Madison Medical Center

All Charges

Charge

Type

Setting

Price

LAMOTRIGINE 150MG TAB EMP

Facility

$32.00

Service Code	NDC 1E+11
Hospital Charge Code	2625765
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

LAMOTRIGINE 150MG TAB EMP

Facility

$32.00

Service Code	NDC 1E+11
Hospital Charge Code	2625765
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 200MG TAB EMP

Facility

$40.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2619151
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

LAMOTRIGINE 200MG TAB EMP

Facility

$40.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2619151
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

LAMOTRIGINE (LAMICTAL) 100MG TAB

Facility

$40.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2626603
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

LAMOTRIGINE (LAMICTAL) 100MG TAB

Facility

$40.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2626603
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

LAMOTRIGINE (LAMICTAL) 25MG TAB

Facility

$35.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2626498
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

LAMOTRIGINE (LAMICTAL) 25MG TAB

Facility

$35.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2626498
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

LAMOTRIGINE (LAMICTAL) 25MG TAB EMP

Facility

$35.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2623772
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

LAMOTRIGINE (LAMICTAL) 25MG TAB EMP

Facility

$35.00

Service Code	NDC 2.93E+10
Hospital Charge Code	2623772
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

LAMOTRIGINE XR 25MG TAB EMP

Facility

$32.00

Service Code	NDC 1E+11
Hospital Charge Code	2623063
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 XR 25MG TAB EMP

Facility

$32.00

Service Code	NDC 1E+11
Hospital Charge Code	2623063
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

LAMOTRIGINE XR 50MG TAB EMP

Facility

$32.00

Service Code	NDC 173075500
Hospital Charge Code	2624743
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

LAMOTRIGINE XR 50MG TAB EMP

Facility

$32.00

Service Code	NDC 173075500
Hospital Charge Code	2624743
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

LANSOPRAZOLE 15MG CAP EMP

Facility

$15.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2624431
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

LANSOPRAZOLE 15MG CAP EMP

Facility

$15.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2624431
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

LANSOPRAZOLE 30MG CAP EMP

Facility

$15.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2620497
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

LANSOPRAZOLE 30MG CAP EMP

Facility

$15.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2620497
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

LANTUS INS VIAL 10ML EMP

Facility

$60.00

Service Code	NDC 88222033
Hospital Charge Code	2626221
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

LANTUS INS VIAL 10ML EMP

Facility

$60.00

Service Code	NDC 88222033
Hospital Charge Code	2626221
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

LANTUS SOLOS INSN PEN EMP 5 PEN BOX

Facility

$346.00

Service Code	NDC 88221905
Hospital Charge Code	2622565
Hospital Revenue Code	250
Rate for Payer: Cash Price	$311.40

LANTUS SOLOS INSN PEN EMP 5 PEN BOX

Facility

$346.00

Service Code	NDC 88221905
Hospital Charge Code	2622565
Hospital Revenue Code	250
Min. Negotiated Rate	$124.56
Max. Negotiated Rate	$247.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$204.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$247.04
Rate for Payer: Cash Price	$311.40
Rate for Payer: UnitedHealthcare Commercial	$230.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.56

LAP APPENDECTOMY

Professional

Both

$1,544.00

Service Code	CPT 44970
Hospital Charge Code	4144970
Hospital Revenue Code	975
Min. Negotiated Rate	$456.89
Max. Negotiated Rate	$549.74
Rate for Payer: Aetna Commercial/Medicare Advantage	$549.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$456.89
Rate for Payer: Cash Price	$1,389.60
Rate for Payer: Cash Price	$1,389.60
Rate for Payer: Cigna Commercial HMO & PPO	$549.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$456.89
Rate for Payer: Home State Health Plan Medicaid Managed Care	$502.58
Rate for Payer: Home State Health Plan Medicare Advantage	$549.74
Rate for Payer: Optum Medicare Advantage	$540.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$456.89

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC

Facility

$30,140.96

Service Code	MSDRG 418
Min. Negotiated Rate	$15,070.48
Max. Negotiated Rate	$30,140.96
Rate for Payer: Aetna Medicare Advantage	$15,070.48
Rate for Payer: Cigna Commercial HMO & PPO	$15,070.48
Rate for Payer: Home State Health Plan Medicare Advantage	$15,070.48
Rate for Payer: Humana Commercial	$30,140.96
Rate for Payer: Humana Medicare Advantage	$15,070.48

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC

Facility

$41,086.68

Service Code	MSDRG 417
Min. Negotiated Rate	$20,543.34
Max. Negotiated Rate	$41,086.68
Rate for Payer: Aetna Medicare Advantage	$20,543.34
Rate for Payer: Cigna Commercial HMO & PPO	$20,543.34
Rate for Payer: Home State Health Plan Medicare Advantage	$20,543.34
Rate for Payer: Humana Commercial	$41,086.68
Rate for Payer: Humana Medicare Advantage	$20,543.34

Know your out-of-pocket cost for care.

All Charges