Madison Medical Center

All Charges

Charge

Type

Setting

Price

LIDO / EPI 2% INJ 30ML VIAL (SURGERY)

Facility

$79.00

Service Code	NDC 409318202
Hospital Charge Code	2624034
Hospital Revenue Code	250
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$56.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$46.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$56.41
Rate for Payer: Cash Price	$71.10
Rate for Payer: UnitedHealthcare Commercial	$52.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.44

LIDO / EPI 2% INJ 30ML VIAL (SURGERY)

Facility

$79.00

Service Code	NDC 409318202
Hospital Charge Code	2624034
Hospital Revenue Code	250
Rate for Payer: Cash Price	$71.10

LIFEPACK

Facility

$240.00

Service Code	CPT Y7506
Hospital Charge Code	1213030
Hospital Revenue Code	271
Rate for Payer: Cash Price	$216.00

LIFEPACK

Facility

$240.00

Service Code	CPT Y7506
Hospital Charge Code	1213030
Hospital Revenue Code	271
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$171.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$142.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$171.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: UnitedHealthcare Commercial	$160.08
Rate for Payer: UnitedHealthcare Medicare Advantage	$86.40

LIGATION MAJOR ARTERY EXTREMITY

Professional

Both

$1,764.00

Service Code	CPT 37618
Hospital Charge Code	4137618
Hospital Revenue Code	975
Min. Negotiated Rate	$292.90
Max. Negotiated Rate	$617.40
Rate for Payer: Aetna Commercial/Medicare Advantage	$350.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$292.90
Rate for Payer: Cash Price	$1,587.60
Rate for Payer: Cash Price	$1,587.60
Rate for Payer: Cigna Commercial HMO & PPO	$350.85
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$292.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$322.19
Rate for Payer: Home State Health Plan Medicare Advantage	$350.85
Rate for Payer: Optum Medicare Advantage	$617.40
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$292.90

LIGATION OF ANGIOACCESS AV FISTULA

Professional

Both

$1,376.00

Service Code	CPT 37607
Hospital Charge Code	4137607
Hospital Revenue Code	975
Min. Negotiated Rate	$279.71
Max. Negotiated Rate	$481.60
Rate for Payer: Aetna Commercial/Medicare Advantage	$331.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$279.71
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Cigna Commercial HMO & PPO	$331.89
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$279.71
Rate for Payer: Home State Health Plan Medicaid Managed Care	$307.68
Rate for Payer: Home State Health Plan Medicare Advantage	$331.89
Rate for Payer: Optum Medicare Advantage	$481.60
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$279.71

LIGATION OF FALLOPIAN TUBES

Facility

$1,234.00

Service Code	CPT 58600
Hospital Charge Code	4258600
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	$730.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$881.08
Rate for Payer: Cash Price	$1,110.60
Rate for Payer: Cash Price	$1,110.60
Rate for Payer: Cash Price	$1,110.60
Rate for Payer: Cash Price	$1,110.60
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	$823.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,918.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

LIGATION OF FALLOPIAN TUBES

Facility

$1,234.00

Service Code	CPT 58600
Hospital Charge Code	4258600
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,110.60

LIGATION OF INTERNAL HEMORRHOIDS-MULTIPL

Facility

$408.00

Service Code	CPT 46946
Hospital Charge Code	4146946
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$5,671.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$2,502.11
Rate for Payer: Aetna Medicare Advantage	$2,835.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$241.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$291.31
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cigna Commercial HMO & PPO	$2,835.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2,251.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$2,677.26
Rate for Payer: Home State Health Plan Medicare Advantage	$2,835.78
Rate for Payer: Humana Commercial	$5,671.56
Rate for Payer: Humana Medicare Advantage	$2,835.78
Rate for Payer: UnitedHealthcare Commercial	$272.14
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,502.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

LIGATION OF INTERNAL HEMORRHOIDS-MULTIPL

Facility

$408.00

Service Code	CPT 46946
Hospital Charge Code	4146946
Hospital Revenue Code	521
Rate for Payer: Cash Price	$367.20

LIGATOR (6-SHOOTER)

Facility

$840.00

Hospital Charge Code	1219485
Hospital Revenue Code	271
Min. Negotiated Rate	$302.40
Max. Negotiated Rate	$599.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$497.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$599.76
Rate for Payer: Cash Price	$756.00
Rate for Payer: UnitedHealthcare Commercial	$560.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$302.40

LIGATOR (6-SHOOTER)

Facility

$840.00

Hospital Charge Code	1219485
Hospital Revenue Code	271
Rate for Payer: Cash Price	$756.00

LIGHTED SPECULUM LARGE

Facility

$20.00

Hospital Charge Code	1819414
Hospital Revenue Code	271
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

LIGHTED SPECULUM LARGE

Facility

$20.00

Hospital Charge Code	1819414
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

LIGHTED SPECULUM MEDIUM

Facility

$20.00

Hospital Charge Code	1819413
Hospital Revenue Code	271
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

LIGHTED SPECULUM MEDIUM

Facility

$20.00

Hospital Charge Code	1819413
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

LIGHTED SPECULUM SMALL

Facility

$20.00

Hospital Charge Code	1819412
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

LIGHTED SPECULUM SMALL

Facility

$20.00

Hospital Charge Code	1819412
Hospital Revenue Code	271
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

LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$62,876.56

Service Code	MSDRG 956
Min. Negotiated Rate	$31,438.28
Max. Negotiated Rate	$62,876.56
Rate for Payer: Aetna Medicare Advantage	$31,438.28
Rate for Payer: Cigna Commercial HMO & PPO	$31,438.28
Rate for Payer: Home State Health Plan Medicare Advantage	$31,438.28
Rate for Payer: Humana Commercial	$62,876.56
Rate for Payer: Humana Medicare Advantage	$31,438.28

LIMITED PFT

Facility

$449.00

Service Code	CPT 94010
Hospital Charge Code	4500345
Hospital Revenue Code	460
Rate for Payer: Cash Price	$404.10

LIMITED PFT

Facility

$449.00

Service Code	CPT 94010
Hospital Charge Code	4500345
Hospital Revenue Code	460
Min. Negotiated Rate	$161.64
Max. Negotiated Rate	$441.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$194.65
Rate for Payer: Aetna Medicare Advantage	$220.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$265.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$320.59
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cigna Commercial HMO & PPO	$220.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$194.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$208.28
Rate for Payer: Home State Health Plan Medicare Advantage	$220.60
Rate for Payer: Humana Commercial	$441.20
Rate for Payer: Humana Medicare Advantage	$220.60
Rate for Payer: UnitedHealthcare Commercial	$299.48
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$194.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$161.64

LINACLOTIDE 145MCG CAP (LINZESS)

Facility

$60.00

Service Code	NDC 456120130
Hospital Charge Code	2698101
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

LINACLOTIDE 145MCG CAP (LINZESS)

Facility

$60.00

Service Code	NDC 456120130
Hospital Charge Code	2698101
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

LINCOCIN

Facility

$21.00

Service Code	CPT J2010
Hospital Charge Code	4102010
Hospital Revenue Code	636
Min. Negotiated Rate	$14.01
Max. Negotiated Rate	$14.01
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01

LINCOCIN

Facility

$21.00

Service Code	CPT J2010
Hospital Charge Code	4102010
Hospital Revenue Code	636
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

Know your out-of-pocket cost for care.

All Charges