Madison Medical Center

All Charges

Charge

Type

Setting

Price

LDH ISOENZYMES

Facility

$166.00

Service Code	CPT 83625
Hospital Charge Code	2212503
Hospital Revenue Code	301
Rate for Payer: Cash Price	$149.40

LDH ISOENZYMES

Facility

$166.00

Service Code	CPT 83625
Hospital Charge Code	2212503
Hospital Revenue Code	301
Min. Negotiated Rate	$11.51
Max. Negotiated Rate	$118.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.51
Rate for Payer: Aetna Medicare Advantage	$12.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$118.52
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cash Price	$149.40
Rate for Payer: Cigna Commercial HMO & PPO	$12.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.51
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.32
Rate for Payer: Home State Health Plan Medicare Advantage	$12.79
Rate for Payer: Humana Commercial	$25.58
Rate for Payer: Humana Medicare Advantage	$12.79
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

LDH (LABCORP)

Facility

$44.00

Service Code	CPT 83615
Hospital Charge Code	2212132
Hospital Revenue Code	301
Rate for Payer: Cash Price	$39.60

LDH (LABCORP)

Facility

$44.00

Service Code	CPT 83615
Hospital Charge Code	2212132
Hospital Revenue Code	301
Min. Negotiated Rate	$5.44
Max. Negotiated Rate	$31.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.44
Rate for Payer: Aetna Medicare Advantage	$6.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cigna Commercial HMO & PPO	$6.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.44
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.82
Rate for Payer: Home State Health Plan Medicare Advantage	$6.04
Rate for Payer: Humana Commercial	$12.08
Rate for Payer: Humana Medicare Advantage	$6.04
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

LDL DIRECT

Facility

$127.00

Service Code	CPT 83721
Hospital Charge Code	2283721
Hospital Revenue Code	301
Min. Negotiated Rate	$9.45
Max. Negotiated Rate	$90.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$9.45
Rate for Payer: Aetna Medicare Advantage	$10.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$90.68
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cigna Commercial HMO & PPO	$10.50
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10.11
Rate for Payer: Home State Health Plan Medicare Advantage	$10.50
Rate for Payer: Humana Commercial	$21.00
Rate for Payer: Humana Medicare Advantage	$10.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

LDL DIRECT

Facility

$127.00

Service Code	CPT 83721
Hospital Charge Code	2283721
Hospital Revenue Code	301
Rate for Payer: Cash Price	$114.30

LEAD LEVEL

Facility

$119.00

Service Code	CPT 83655
Hospital Charge Code	2212275
Hospital Revenue Code	301
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$84.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.90
Rate for Payer: Aetna Medicare Advantage	$12.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$70.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$84.97
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cigna Commercial HMO & PPO	$12.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.66
Rate for Payer: Home State Health Plan Medicare Advantage	$12.11
Rate for Payer: Humana Commercial	$24.22
Rate for Payer: Humana Medicare Advantage	$12.11
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84

LEAD LEVEL

Facility

$119.00

Service Code	CPT 83655
Hospital Charge Code	2212275
Hospital Revenue Code	301
Rate for Payer: Cash Price	$107.10

LEAD, OTHER SOURCE

Facility

$129.00

Service Code	CPT 83655
Hospital Charge Code	2283655
Hospital Revenue Code	301
Rate for Payer: Cash Price	$116.10

LEAD, OTHER SOURCE

Facility

$129.00

Service Code	CPT 83655
Hospital Charge Code	2283655
Hospital Revenue Code	301
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$92.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.90
Rate for Payer: Aetna Medicare Advantage	$12.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cigna Commercial HMO & PPO	$12.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.66
Rate for Payer: Home State Health Plan Medicare Advantage	$12.11
Rate for Payer: Humana Commercial	$24.22
Rate for Payer: Humana Medicare Advantage	$12.11
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

LEAD, PEDIATRIC

Facility

$111.00

Service Code	CPT 83655
Hospital Charge Code	2212274
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.90

LEAD, PEDIATRIC

Facility

$111.00

Service Code	CPT 83655
Hospital Charge Code	2212274
Hospital Revenue Code	301
Min. Negotiated Rate	$10.90
Max. Negotiated Rate	$79.25
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.90
Rate for Payer: Aetna Medicare Advantage	$12.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.25
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cash Price	$99.90
Rate for Payer: Cigna Commercial HMO & PPO	$12.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.66
Rate for Payer: Home State Health Plan Medicare Advantage	$12.11
Rate for Payer: Humana Commercial	$24.22
Rate for Payer: Humana Medicare Advantage	$12.11
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.96

LEAVE OF ABSENCE DAY NH

Facility

$98.00

Hospital Charge Code	99100
Rate for Payer: Cash Price	$88.20

LEEP

Facility

$566.00

Service Code	CPT 57460
Hospital Charge Code	4257460
Hospital Revenue Code	521
Rate for Payer: Cash Price	$509.40

LEEP

Facility

$566.00

Service Code	CPT 57460
Hospital Charge Code	4257460
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$6,614.48
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,918.10
Rate for Payer: Aetna Medicare Advantage	$3,307.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$335.07
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$404.12
Rate for Payer: Cash Price	$509.40
Rate for Payer: Cash Price	$509.40
Rate for Payer: Cash Price	$509.40
Rate for Payer: Cash Price	$509.40
Rate for Payer: Cigna Commercial HMO & PPO	$3,307.24
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,626.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,122.37
Rate for Payer: Home State Health Plan Medicare Advantage	$3,307.24
Rate for Payer: Humana Commercial	$6,614.48
Rate for Payer: Humana Medicare Advantage	$3,307.24
Rate for Payer: UnitedHealthcare Commercial	$377.52
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,918.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

LEFLUNOMIDE (ARAVA) 10MG TAB EMP

Facility

$70.00

Service Code	NDC 88216130
Hospital Charge Code	2624449
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.00

LEFLUNOMIDE (ARAVA) 10MG TAB EMP

Facility

$70.00

Service Code	NDC 88216130
Hospital Charge Code	2624449
Hospital Revenue Code	250
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$49.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

LEFLUNOMIDE (ARAVA) 20MG TAB EMP

Facility

$70.00

Service Code	NDC 88216130
Hospital Charge Code	2622247
Hospital Revenue Code	250
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$49.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

LEFLUNOMIDE (ARAVA) 20MG TAB EMP

Facility

$70.00

Service Code	NDC 88216130
Hospital Charge Code	2622247
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.00

LEGIONELLA ANTIGEN

Facility

$389.00

Service Code	CPT 87278
Hospital Charge Code	2286313
Hospital Revenue Code	305
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$277.75
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.04
Rate for Payer: Aetna Medicare Advantage	$15.60
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: Cigna Commercial HMO & PPO	$15.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.02
Rate for Payer: Home State Health Plan Medicare Advantage	$15.60
Rate for Payer: Humana Commercial	$31.20
Rate for Payer: Humana Medicare Advantage	$15.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$140.04

LEGIONELLA ANTIGEN

Facility

$389.00

Service Code	CPT 87278
Hospital Charge Code	2286313
Hospital Revenue Code	305
Rate for Payer: Cash Price	$350.10

LEGIONELLA PNEUMOPHILA ANTIBODY

Facility

$106.00

Service Code	CPT 87278
Hospital Charge Code	2212902
Hospital Revenue Code	301
Rate for Payer: Cash Price	$95.40

LEGIONELLA PNEUMOPHILA ANTIBODY

Facility

$106.00

Service Code	CPT 87278
Hospital Charge Code	2212902
Hospital Revenue Code	301
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$75.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.04
Rate for Payer: Aetna Medicare Advantage	$15.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: Cash Price	$95.40
Rate for Payer: Cash Price	$95.40
Rate for Payer: Cigna Commercial HMO & PPO	$15.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.02
Rate for Payer: Home State Health Plan Medicare Advantage	$15.60
Rate for Payer: Humana Commercial	$31.20
Rate for Payer: Humana Medicare Advantage	$15.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

LENS, CONTINUOUS CORNEA LEVAGE

Facility

$126.00

Hospital Charge Code	2812008
Hospital Revenue Code	271
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$89.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: UnitedHealthcare Commercial	$84.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

LENS, CONTINUOUS CORNEA LEVAGE

Facility

$126.00

Hospital Charge Code	2812008
Hospital Revenue Code	271
Rate for Payer: Cash Price	$113.40

Know your out-of-pocket cost for care.

All Charges