Madison Medical Center

All Charges

Charge

Type

Setting

Price

LACOSAMIDE

Facility

$409.00

Service Code	CPT 80339
Hospital Charge Code	2220299
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$292.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$242.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$292.03
Rate for Payer: Cash Price	$368.10
Rate for Payer: Cash Price	$368.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$147.24

LAC RING3000ML IRRIG

Facility

$34.00

Hospital Charge Code	123175
Hospital Revenue Code	271
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$24.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.28
Rate for Payer: Cash Price	$30.60
Rate for Payer: UnitedHealthcare Commercial	$22.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.24

LAC RING3000ML IRRIG

Facility

$34.00

Hospital Charge Code	123175
Hospital Revenue Code	271
Rate for Payer: Cash Price	$30.60

LACTIC ACID

Facility

$80.00

Service Code	CPT 83605
Hospital Charge Code	2212022
Hospital Revenue Code	301
Rate for Payer: Cash Price	$72.00

LACTIC ACID

Facility

$80.00

Service Code	CPT 83605
Hospital Charge Code	2212022
Hospital Revenue Code	301
Min. Negotiated Rate	$10.41
Max. Negotiated Rate	$57.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.41
Rate for Payer: Aetna Medicare Advantage	$11.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cigna Commercial HMO & PPO	$11.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.14
Rate for Payer: Home State Health Plan Medicare Advantage	$11.57
Rate for Payer: Humana Commercial	$23.14
Rate for Payer: Humana Medicare Advantage	$11.57
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.80

LACTOBACILLUS (ACIDOPHILUS) CAP

Facility

$20.00

Service Code	NDC 904421360
Hospital Charge Code	2626496
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

LACTOBACILLUS (ACIDOPHILUS) CAP

Facility

$20.00

Service Code	NDC 904421360
Hospital Charge Code	2626496
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

LACTOBACILLUS (LACTINEX) CHEW TAB

Facility

$20.00

Service Code	NDC 8290236850
Hospital Charge Code	2626385
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

LACTOBACILLUS (LACTINEX) CHEW TAB

Facility

$20.00

Service Code	NDC 8290236850
Hospital Charge Code	2626385
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

LACTOFERRIN STOOL

Facility

$414.00

Service Code	CPT 83631
Hospital Charge Code	2283630
Hospital Revenue Code	301
Min. Negotiated Rate	$17.67
Max. Negotiated Rate	$295.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$17.67
Rate for Payer: Aetna Medicare Advantage	$19.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$245.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$295.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: Cash Price	$372.60
Rate for Payer: Cigna Commercial HMO & PPO	$19.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$18.91
Rate for Payer: Home State Health Plan Medicare Advantage	$19.63
Rate for Payer: Humana Commercial	$39.26
Rate for Payer: Humana Medicare Advantage	$19.63
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$149.04

LACTOFERRIN STOOL

Facility

$414.00

Service Code	CPT 83631
Hospital Charge Code	2283630
Hospital Revenue Code	301
Rate for Payer: Cash Price	$372.60

LACTULOSE 10G/15ML SOL 237ML BOTTLE

Facility

$45.00

Service Code	NDC 121087308
Hospital Charge Code	2625505
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

LACTULOSE 10G/15ML SOL 237ML BOTTLE

Facility

$45.00

Service Code	NDC 121087308
Hospital Charge Code	2625505
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

LACTULOSE 10G/15ML SOL 946ML EMP

Facility

$45.00

Service Code	NDC 527512578
Hospital Charge Code	2625894
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

LACTULOSE 10G/15ML SOL 946ML EMP

Facility

$45.00

Service Code	NDC 527512578
Hospital Charge Code	2625894
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

LACTULOSE (DUPHALAC) 10G/15ML SOL UD

Facility

$20.00

Service Code	NDC 116400515
Hospital Charge Code	2626614
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

LACTULOSE (DUPHALAC) 10G/15ML SOL UD

Facility

$20.00

Service Code	NDC 116400515
Hospital Charge Code	2626614
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

LAMBDA LIGHT CHAIN

Facility

$352.00

Service Code	CPT 83883
Hospital Charge Code	2215122
Hospital Revenue Code	305
Rate for Payer: Cash Price	$316.80

LAMBDA LIGHT CHAIN

Facility

$352.00

Service Code	CPT 83883
Hospital Charge Code	2215122
Hospital Revenue Code	305
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$251.33
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.24
Rate for Payer: Aetna Medicare Advantage	$13.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$208.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$251.33
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cigna Commercial HMO & PPO	$13.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.10
Rate for Payer: Home State Health Plan Medicare Advantage	$13.60
Rate for Payer: Humana Commercial	$27.20
Rate for Payer: Humana Medicare Advantage	$13.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$126.72

LAMICTAL

Facility

$107.00

Service Code	CPT 80175
Hospital Charge Code	2212300
Hospital Revenue Code	301
Min. Negotiated Rate	$11.93
Max. Negotiated Rate	$76.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.93
Rate for Payer: Aetna Medicare Advantage	$13.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cigna Commercial HMO & PPO	$13.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.77
Rate for Payer: Home State Health Plan Medicare Advantage	$13.25
Rate for Payer: Humana Commercial	$26.50
Rate for Payer: Humana Medicare Advantage	$13.25
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

LAMICTAL

Facility

$107.00

Service Code	CPT 80175
Hospital Charge Code	2212300
Hospital Revenue Code	301
Rate for Payer: Cash Price	$96.30

LAMOITRIGINE XR 50MG TAB EMP

Facility

$26.00

Service Code	NDC 173075500
Hospital Charge Code	2623302
Hospital Revenue Code	250
Rate for Payer: Cash Price	$23.40

LAMOITRIGINE XR 50MG TAB EMP

Facility

$26.00

Service Code	NDC 173075500
Hospital Charge Code	2623302
Hospital Revenue Code	250
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$18.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$15.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$18.56
Rate for Payer: Cash Price	$23.40
Rate for Payer: UnitedHealthcare Commercial	$17.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.36

LAMOTRIGINE 100MG TAB EMP

Facility

$32.00

Service Code	NDC 1E+11
Hospital Charge Code	2619686
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

LAMOTRIGINE 100MG TAB EMP

Facility

$32.00

Service Code	NDC 1E+11
Hospital Charge Code	2619686
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

Know your out-of-pocket cost for care.

All Charges