Madison Medical Center

All Charges

Charge

Type

Setting

Price

LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC

Facility

$25,019.00

Service Code	MSDRG 419
Min. Negotiated Rate	$12,509.50
Max. Negotiated Rate	$25,019.00
Rate for Payer: Aetna Medicare Advantage	$12,509.50
Rate for Payer: Cigna Commercial HMO & PPO	$12,509.50
Rate for Payer: Home State Health Plan Medicare Advantage	$12,509.50
Rate for Payer: Humana Commercial	$25,019.00
Rate for Payer: Humana Medicare Advantage	$12,509.50

LAPAROSCOPIC EXTENSIVE LYSIS OF ADHESION

Professional

Both

$2,520.00

Service Code	CPT 44180
Hospital Charge Code	5444200
Hospital Revenue Code	975
Min. Negotiated Rate	$696.05
Max. Negotiated Rate	$882.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$827.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$696.05
Rate for Payer: Cash Price	$2,268.00
Rate for Payer: Cash Price	$2,268.00
Rate for Payer: Cigna Commercial HMO & PPO	$827.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$696.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$765.65
Rate for Payer: Home State Health Plan Medicare Advantage	$827.94
Rate for Payer: Optum Medicare Advantage	$882.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$696.05

LAPAROSCOPIC EXTENSIVE LYSIS OF ADHESION

Professional

Both

$2,940.00

Service Code	CPT 44180
Hospital Charge Code	5444180
Hospital Revenue Code	975
Min. Negotiated Rate	$696.05
Max. Negotiated Rate	$1,029.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$827.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$696.05
Rate for Payer: Cash Price	$2,646.00
Rate for Payer: Cash Price	$2,646.00
Rate for Payer: Cigna Commercial HMO & PPO	$827.94
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$696.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$765.65
Rate for Payer: Home State Health Plan Medicare Advantage	$827.94
Rate for Payer: Optum Medicare Advantage	$1,029.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$696.05

LAPAROSCOPIC GASTROSTOMY TUBE

Facility

$888.00

Hospital Charge Code	127493
Hospital Revenue Code	271
Rate for Payer: Cash Price	$799.20

LAPAROSCOPIC GASTROSTOMY TUBE

Facility

$888.00

Hospital Charge Code	127493
Hospital Revenue Code	271
Min. Negotiated Rate	$319.68
Max. Negotiated Rate	$634.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$525.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$634.03
Rate for Payer: Cash Price	$799.20
Rate for Payer: UnitedHealthcare Commercial	$592.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$319.68

LAPAROSCOPIC NISSEN FUNDOPLICATION

Professional

Both

$2,205.00

Service Code	CPT 43280
Hospital Charge Code	4143280
Hospital Revenue Code	975
Min. Negotiated Rate	$771.75
Max. Negotiated Rate	$970.95
Rate for Payer: Aetna Commercial/Medicare Advantage	$970.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$815.62
Rate for Payer: Cash Price	$1,984.50
Rate for Payer: Cash Price	$1,984.50
Rate for Payer: Cigna Commercial HMO & PPO	$970.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$815.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$897.18
Rate for Payer: Home State Health Plan Medicare Advantage	$970.95
Rate for Payer: Optum Medicare Advantage	$771.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$815.62

LAPAROSCOPY

Facility

$1,621.00

Service Code	CPT 49320
Hospital Charge Code	5256300
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$12,352.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,449.73
Rate for Payer: Aetna Medicare Advantage	$6,176.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$959.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,157.39
Rate for Payer: Cash Price	$1,458.90
Rate for Payer: Cash Price	$1,458.90
Rate for Payer: Cash Price	$1,458.90
Rate for Payer: Cash Price	$1,458.90
Rate for Payer: Cigna Commercial HMO & PPO	$6,176.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,904.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,831.21
Rate for Payer: Home State Health Plan Medicare Advantage	$6,176.47
Rate for Payer: Humana Commercial	$12,352.94
Rate for Payer: Humana Medicare Advantage	$6,176.47
Rate for Payer: UnitedHealthcare Commercial	$1,081.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,449.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

LAPAROSCOPY

Facility

$1,621.00

Service Code	CPT 49320
Hospital Charge Code	5256300
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,458.90

LAPAROSCOPY, APPENDECTOMY

Professional

Both

$1,563.00

Service Code	CPT 44970
Hospital Charge Code	4156315
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	$1,406.70
Rate for Payer: Cash Price	$1,406.70
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	$547.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$456.89

LAPAROSCOPY CHOLECYSTECTOMY

Professional

Both

$3,570.00

Service Code	CPT 47562
Hospital Charge Code	5447562
Hospital Revenue Code	975
Min. Negotiated Rate	$501.18
Max. Negotiated Rate	$1,249.50
Rate for Payer: Aetna Commercial/Medicare Advantage	$601.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$501.18
Rate for Payer: Cash Price	$3,213.00
Rate for Payer: Cash Price	$3,213.00
Rate for Payer: Cigna Commercial HMO & PPO	$601.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$501.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$551.30
Rate for Payer: Home State Health Plan Medicare Advantage	$601.79
Rate for Payer: Optum Medicare Advantage	$1,249.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$501.18

LAPAROSCOPY, CHOLECYSTECTOMY W/CHOLANGIO

Professional

Both

$3,166.00

Service Code	CPT 47563
Hospital Charge Code	4156341
Hospital Revenue Code	975
Min. Negotiated Rate	$545.34
Max. Negotiated Rate	$1,108.10
Rate for Payer: Aetna Commercial/Medicare Advantage	$652.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$545.34
Rate for Payer: Cash Price	$2,849.40
Rate for Payer: Cash Price	$2,849.40
Rate for Payer: Cigna Commercial HMO & PPO	$652.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$545.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$599.87
Rate for Payer: Home State Health Plan Medicare Advantage	$652.47
Rate for Payer: Optum Medicare Advantage	$1,108.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$545.34

LAPAROSCOPY CHOLECYSTECTOMY W/CHOLANGIOG

Professional

Both

$3,675.00

Service Code	CPT 47563
Hospital Charge Code	5447563
Hospital Revenue Code	975
Min. Negotiated Rate	$545.34
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$652.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$545.34
Rate for Payer: Cash Price	$3,307.50
Rate for Payer: Cash Price	$3,307.50
Rate for Payer: Cigna Commercial HMO & PPO	$652.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$545.34
Rate for Payer: Home State Health Plan Medicaid Managed Care	$599.87
Rate for Payer: Home State Health Plan Medicare Advantage	$652.47
Rate for Payer: Optum Medicare Advantage	$1,286.25
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$545.34

LAPAROSCOPY, CHOLECYSTECTOMY W/XPLOR-DUC

Professional

Both

$4,143.00

Service Code	CPT 47564
Hospital Charge Code	4156342
Hospital Revenue Code	975
Min. Negotiated Rate	$846.23
Max. Negotiated Rate	$1,450.05
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,013.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$846.23
Rate for Payer: Cash Price	$3,728.70
Rate for Payer: Cash Price	$3,728.70
Rate for Payer: Cigna Commercial HMO & PPO	$1,013.10
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$846.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$930.85
Rate for Payer: Home State Health Plan Medicare Advantage	$1,013.10
Rate for Payer: Optum Medicare Advantage	$1,450.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$846.23

LAPAROSCOPY CORE NEEDLE LIVER BIOPSY

Professional

Both

$1,050.00

Service Code	CPT 47379
Hospital Charge Code	5447379
Hospital Revenue Code	975
Min. Negotiated Rate	$367.50
Max. Negotiated Rate	$367.50
Rate for Payer: Cash Price	$945.00
Rate for Payer: Optum Medicare Advantage	$367.50

LAPAROSCOPY, DIAGNOSTIC

Professional

Both

$1,649.00

Service Code	CPT 49320
Hospital Charge Code	4156300
Hospital Revenue Code	975
Min. Negotiated Rate	$248.54
Max. Negotiated Rate	$577.15
Rate for Payer: Aetna Commercial/Medicare Advantage	$300.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$248.54
Rate for Payer: Cash Price	$1,484.10
Rate for Payer: Cash Price	$1,484.10
Rate for Payer: Cigna Commercial HMO & PPO	$300.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$248.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$273.39
Rate for Payer: Home State Health Plan Medicare Advantage	$300.35
Rate for Payer: Optum Medicare Advantage	$577.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$248.54

LAPAROSCOPY, INTESTINAL RESEC W/ANASTOMO

Professional

Both

$2,205.00

Service Code	CPT 44202
Hospital Charge Code	4144202
Hospital Revenue Code	975
Min. Negotiated Rate	$771.75
Max. Negotiated Rate	$1,237.12
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,237.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$1,047.08
Rate for Payer: Cash Price	$1,984.50
Rate for Payer: Cash Price	$1,984.50
Rate for Payer: Cigna Commercial HMO & PPO	$1,237.12
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,047.08
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,151.79
Rate for Payer: Home State Health Plan Medicare Advantage	$1,237.12
Rate for Payer: Optum Medicare Advantage	$771.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,047.08

LAPAROSCOPY, LYMPHNODE BIOPSY

Professional

Both

$2,025.00

Service Code	CPT 38570
Hospital Charge Code	4156311
Hospital Revenue Code	975
Min. Negotiated Rate	$388.03
Max. Negotiated Rate	$708.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$458.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$388.03
Rate for Payer: Cash Price	$1,822.50
Rate for Payer: Cash Price	$1,822.50
Rate for Payer: Cigna Commercial HMO & PPO	$458.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$388.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$426.83
Rate for Payer: Home State Health Plan Medicare Advantage	$458.95
Rate for Payer: Optum Medicare Advantage	$708.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$388.03

LAPAROSCOPY WITH LYSIS OF ADHESIONS

Facility

$523.00

Service Code	CPT 58660
Hospital Charge Code	5256304
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$12,352.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,449.73
Rate for Payer: Aetna Medicare Advantage	$6,176.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$309.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$373.42
Rate for Payer: Cash Price	$470.70
Rate for Payer: Cash Price	$470.70
Rate for Payer: Cash Price	$470.70
Rate for Payer: Cash Price	$470.70
Rate for Payer: Cigna Commercial HMO & PPO	$6,176.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,904.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,831.21
Rate for Payer: Home State Health Plan Medicare Advantage	$6,176.47
Rate for Payer: Humana Commercial	$12,352.94
Rate for Payer: Humana Medicare Advantage	$6,176.47
Rate for Payer: UnitedHealthcare Commercial	$348.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,449.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

LAPAROSCOPY WITH LYSIS OF ADHESIONS

Facility

$523.00

Service Code	CPT 58660
Hospital Charge Code	5256304
Hospital Revenue Code	521
Rate for Payer: Cash Price	$470.70

LAPAROSCOPY W/LYSIS OF ADHES

Professional

Both

$1,744.00

Service Code	CPT 58660
Hospital Charge Code	4156304
Hospital Revenue Code	975
Min. Negotiated Rate	$601.95
Max. Negotiated Rate	$670.46
Rate for Payer: Aetna Commercial/Medicare Advantage	$601.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$609.51
Rate for Payer: Cash Price	$1,569.60
Rate for Payer: Cash Price	$1,569.60
Rate for Payer: Cigna Commercial HMO & PPO	$601.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$609.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$670.46
Rate for Payer: Home State Health Plan Medicare Advantage	$601.95
Rate for Payer: Optum Medicare Advantage	$610.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$609.51

LAPAROSCOPY W/TUBAL

Facility

$1,621.00

Service Code	CPT 58670
Hospital Charge Code	5256301
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,458.90

LAPAROSCOPY W/TUBAL

Facility

$1,621.00

Service Code	CPT 58670
Hospital Charge Code	5256301
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$12,352.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,449.73
Rate for Payer: Aetna Medicare Advantage	$6,176.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$959.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,157.39
Rate for Payer: Cash Price	$1,458.90
Rate for Payer: Cash Price	$1,458.90
Rate for Payer: Cash Price	$1,458.90
Rate for Payer: Cash Price	$1,458.90
Rate for Payer: Cigna Commercial HMO & PPO	$6,176.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,904.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,831.21
Rate for Payer: Home State Health Plan Medicare Advantage	$6,176.47
Rate for Payer: Humana Commercial	$12,352.94
Rate for Payer: Humana Medicare Advantage	$6,176.47
Rate for Payer: UnitedHealthcare Commercial	$1,081.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,449.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

LAP CHOLE INST.

Facility

$777.00

Hospital Charge Code	125345
Hospital Revenue Code	360
Min. Negotiated Rate	$279.72
Max. Negotiated Rate	$518.26
Rate for Payer: Cash Price	$699.30
Rate for Payer: UnitedHealthcare Commercial	$518.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$279.72

LAP CHOLE INST.

Facility

$777.00

Hospital Charge Code	125345
Hospital Revenue Code	360
Rate for Payer: Cash Price	$699.30

LAP GASTROSTOMY W/G-TUBE

Professional

Both

$3,473.00

Service Code	CPT 43653
Hospital Charge Code	4156346
Hospital Revenue Code	975
Min. Negotiated Rate	$439.06
Max. Negotiated Rate	$1,215.55
Rate for Payer: Aetna Commercial/Medicare Advantage	$533.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$439.06
Rate for Payer: Cash Price	$3,125.70
Rate for Payer: Cash Price	$3,125.70
Rate for Payer: Cigna Commercial HMO & PPO	$533.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$439.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$482.97
Rate for Payer: Home State Health Plan Medicare Advantage	$533.35
Rate for Payer: Optum Medicare Advantage	$1,215.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$439.06

Know your out-of-pocket cost for care.

All Charges