Madison Medical Center

All Charges

Charge

Type

Setting

Price

.LITHOLINK VOLUME MEASUREMENT

Facility

$30.00

Service Code	CPT 81050
Hospital Charge Code	221340
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

.LITHOLINK VOLUME MEASUREMENT

Facility

$30.00

Service Code	CPT 81050
Hospital Charge Code	221340
Hospital Revenue Code	301
Min. Negotiated Rate	$3.28
Max. Negotiated Rate	$21.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.28
Rate for Payer: Aetna Medicare Advantage	$3.64
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	$3.64
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.28
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.51
Rate for Payer: Home State Health Plan Medicare Advantage	$3.64
Rate for Payer: Humana Commercial	$7.28
Rate for Payer: Humana Medicare Advantage	$3.64
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.28
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE

Professional

Both

$4,400.00

Service Code	CPT 50590
Hospital Charge Code	9350590
Hospital Revenue Code	975
Min. Negotiated Rate	$497.68
Max. Negotiated Rate	$1,540.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$497.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$587.02
Rate for Payer: Cash Price	$3,960.00
Rate for Payer: Cash Price	$3,960.00
Rate for Payer: Cigna Commercial HMO & PPO	$497.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$587.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$645.72
Rate for Payer: Home State Health Plan Medicare Advantage	$497.68
Rate for Payer: Optum Medicare Advantage	$1,540.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$587.02

LIVER BIOPSY TRAY

Facility

$89.00

Hospital Charge Code	2812039
Hospital Revenue Code	271
Min. Negotiated Rate	$32.04
Max. Negotiated Rate	$63.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$63.55
Rate for Payer: Cash Price	$80.10
Rate for Payer: UnitedHealthcare Commercial	$59.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.04

LIVER BIOPSY TRAY

Facility

$89.00

Hospital Charge Code	2812039
Hospital Revenue Code	271
Rate for Payer: Cash Price	$80.10

LIVER FUNCTION PANEL

Facility

$47.00

Service Code	CPT 80076
Hospital Charge Code	4280058
Hospital Revenue Code	521
Min. Negotiated Rate	$6.62
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.35
Rate for Payer: Aetna Medicare Advantage	$8.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$27.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$33.56
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cigna Commercial HMO & PPO	$8.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.86
Rate for Payer: Home State Health Plan Medicare Advantage	$8.17
Rate for Payer: Humana Commercial	$16.34
Rate for Payer: Humana Medicare Advantage	$8.17
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

LIVER FUNCTION PANEL

Facility

$47.00

Service Code	CPT 80076
Hospital Charge Code	4280058
Hospital Revenue Code	521
Rate for Payer: Cash Price	$42.30

LIVER KIDNEY MICROSOMAL ANTIBODY

Facility

$186.00

Service Code	CPT 86376
Hospital Charge Code	2215038
Hospital Revenue Code	302
Min. Negotiated Rate	$13.10
Max. Negotiated Rate	$132.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.10
Rate for Payer: Aetna Medicare Advantage	$14.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$110.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.80
Rate for Payer: Cash Price	$167.40
Rate for Payer: Cash Price	$167.40
Rate for Payer: Cash Price	$167.40
Rate for Payer: Cigna Commercial HMO & PPO	$14.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.02
Rate for Payer: Home State Health Plan Medicare Advantage	$14.55
Rate for Payer: Humana Commercial	$29.10
Rate for Payer: Humana Medicare Advantage	$14.55
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.96

LIVER KIDNEY MICROSOMAL ANTIBODY

Facility

$186.00

Service Code	CPT 86376
Hospital Charge Code	2215038
Hospital Revenue Code	302
Rate for Payer: Cash Price	$167.40

LIVER PROFILE

Facility

$288.00

Service Code	CPT 80076
Hospital Charge Code	221006
Hospital Revenue Code	301
Min. Negotiated Rate	$7.35
Max. Negotiated Rate	$205.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$7.35
Rate for Payer: Aetna Medicare Advantage	$8.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$170.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$205.63
Rate for Payer: Cash Price	$259.20
Rate for Payer: Cash Price	$259.20
Rate for Payer: Cash Price	$259.20
Rate for Payer: Cigna Commercial HMO & PPO	$8.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7.86
Rate for Payer: Home State Health Plan Medicare Advantage	$8.17
Rate for Payer: Humana Commercial	$16.34
Rate for Payer: Humana Medicare Advantage	$8.17
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$103.68

LIVER PROFILE

Facility

$288.00

Service Code	CPT 80076
Hospital Charge Code	221006
Hospital Revenue Code	301
Rate for Payer: Cash Price	$259.20

LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT

Facility

$166,810.18

Service Code	MSDRG 005
Min. Negotiated Rate	$83,405.09
Max. Negotiated Rate	$166,810.18
Rate for Payer: Aetna Medicare Advantage	$83,405.09
Rate for Payer: Cigna Commercial HMO & PPO	$83,405.09
Rate for Payer: Home State Health Plan Medicare Advantage	$83,405.09
Rate for Payer: Humana Commercial	$166,810.18
Rate for Payer: Humana Medicare Advantage	$83,405.09

LIVER TRANSPLANT WITHOUT MCC

Facility

$76,745.22

Service Code	MSDRG 006
Min. Negotiated Rate	$38,372.61
Max. Negotiated Rate	$76,745.22
Rate for Payer: Aetna Medicare Advantage	$38,372.61
Rate for Payer: Cigna Commercial HMO & PPO	$38,372.61
Rate for Payer: Home State Health Plan Medicare Advantage	$38,372.61
Rate for Payer: Humana Commercial	$76,745.22
Rate for Payer: Humana Medicare Advantage	$38,372.61

LMA MASK #3

Facility

$152.00

Hospital Charge Code	1213050
Hospital Revenue Code	271
Rate for Payer: Cash Price	$136.80

LMA MASK #3

Facility

$152.00

Hospital Charge Code	1213050
Hospital Revenue Code	271
Min. Negotiated Rate	$54.72
Max. Negotiated Rate	$108.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$108.53
Rate for Payer: Cash Price	$136.80
Rate for Payer: UnitedHealthcare Commercial	$101.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.72

LOBECTOMY, PARTIAL THYROIDECTOMY

Facility

$1,216.00

Service Code	CPT 60212
Hospital Charge Code	5260212
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	$719.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$868.22
Rate for Payer: Cash Price	$1,094.40
Rate for Payer: Cash Price	$1,094.40
Rate for Payer: Cash Price	$1,094.40
Rate for Payer: Cash Price	$1,094.40
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	$811.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,449.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

LOBECTOMY, PARTIAL THYROIDECTOMY

Facility

$1,216.00

Service Code	CPT 60212
Hospital Charge Code	5260212
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,094.40

LOBECTOMY,PARTIAL THYROID,UNILATER W/CON

Professional

Both

$3,026.00

Service Code	CPT 60212
Hospital Charge Code	4160212
Hospital Revenue Code	975
Min. Negotiated Rate	$779.03
Max. Negotiated Rate	$1,059.10
Rate for Payer: Aetna Commercial/Medicare Advantage	$928.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$779.03
Rate for Payer: Cash Price	$2,723.40
Rate for Payer: Cash Price	$2,723.40
Rate for Payer: Cigna Commercial HMO & PPO	$928.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$779.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$856.93
Rate for Payer: Home State Health Plan Medicare Advantage	$928.55
Rate for Payer: Optum Medicare Advantage	$1,059.10
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$779.03

LOBECTOMY,PARTIAL THYROID,UNILATER W/IST

Professional

Both

$2,311.00

Service Code	CPT 60210
Hospital Charge Code	4160210
Hospital Revenue Code	975
Min. Negotiated Rate	$534.69
Max. Negotiated Rate	$808.85
Rate for Payer: Aetna Commercial/Medicare Advantage	$616.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$534.69
Rate for Payer: Cash Price	$2,079.90
Rate for Payer: Cash Price	$2,079.90
Rate for Payer: Cigna Commercial HMO & PPO	$616.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$534.69
Rate for Payer: Home State Health Plan Medicaid Managed Care	$588.16
Rate for Payer: Home State Health Plan Medicare Advantage	$616.98
Rate for Payer: Optum Medicare Advantage	$808.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$534.69

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC

Facility

$31,910.10

Service Code	MSDRG 496
Min. Negotiated Rate	$15,955.05
Max. Negotiated Rate	$31,910.10
Rate for Payer: Aetna Medicare Advantage	$15,955.05
Rate for Payer: Cigna Commercial HMO & PPO	$15,955.05
Rate for Payer: Home State Health Plan Medicare Advantage	$15,955.05
Rate for Payer: Humana Commercial	$31,910.10
Rate for Payer: Humana Medicare Advantage	$15,955.05

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC

Facility

$60,698.88

Service Code	MSDRG 495
Min. Negotiated Rate	$30,349.44
Max. Negotiated Rate	$60,698.88
Rate for Payer: Aetna Medicare Advantage	$30,349.44
Rate for Payer: Cigna Commercial HMO & PPO	$30,349.44
Rate for Payer: Home State Health Plan Medicare Advantage	$30,349.44
Rate for Payer: Humana Commercial	$60,698.88
Rate for Payer: Humana Medicare Advantage	$30,349.44

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC

Facility

$22,553.62

Service Code	MSDRG 497
Min. Negotiated Rate	$11,276.81
Max. Negotiated Rate	$22,553.62
Rate for Payer: Aetna Medicare Advantage	$11,276.81
Rate for Payer: Cigna Commercial HMO & PPO	$11,276.81
Rate for Payer: Home State Health Plan Medicare Advantage	$11,276.81
Rate for Payer: Humana Commercial	$22,553.62
Rate for Payer: Humana Medicare Advantage	$11,276.81

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC

Facility

$51,053.08

Service Code	MSDRG 498
Min. Negotiated Rate	$25,526.54
Max. Negotiated Rate	$51,053.08
Rate for Payer: Aetna Medicare Advantage	$25,526.54
Rate for Payer: Cigna Commercial HMO & PPO	$25,526.54
Rate for Payer: Home State Health Plan Medicare Advantage	$25,526.54
Rate for Payer: Humana Commercial	$51,053.08
Rate for Payer: Humana Medicare Advantage	$25,526.54

LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC

Facility

$35,232.58

Service Code	MSDRG 499
Min. Negotiated Rate	$17,616.29
Max. Negotiated Rate	$35,232.58
Rate for Payer: Aetna Medicare Advantage	$17,616.29
Rate for Payer: Cigna Commercial HMO & PPO	$17,616.29
Rate for Payer: Home State Health Plan Medicare Advantage	$17,616.29
Rate for Payer: Humana Commercial	$35,232.58
Rate for Payer: Humana Medicare Advantage	$17,616.29

LOCKING PLATE LATERAL 8mm

Facility

$3,160.00

Hospital Charge Code	123408
Hospital Revenue Code	271
Rate for Payer: Cash Price	$2,844.00

Know your out-of-pocket cost for care.

All Charges