	MSDRG 623
Min. Negotiated Rate	$15,876.28
Max. Negotiated Rate	$31,752.56
Rate for Payer: Aetna Medicare Advantage	$15,876.28
Rate for Payer: Cigna Commercial HMO & PPO	$15,876.28
Rate for Payer: Home State Health Plan Medicare Advantage	$15,876.28
Rate for Payer: Humana Commercial	$31,752.56
Rate for Payer: Humana Medicare Advantage	$15,876.28

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC

Facility

$59,644.18

Service Code	MSDRG 622
Min. Negotiated Rate	$29,822.09
Max. Negotiated Rate	$59,644.18
Rate for Payer: Aetna Medicare Advantage	$29,822.09
Rate for Payer: Cigna Commercial HMO & PPO	$29,822.09
Rate for Payer: Home State Health Plan Medicare Advantage	$29,822.09
Rate for Payer: Humana Commercial	$59,644.18
Rate for Payer: Humana Medicare Advantage	$29,822.09

SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC

Facility

$23,235.94

Service Code	MSDRG 624
Min. Negotiated Rate	$11,617.97
Max. Negotiated Rate	$23,235.94
Rate for Payer: Aetna Medicare Advantage	$11,617.97
Rate for Payer: Cigna Commercial HMO & PPO	$11,617.97
Rate for Payer: Home State Health Plan Medicare Advantage	$11,617.97
Rate for Payer: Humana Commercial	$23,235.94
Rate for Payer: Humana Medicare Advantage	$11,617.97

SKIN GRAFTS FOR INJURIES WITH CC/MCC

Facility

$61,450.70

Service Code	MSDRG 904
Min. Negotiated Rate	$30,725.35
Max. Negotiated Rate	$61,450.70
Rate for Payer: Aetna Medicare Advantage	$30,725.35
Rate for Payer: Cigna Commercial HMO & PPO	$30,725.35
Rate for Payer: Home State Health Plan Medicare Advantage	$30,725.35
Rate for Payer: Humana Commercial	$61,450.70
Rate for Payer: Humana Medicare Advantage	$30,725.35

SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC

Facility

$26,863.80

Service Code	MSDRG 905
Min. Negotiated Rate	$13,431.90
Max. Negotiated Rate	$26,863.80
Rate for Payer: Aetna Medicare Advantage	$13,431.90
Rate for Payer: Cigna Commercial HMO & PPO	$13,431.90
Rate for Payer: Home State Health Plan Medicare Advantage	$13,431.90
Rate for Payer: Humana Commercial	$26,863.80
Rate for Payer: Humana Medicare Advantage	$13,431.90

SKIN STAPLE REMOVER

Facility

$111.00

Hospital Charge Code	2819289
Hospital Revenue Code	271
Rate for Payer: Cash Price	$99.90

SKIN STAPLE REMOVER

Facility

$111.00

Hospital Charge Code	2819289
Hospital Revenue Code	271
Min. Negotiated Rate	$39.96
Max. Negotiated Rate	$79.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.25
Rate for Payer: Cash Price	$99.90
Rate for Payer: UnitedHealthcare Commercial	$74.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.96

SKIN STAPLER PMW35

Facility

$43.00

Hospital Charge Code	1219291
Hospital Revenue Code	272
Rate for Payer: Cash Price	$38.70

SKIN STAPLER PMW35

Facility

$43.00

Hospital Charge Code	1219291
Hospital Revenue Code	272
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

SKIN TAG EXCISION

Facility

$190.00

Service Code	CPT 11200
Hospital Charge Code	9811200
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

SKIN TAG EXCISION

Facility

$105.00

Service Code	CPT 11200
Hospital Charge Code	5211200
Hospital Revenue Code	521
Rate for Payer: Cash Price	$94.50

SKIN TAG EXCISION

Facility

$105.00

Service Code	CPT 11200
Hospital Charge Code	5211200
Hospital Revenue Code	521
Min. Negotiated Rate	$62.16
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	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
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	$70.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SKIN TAG EXCISION

Facility

$190.00

Service Code	CPT 11200
Hospital Charge Code	9811200
Hospital Revenue Code	521
Rate for Payer: Cash Price	$171.00

SKIN TAG EXCISION ADDL 10

Facility

$100.00

Service Code	CPT 11201
Hospital Charge Code	9811201
Hospital Revenue Code	521
Min. Negotiated Rate	$59.20
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$71.40
Rate for Payer: Cash Price	$90.00
Rate for Payer: Cash Price	$90.00
Rate for Payer: UnitedHealthcare Commercial	$66.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SKIN TAG EXCISION ADDL 10

Facility

$100.00

Service Code	CPT 11201
Hospital Charge Code	9811201
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

SKIN TAG REMOVAL

Facility

$105.00

Service Code	CPT 11200
Hospital Charge Code	9711200
Hospital Revenue Code	521
Rate for Payer: Cash Price	$94.50

SKIN TAG REMOVAL

Facility

$105.00

Service Code	CPT 11200
Hospital Charge Code	9711200
Hospital Revenue Code	521
Min. Negotiated Rate	$62.16
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	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
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	$70.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$180.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

SKIN ULCERS

Facility

$14,170.10

Service Code	APR-DRG 3803
Min. Negotiated Rate	$14,170.10
Max. Negotiated Rate	$14,170.10
Rate for Payer: Aetna Better Health Medicaid/QHP	$14,170.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14,170.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14,170.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14,170.10

SKIN ULCERS

Facility

$8,036.99

Service Code	APR-DRG 3801
Min. Negotiated Rate	$8,036.99
Max. Negotiated Rate	$8,036.99
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,036.99
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,036.99
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,036.99
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,036.99

Know your out-of-pocket cost for care.

All Charges