Madison Medical Center

All Charges

Charge

Type

Setting

Price

LAPHROSCOPY W/FULGURATION OF OVARY

Facility

$2,431.00

Service Code	CPT 58662
Hospital Charge Code	5256303
Hospital Revenue Code	521
Rate for Payer: Cash Price	$2,187.90

LAPHROSCOPY W/FULGURATION OF OVARY

Facility

$2,431.00

Service Code	CPT 58662
Hospital Charge Code	5256303
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	$1,439.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,735.73
Rate for Payer: Cash Price	$2,187.90
Rate for Payer: Cash Price	$2,187.90
Rate for Payer: Cash Price	$2,187.90
Rate for Payer: Cash Price	$2,187.90
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	$1,621.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,449.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

LAP. OVARIA CYSTOTOMY

Professional

Both

$1,459.00

Service Code	CPT 49322
Hospital Charge Code	4156306
Hospital Revenue Code	975
Min. Negotiated Rate	$283.86
Max. Negotiated Rate	$510.65
Rate for Payer: Aetna Commercial/Medicare Advantage	$338.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$283.86
Rate for Payer: Cash Price	$1,313.10
Rate for Payer: Cash Price	$1,313.10
Rate for Payer: Cigna Commercial HMO & PPO	$338.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$283.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$312.25
Rate for Payer: Home State Health Plan Medicare Advantage	$338.67
Rate for Payer: Optum Medicare Advantage	$510.65
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$283.86

LAPROSCOPE

Facility

$1,439.00

Hospital Charge Code	1211815
Hospital Revenue Code	360
Min. Negotiated Rate	$518.04
Max. Negotiated Rate	$959.81
Rate for Payer: Cash Price	$1,295.10
Rate for Payer: UnitedHealthcare Commercial	$959.81
Rate for Payer: UnitedHealthcare Medicare Advantage	$518.04

LAPROSCOPE

Facility

$715.00

Hospital Charge Code	2811815
Hospital Revenue Code	271
Rate for Payer: Cash Price	$643.50

LAPROSCOPE

Facility

$715.00

Hospital Charge Code	2811815
Hospital Revenue Code	271
Min. Negotiated Rate	$257.40
Max. Negotiated Rate	$510.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$423.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$510.51
Rate for Payer: Cash Price	$643.50
Rate for Payer: UnitedHealthcare Commercial	$476.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$257.40

LAPROSCOPE

Facility

$1,439.00

Hospital Charge Code	1211815
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,295.10

LAPROSCOPY (ECTOPIC) W/O SALPINGECTOMY

Facility

$1,731.00

Service Code	CPT 59121
Hospital Charge Code	4259121
Rate for Payer: Cash Price	$1,557.90

LAPROSCOPY (ECTOPIC) W/SALPINGECTOMY

Facility

$1,779.00

Service Code	CPT 59120
Hospital Charge Code	4259120
Rate for Payer: Cash Price	$1,601.10

LAPROSCOPY W/ASPIRATION

Facility

$1,242.00

Service Code	CPT 49322
Hospital Charge Code	4256306
Rate for Payer: Cash Price	$1,117.80

LAPROSCOPY W/BIOPSY

Facility

$1,242.00

Service Code	CPT 49321
Hospital Charge Code	4256305
Rate for Payer: Cash Price	$1,117.80

LAPROSCOPY W/ EXCISION/FULG OF LESION

Facility

$1,810.00

Service Code	CPT 58662
Hospital Charge Code	4256303
Rate for Payer: Cash Price	$1,629.00

LAPROSCOPY W/LYSES OF ADHESIONS

Facility

$1,810.00

Service Code	CPT 58660
Hospital Charge Code	4256304
Rate for Payer: Cash Price	$1,629.00

LAPROSCOPY W/MECH. TUBAL OCCLUSION

Facility

$1,212.00

Service Code	CPT 58671
Hospital Charge Code	4256302
Rate for Payer: Cash Price	$1,090.80

LAPROSCOPY W/RESECTION OF ADNEXAL STRUCT

Facility

$1,810.00

Service Code	CPT 58661
Hospital Charge Code	4256307
Rate for Payer: Cash Price	$1,629.00

LAPROSCOPY W/TUBAL FULGERATION

Facility

$1,212.00

Service Code	CPT 58670
Hospital Charge Code	4256301
Rate for Payer: Cash Price	$1,090.80

LAP SPONGE

Facility

$28.00

Hospital Charge Code	1219483
Hospital Revenue Code	271
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

LAP SPONGE

Facility

$28.00

Hospital Charge Code	1219483
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

LAP W/LYSIS ADHES W FULG OR EXC LES OVAR

Professional

Both

$1,654.00

Service Code	CPT 58662
Hospital Charge Code	4158662
Hospital Revenue Code	975
Min. Negotiated Rate	$578.90
Max. Negotiated Rate	$704.05
Rate for Payer: Aetna Commercial/Medicare Advantage	$620.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$640.05
Rate for Payer: Cash Price	$1,488.60
Rate for Payer: Cash Price	$1,488.60
Rate for Payer: Cigna Commercial HMO & PPO	$620.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$640.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$704.05
Rate for Payer: Home State Health Plan Medicare Advantage	$620.63
Rate for Payer: Optum Medicare Advantage	$578.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$640.05

LARIN FE 1/20 6X28 TAB EMP

Facility

$113.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2625890
Hospital Revenue Code	250
Rate for Payer: Cash Price	$101.70

LARIN FE 1/20 6X28 TAB EMP

Facility

$113.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2625890
Hospital Revenue Code	250
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$80.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: UnitedHealthcare Commercial	$75.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

LARYNGOSCOPY/BIOPSY TRAY

Facility

$1,341.00

Hospital Charge Code	129110
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,206.90

LARYNGOSCOPY/BIOPSY TRAY

Facility

$1,341.00

Hospital Charge Code	129110
Hospital Revenue Code	360
Min. Negotiated Rate	$482.76
Max. Negotiated Rate	$894.45
Rate for Payer: Cash Price	$1,206.90
Rate for Payer: UnitedHealthcare Commercial	$894.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$482.76

LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; DIAGN

Facility

$500.00

Service Code	CPT 31575
Hospital Charge Code	9331575
Hospital Revenue Code	521
Rate for Payer: Cash Price	$450.00

LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; DIAGN

Facility

$500.00

Service Code	CPT 31575
Hospital Charge Code	9331575
Hospital Revenue Code	521
Min. Negotiated Rate	$161.94
Max. Negotiated Rate	$407.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$179.93
Rate for Payer: Aetna Medicare Advantage	$203.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$296.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$357.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cash Price	$450.00
Rate for Payer: Cigna Commercial HMO & PPO	$203.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$161.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$192.53
Rate for Payer: Home State Health Plan Medicare Advantage	$203.93
Rate for Payer: Humana Commercial	$407.86
Rate for Payer: Humana Medicare Advantage	$203.93
Rate for Payer: UnitedHealthcare Commercial	$333.50
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$179.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges