Madison Medical Center

All Charges

Charge

Type

Setting

Price

BIOPSY LIVER ADD ON (SECONDARY) CODE

Professional

Both

$446.00

Service Code	CPT 47001
Hospital Charge Code	5447001
Hospital Revenue Code	975
Min. Negotiated Rate	$77.69
Max. Negotiated Rate	$156.10
Rate for Payer: Aetna Commercial/Medicare Advantage	$90.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$77.69
Rate for Payer: Cash Price	$401.40
Rate for Payer: Cash Price	$401.40
Rate for Payer: Cigna Commercial HMO & PPO	$90.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$77.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$85.46
Rate for Payer: Home State Health Plan Medicare Advantage	$90.04
Rate for Payer: Optum Medicare Advantage	$156.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$77.69

BIOPSY (NEEDLE), LIVER

Professional

Both

$370.00

Service Code	CPT 47001-51
Hospital Charge Code	4147001
Hospital Revenue Code	975
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$129.50
Rate for Payer: Cash Price	$333.00
Rate for Payer: Optum Medicare Advantage	$129.50

BIOPSY OF BREAST; NEEDLE OPEN INCISIONAL

Professional

Both

$945.00

Service Code	CPT 19101
Hospital Charge Code	5419101
Hospital Revenue Code	975
Min. Negotiated Rate	$204.04
Max. Negotiated Rate	$330.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$204.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$253.59
Rate for Payer: Cash Price	$850.50
Rate for Payer: Cash Price	$850.50
Rate for Payer: Cigna Commercial HMO & PPO	$204.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$253.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$278.95
Rate for Payer: Home State Health Plan Medicare Advantage	$204.04
Rate for Payer: Optum Medicare Advantage	$330.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$253.59

BIOPSY OF BREAST,PERCUTANEOUS NEEDLE COR

Professional

Both

$341.00

Service Code	CPT 19100
Hospital Charge Code	5419100
Hospital Revenue Code	975
Min. Negotiated Rate	$60.10
Max. Negotiated Rate	$129.68
Rate for Payer: Aetna Commercial/Medicare Advantage	$60.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$117.89
Rate for Payer: Cash Price	$306.90
Rate for Payer: Cash Price	$306.90
Rate for Payer: Cigna Commercial HMO & PPO	$60.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$117.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$129.68
Rate for Payer: Home State Health Plan Medicare Advantage	$60.10
Rate for Payer: Optum Medicare Advantage	$119.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$117.89

BIOPSY OF CERVIX SINGLE OR MULT W OR W/O

Facility

$400.00

Service Code	CPT 57500
Hospital Charge Code	9257500
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$1,882.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$830.28
Rate for Payer: Aetna Medicare Advantage	$941.00
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	$941.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$747.25
Rate for Payer: Home State Health Plan Medicaid Managed Care	$888.40
Rate for Payer: Home State Health Plan Medicare Advantage	$941.00
Rate for Payer: Humana Commercial	$1,882.00
Rate for Payer: Humana Medicare Advantage	$941.00
Rate for Payer: UnitedHealthcare Commercial	$266.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$830.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY OF CERVIX SINGLE OR MULT W OR W/O

Facility

$400.00

Service Code	CPT 57500
Hospital Charge Code	9257500
Hospital Revenue Code	521
Rate for Payer: Cash Price	$360.00

BIOPSY OF FLOOR OF MOUTH

Facility

$389.00

Service Code	CPT 41108
Hospital Charge Code	5441108
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$3,374.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,488.83
Rate for Payer: Aetna Medicare Advantage	$1,687.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$230.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$277.75
Rate for Payer: Cash Price	$350.10
Rate for Payer: Cash Price	$350.10
Rate for Payer: Cash Price	$350.10
Rate for Payer: Cash Price	$350.10
Rate for Payer: Cigna Commercial HMO & PPO	$1,687.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,339.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,593.05
Rate for Payer: Home State Health Plan Medicare Advantage	$1,687.37
Rate for Payer: Humana Commercial	$3,374.74
Rate for Payer: Humana Medicare Advantage	$1,687.37
Rate for Payer: UnitedHealthcare Commercial	$259.46
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY OF FLOOR OF MOUTH

Facility

$389.00

Service Code	CPT 41108
Hospital Charge Code	5441108
Hospital Revenue Code	521
Rate for Payer: Cash Price	$350.10

BIOPSY OF SALIVARY GLAND .

Facility

$198.00

Service Code	CPT 42400
Hospital Charge Code	4142400
Hospital Revenue Code	521
Rate for Payer: Cash Price	$178.20

BIOPSY OF SALIVARY GLAND .

Facility

$198.00

Service Code	CPT 42400
Hospital Charge Code	4142400
Hospital Revenue Code	521
Min. Negotiated Rate	$117.22
Max. Negotiated Rate	$1,446.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$638.34
Rate for Payer: Aetna Medicare Advantage	$723.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$117.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$141.37
Rate for Payer: Cash Price	$178.20
Rate for Payer: Cash Price	$178.20
Rate for Payer: Cash Price	$178.20
Rate for Payer: Cash Price	$178.20
Rate for Payer: Cigna Commercial HMO & PPO	$723.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$574.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$683.02
Rate for Payer: Home State Health Plan Medicare Advantage	$723.47
Rate for Payer: Humana Commercial	$1,446.94
Rate for Payer: Humana Medicare Advantage	$723.47
Rate for Payer: UnitedHealthcare Commercial	$132.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$638.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY OF SKIN ADD'L LESION

Facility

$100.00

Service Code	CPT 11103
Hospital Charge Code	5411101
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

BIOPSY OF SKIN ADD'L LESION

Facility

$100.00

Service Code	CPT 11103
Hospital Charge Code	5411101
Hospital Revenue Code	521
Rate for Payer: Cash Price	$90.00

BIOPSY OF SKIN, EA ADDL LESION

Facility

$150.00

Service Code	CPT 11103
Hospital Charge Code	9711101
Hospital Revenue Code	521
Rate for Payer: Cash Price	$135.00

BIOPSY OF SKIN, EA ADDL LESION

Facility

$150.00

Service Code	CPT 11103
Hospital Charge Code	9711101
Hospital Revenue Code	521
Min. Negotiated Rate	$88.80
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$107.10
Rate for Payer: Cash Price	$135.00
Rate for Payer: Cash Price	$135.00
Rate for Payer: UnitedHealthcare Commercial	$100.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY OF SKIN SINGLE LESION

Facility

$170.00

Service Code	CPT 11102
Hospital Charge Code	4211100
Hospital Revenue Code	521
Min. Negotiated Rate	$100.64
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	$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	$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	$113.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY OF SKIN SINGLE LESION

Facility

$175.00

Service Code	CPT 11102
Hospital Charge Code	5411100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$157.50

BIOPSY OF SKIN SINGLE LESION

Facility

$175.00

Service Code	CPT 11102
Hospital Charge Code	5411100
Hospital Revenue Code	521
Min. Negotiated Rate	$103.60
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	$103.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$124.95
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cash Price	$157.50
Rate for Payer: Cash Price	$157.50
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	$116.72
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY OF SKIN SINGLE LESION

Facility

$170.00

Service Code	CPT 11102
Hospital Charge Code	4211100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$153.00

BIOPSY OF SKIN, SINGLE LESION

Facility

$165.00

Service Code	CPT 11102
Hospital Charge Code	9711100
Hospital Revenue Code	521
Rate for Payer: Cash Price	$148.50

BIOPSY OF SKIN, SINGLE LESION

Facility

$165.00

Service Code	CPT 11102
Hospital Charge Code	9711100
Hospital Revenue Code	521
Min. Negotiated Rate	$97.68
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	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
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	$110.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$366.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY OF TEMPORAL ARTERY

Facility

$616.00

Service Code	CPT 37609
Hospital Charge Code	4137609
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$3,374.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,488.83
Rate for Payer: Aetna Medicare Advantage	$1,687.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$364.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$439.82
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cigna Commercial HMO & PPO	$1,687.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,339.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,593.05
Rate for Payer: Home State Health Plan Medicare Advantage	$1,687.37
Rate for Payer: Humana Commercial	$3,374.74
Rate for Payer: Humana Medicare Advantage	$1,687.37
Rate for Payer: UnitedHealthcare Commercial	$410.87
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,488.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY OF TEMPORAL ARTERY

Facility

$616.00

Service Code	CPT 37609
Hospital Charge Code	4137609
Hospital Revenue Code	521
Rate for Payer: Cash Price	$554.40

BIOPSY OF TONGUE POSTERIOR ONE-THIRD

Facility

$425.00

Service Code	CPT 41105
Hospital Charge Code	4241105
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$6,774.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,988.72
Rate for Payer: Aetna Medicare Advantage	$3,387.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$251.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$303.45
Rate for Payer: Cash Price	$382.50
Rate for Payer: Cash Price	$382.50
Rate for Payer: Cash Price	$382.50
Rate for Payer: Cash Price	$382.50
Rate for Payer: Cigna Commercial HMO & PPO	$3,387.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,689.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,197.93
Rate for Payer: Home State Health Plan Medicare Advantage	$3,387.27
Rate for Payer: Humana Commercial	$6,774.54
Rate for Payer: Humana Medicare Advantage	$3,387.27
Rate for Payer: UnitedHealthcare Commercial	$283.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,988.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

BIOPSY OF TONGUE POSTERIOR ONE-THIRD

Facility

$425.00

Service Code	CPT 41105
Hospital Charge Code	4241105
Hospital Revenue Code	521
Rate for Payer: Cash Price	$382.50

BIOPSY OF VULVA ONE LESION

Facility

$232.00

Service Code	CPT 56605
Hospital Charge Code	5256605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$208.80

Know your out-of-pocket cost for care.

All Charges