Madison Medical Center

All Charges

Charge

Type

Setting

Price

LISINOPRIL (PRINIVIL) 10MG TAB UD

Facility

$22.00

Service Code	NDC 904648561
Hospital Charge Code	2655431
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

LISINOPRIL (PRINIVIL) 10MG TAB UD

Facility

$22.00

Service Code	NDC 904648561
Hospital Charge Code	2655431
Hospital Revenue Code	250
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

LISINOPRIL (PRINIVIL) 20MG TAB UD

Facility

$21.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2656001
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

LISINOPRIL (PRINIVIL) 20MG TAB UD

Facility

$21.00

Service Code	NDC 6.0687E+10
Hospital Charge Code	2656001
Hospital Revenue Code	250
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

LISINOPRIL (PRINIVIL) 40MG TAB

Facility

$20.00

Hospital Charge Code	2697062
Hospital Revenue Code	250
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

LISINOPRIL (PRINIVIL) 40MG TAB

Facility

$20.00

Hospital Charge Code	2697062
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

LISINOPRIL (PRINIVIL) 5MG TAB HE

Facility

$20.00

Service Code	NDC 7.6282E+10
Hospital Charge Code	2625811
Hospital Revenue Code	250
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

LISINOPRIL (PRINIVIL) 5MG TAB HE

Facility

$20.00

Service Code	NDC 7.6282E+10
Hospital Charge Code	2625811
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

LISINOPRIL (PRINIVIL) 5MG TAB UD

Facility

$20.00

Service Code	NDC 904679761
Hospital Charge Code	2656006
Hospital Revenue Code	250
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

LISINOPRIL (PRINIVIL) 5MG TAB UD

Facility

$20.00

Service Code	NDC 904679761
Hospital Charge Code	2656006
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

LITEAIRE VAL HOODING CHMR

Facility

$25.00

Hospital Charge Code	4500293
Hospital Revenue Code	271
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$17.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: UnitedHealthcare Commercial	$16.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.00

LITEAIRE VAL HOODING CHMR

Facility

$25.00

Hospital Charge Code	4500293
Hospital Revenue Code	271
Rate for Payer: Cash Price	$22.50

LITHIUM CARBONATE (LITHOBID) 300MG CAP

Facility

$14.00

Hospital Charge Code	2684664
Hospital Revenue Code	250
Min. Negotiated Rate	$5.04
Max. Negotiated Rate	$10.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.00
Rate for Payer: Cash Price	$12.60
Rate for Payer: UnitedHealthcare Commercial	$9.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.04

LITHIUM CARBONATE (LITHOBID) 300MG CAP

Facility

$14.00

Hospital Charge Code	2684664
Hospital Revenue Code	250
Rate for Payer: Cash Price	$12.60

LITHIUM (LABCORP)

Facility

$91.00

Service Code	CPT 80178
Hospital Charge Code	2212505
Hospital Revenue Code	301
Rate for Payer: Cash Price	$81.90

LITHIUM (LABCORP)

Facility

$91.00

Service Code	CPT 80178
Hospital Charge Code	2212505
Hospital Revenue Code	301
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$64.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.95
Rate for Payer: Aetna Medicare Advantage	$6.61
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cash Price	$81.90
Rate for Payer: Cigna Commercial HMO & PPO	$6.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.37
Rate for Payer: Home State Health Plan Medicare Advantage	$6.61
Rate for Payer: Humana Commercial	$13.22
Rate for Payer: Humana Medicare Advantage	$6.61
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

LITHIUM (LITHOBID) 150MG CAP

Facility

$20.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2626596
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

LITHIUM (LITHOBID) 150MG CAP

Facility

$20.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2626596
Hospital Revenue Code	250
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

.LITHOLINK AMMONIA

Facility

$30.00

Service Code	CPT 82140
Hospital Charge Code	221326
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

.LITHOLINK AMMONIA

Facility

$30.00

Service Code	CPT 82140
Hospital Charge Code	221326
Hospital Revenue Code	301
Min. Negotiated Rate	$10.80
Max. Negotiated Rate	$29.14
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.11
Rate for Payer: Aetna Medicare Advantage	$14.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$14.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.03
Rate for Payer: Home State Health Plan Medicare Advantage	$14.57
Rate for Payer: Humana Commercial	$29.14
Rate for Payer: Humana Medicare Advantage	$14.57
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

.LITHOLINK CALCIUM

Facility

$30.00

Service Code	CPT 82340
Hospital Charge Code	221327
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

.LITHOLINK CALCIUM

Facility

$30.00

Service Code	CPT 82340
Hospital Charge Code	221327
Hospital Revenue Code	301
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$21.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.43
Rate for Payer: Aetna Medicare Advantage	$6.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$6.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.81
Rate for Payer: Home State Health Plan Medicare Advantage	$6.03
Rate for Payer: Humana Commercial	$12.06
Rate for Payer: Humana Medicare Advantage	$6.03
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

.LITHOLINK CHLORIDE

Facility

$30.00

Service Code	CPT 82436
Hospital Charge Code	221328
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

.LITHOLINK CHLORIDE

Facility

$30.00

Service Code	CPT 82436
Hospital Charge Code	221328
Hospital Revenue Code	301
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$21.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.18
Rate for Payer: Aetna Medicare Advantage	$5.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$5.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.54
Rate for Payer: Home State Health Plan Medicare Advantage	$5.75
Rate for Payer: Humana Commercial	$11.50
Rate for Payer: Humana Medicare Advantage	$5.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

.LITHOLINK CITRATE

Facility

$30.00

Service Code	CPT 82507
Hospital Charge Code	221329
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

Know your out-of-pocket cost for care.

All Charges