Madison Medical Center

All Charges

Charge

Type

Setting

Price

MANIPULATION 5 -6

Facility

$170.00

Service Code	CPT 98927
Hospital Charge Code	4198927
Hospital Revenue Code	521
Rate for Payer: Cash Price	$153.00

MANIPULATION OF FORESKIN (PHINOSIS)

Professional

Both

$551.00

Service Code	CPT 54450
Hospital Charge Code	1854450
Hospital Revenue Code	975
Min. Negotiated Rate	$49.06
Max. Negotiated Rate	$192.85
Rate for Payer: Aetna Commercial/Medicare Advantage	$49.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$50.84
Rate for Payer: Cash Price	$495.90
Rate for Payer: Cash Price	$495.90
Rate for Payer: Cigna Commercial HMO & PPO	$49.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$50.84
Rate for Payer: Home State Health Plan Medicaid Managed Care	$55.92
Rate for Payer: Home State Health Plan Medicare Advantage	$49.06
Rate for Payer: Optum Medicare Advantage	$192.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$50.84

MANIP UNDER ANESTH SHOULDER JOINT

Professional

Both

$1,080.00

Service Code	CPT 23700
Hospital Charge Code	9323700
Hospital Revenue Code	975
Min. Negotiated Rate	$148.13
Max. Negotiated Rate	$378.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$172.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$148.13
Rate for Payer: Cash Price	$972.00
Rate for Payer: Cash Price	$972.00
Rate for Payer: Cigna Commercial HMO & PPO	$172.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$148.13
Rate for Payer: Home State Health Plan Medicaid Managed Care	$162.94
Rate for Payer: Home State Health Plan Medicare Advantage	$172.62
Rate for Payer: Optum Medicare Advantage	$378.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$148.13

MANNITOL 12.5GM/50ML (25%) INJECTION

Facility

$93.00

Service Code	HCPCS J2150
Hospital Charge Code	2655460
Hospital Revenue Code	250
Rate for Payer: Cash Price	$83.70

MANNITOL 12.5GM/50ML (25%) INJECTION

Facility

$93.00

Service Code	HCPCS J2150
Hospital Charge Code	2655460
Hospital Revenue Code	250
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$66.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: UnitedHealthcare Commercial	$62.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

MANNITOL INJ

Facility

$65.00

Hospital Charge Code	2058032
Hospital Revenue Code	370
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

MANNITOL INJ

Facility

$65.00

Hospital Charge Code	2058032
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

MANOMETER CUFFILL 10CC

Facility

$80.00

Hospital Charge Code	4500291
Hospital Revenue Code	271
Min. Negotiated Rate	$28.80
Max. Negotiated Rate	$57.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: UnitedHealthcare Commercial	$53.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.80

MANOMETER CUFFILL 10CC

Facility

$80.00

Hospital Charge Code	4500291
Hospital Revenue Code	271
Rate for Payer: Cash Price	$72.00

.MANUAL DIFF CHG

Facility

$63.00

Service Code	CPT 85007
Hospital Charge Code	2285007
Hospital Revenue Code	305
Min. Negotiated Rate	$3.42
Max. Negotiated Rate	$44.98
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.42
Rate for Payer: Aetna Medicare Advantage	$3.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cash Price	$56.70
Rate for Payer: Cigna Commercial HMO & PPO	$3.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.66
Rate for Payer: Home State Health Plan Medicare Advantage	$3.80
Rate for Payer: Humana Commercial	$7.60
Rate for Payer: Humana Medicare Advantage	$3.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

.MANUAL DIFF CHG

Facility

$63.00

Service Code	CPT 85007
Hospital Charge Code	2285007
Hospital Revenue Code	305
Rate for Payer: Cash Price	$56.70

MANUAL THERAPY TECHNIQUE 1 REGION 15 MIN

Facility

$80.00

Service Code	CPT 97140
Hospital Charge Code	9897140
Hospital Revenue Code	521
Min. Negotiated Rate	$21.95
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$24.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.12
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$26.10
Rate for Payer: UnitedHealthcare Commercial	$53.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$24.39
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MANUAL THERAPY TECHNIQUE 1 REGION 15 MIN

Facility

$80.00

Service Code	CPT 97140
Hospital Charge Code	9897140
Hospital Revenue Code	521
Rate for Payer: Cash Price	$72.00

MARFAN SYNDROME GENE SEQ

Facility

$3,980.00

Service Code	CPT 81408
Hospital Charge Code	2281408
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$4,000.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,800.00
Rate for Payer: Aetna Medicare Advantage	$2,000.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,356.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,841.72
Rate for Payer: Cash Price	$3,582.00
Rate for Payer: Cash Price	$3,582.00
Rate for Payer: Cash Price	$3,582.00
Rate for Payer: Cigna Commercial HMO & PPO	$2,000.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,800.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,926.00
Rate for Payer: Home State Health Plan Medicare Advantage	$2,000.00
Rate for Payer: Humana Commercial	$4,000.00
Rate for Payer: Humana Medicare Advantage	$2,000.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,800.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,432.80

MARFAN SYNDROME GENE SEQ

Facility

$3,980.00

Service Code	CPT 81408
Hospital Charge Code	2281408
Hospital Revenue Code	301
Rate for Payer: Cash Price	$3,582.00

MARKER W/ LABELS SANDEL #3310-P

Facility

$20.00

Hospital Charge Code	1269037
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

MARKER W/ LABELS SANDEL #3310-P

Facility

$20.00

Hospital Charge Code	1269037
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

MARKING PEN

Facility

$21.00

Hospital Charge Code	1269035
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

MARKING PEN

Facility

$21.00

Hospital Charge Code	1269035
Hospital Revenue Code	271
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

MARLEX MESH 2X12

Facility

$685.00

Hospital Charge Code	2813052
Hospital Revenue Code	271
Min. Negotiated Rate	$246.60
Max. Negotiated Rate	$489.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$405.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$489.09
Rate for Payer: Cash Price	$616.50
Rate for Payer: UnitedHealthcare Commercial	$456.89
Rate for Payer: UnitedHealthcare Medicare Advantage	$246.60

MARLEX MESH 2X12

Facility

$685.00

Hospital Charge Code	2813052
Hospital Revenue Code	271
Rate for Payer: Cash Price	$616.50

MARSAP. OF BARTHOLINS GLAND CYST

Facility

$695.00

Service Code	CPT 56440
Hospital Charge Code	5256440
Hospital Revenue Code	521
Rate for Payer: Cash Price	$625.50

MARSAP. OF BARTHOLINS GLAND CYST

Facility

$695.00

Service Code	CPT 56440
Hospital Charge Code	5256440
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	$411.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$496.23
Rate for Payer: Cash Price	$625.50
Rate for Payer: Cash Price	$625.50
Rate for Payer: Cash Price	$625.50
Rate for Payer: Cash Price	$625.50
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	$463.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2,918.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MARSUPIALIZATION CYST ABCESS OF LIVER

Professional

Both

$2,492.00

Service Code	CPT 47300
Hospital Charge Code	4147300
Hospital Revenue Code	975
Min. Negotiated Rate	$858.75
Max. Negotiated Rate	$1,023.20
Rate for Payer: Aetna Commercial/Medicare Advantage	$1,023.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$858.75
Rate for Payer: Cash Price	$2,242.80
Rate for Payer: Cash Price	$2,242.80
Rate for Payer: Cigna Commercial HMO & PPO	$1,023.20
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$858.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$944.62
Rate for Payer: Home State Health Plan Medicare Advantage	$1,023.20
Rate for Payer: Optum Medicare Advantage	$872.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$858.75

MARSUPIALIZATION OF BARTHOLIN'S GLAND

Facility

$900.00

Service Code	CPT 56440
Hospital Charge Code	4456440
Hospital Revenue Code	521
Rate for Payer: Cash Price	$810.00

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