Madison Medical Center

All Charges

Charge

Type

Setting

Price

MELOXICAM (MOBIC) 7.5MG TAB

Facility

$22.00

Service Code	NDC 5.0268E+10
Hospital Charge Code	2626599
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

MELOXICAM (MOBIC) 7.5MG TAB EMP

Facility

$22.00

Service Code	NDC 6.9097E+10
Hospital Charge Code	2621756
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

MELOXICAM (MOBIC) 7.5MG TAB EMP

Facility

$22.00

Service Code	NDC 6.9097E+10
Hospital Charge Code	2621756
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

MEMANTINE (NAMENDA) 5MG TAB UD

Facility

$32.00

Service Code	NDC 591387045
Hospital Charge Code	2626526
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

MEMANTINE (NAMENDA) 5MG TAB UD

Facility

$32.00

Service Code	NDC 591387045
Hospital Charge Code	2626526
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$8,336.39

Service Code	APR-DRG 5323
Min. Negotiated Rate	$8,336.39
Max. Negotiated Rate	$8,336.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,336.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,336.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,336.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,336.39

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$15,846.26

Service Code	APR-DRG 5324
Min. Negotiated Rate	$15,846.26
Max. Negotiated Rate	$15,846.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,846.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,846.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,846.26
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,846.26

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$4,768.67

Service Code	APR-DRG 5321
Min. Negotiated Rate	$4,768.67
Max. Negotiated Rate	$4,768.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$4,768.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4,768.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4,768.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4,768.67

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS

Facility

$7,023.57

Service Code	APR-DRG 5322
Min. Negotiated Rate	$7,023.57
Max. Negotiated Rate	$7,023.57
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,023.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,023.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,023.57
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,023.57

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC

Facility

$19,411.26

Service Code	MSDRG 760
Min. Negotiated Rate	$9,705.63
Max. Negotiated Rate	$19,411.26
Rate for Payer: Aetna Medicare Advantage	$9,705.63
Rate for Payer: Cigna Commercial HMO & PPO	$9,705.63
Rate for Payer: Home State Health Plan Medicare Advantage	$9,705.63
Rate for Payer: Humana Commercial	$19,411.26
Rate for Payer: Humana Medicare Advantage	$9,705.63

MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC

Facility

$12,590.22

Service Code	MSDRG 761
Min. Negotiated Rate	$6,295.11
Max. Negotiated Rate	$12,590.22
Rate for Payer: Aetna Medicare Advantage	$6,295.11
Rate for Payer: Cigna Commercial HMO & PPO	$6,295.11
Rate for Payer: Home State Health Plan Medicare Advantage	$6,295.11
Rate for Payer: Humana Commercial	$12,590.22
Rate for Payer: Humana Medicare Advantage	$6,295.11

MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE

Facility

$8,818.06

Service Code	APR-DRG 7401
Min. Negotiated Rate	$8,818.06
Max. Negotiated Rate	$8,818.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,818.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,818.06
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,818.06
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,818.06

MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE

Facility

$13,670.86

Service Code	APR-DRG 7402
Min. Negotiated Rate	$13,670.86
Max. Negotiated Rate	$13,670.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$13,670.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13,670.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13,670.86
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13,670.86

MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE

Facility

$63,001.35

Service Code	APR-DRG 7404
Min. Negotiated Rate	$63,001.35
Max. Negotiated Rate	$63,001.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$63,001.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$63,001.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$63,001.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$63,001.35

MENTAL ILLNESS DIAGNOSIS WITH O.R. PROCEDURE

Facility

$27,032.01

Service Code	APR-DRG 7403
Min. Negotiated Rate	$27,032.01
Max. Negotiated Rate	$27,032.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$27,032.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$27,032.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27,032.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$27,032.01

MENTHOL COUGH DROPS BOX OF 20 LOZENGES

Facility

$20.00

Service Code	NDC 2.39E+10
Hospital Charge Code	2622205
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

MENTHOL COUGH DROPS BOX OF 20 LOZENGES

Facility

$20.00

Service Code	NDC 2.39E+10
Hospital Charge Code	2622205
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

MENTHOL COUGH LOZENGE

Facility

$32.00

Service Code	NDC 1.2546E+10
Hospital Charge Code	2698427
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

MENTHOL COUGH LOZENGE

Facility

$32.00

Service Code	NDC 1.2546E+10
Hospital Charge Code	2698427
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

MENTHOL/ZINC OX (CALMOSEPTINE) OINT 4OZ

Facility

$55.00

Service Code	NDC 799000104
Hospital Charge Code	2697107
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

MENTHOL/ZINC OX (CALMOSEPTINE) OINT 4OZ

Facility

$55.00

Service Code	NDC 799000104
Hospital Charge Code	2697107
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

MENZ GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9782962
Hospital Revenue Code	521
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.95
Rate for Payer: Aetna Medicare Advantage	$3.28
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: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$3.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.16
Rate for Payer: Home State Health Plan Medicare Advantage	$3.28
Rate for Payer: Humana Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.28
Rate for Payer: UnitedHealthcare Commercial	$20.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MENZ GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9782962
Hospital Revenue Code	521
Rate for Payer: Cash Price	$27.00

MENZ INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	9787502
Hospital Revenue Code	521
Rate for Payer: Cash Price	$110.70

MENZ INFLUENZA A&B TEST

Facility

$123.00

Service Code	CPT 87502
Hospital Charge Code	9787502
Hospital Revenue Code	521
Min. Negotiated Rate	$72.82
Max. Negotiated Rate	$191.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$86.22
Rate for Payer: Aetna Medicare Advantage	$95.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$72.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$87.82
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cash Price	$110.70
Rate for Payer: Cigna Commercial HMO & PPO	$95.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$77.60
Rate for Payer: Home State Health Plan Medicaid Managed Care	$92.26
Rate for Payer: Home State Health Plan Medicare Advantage	$95.80
Rate for Payer: Humana Commercial	$191.60
Rate for Payer: Humana Medicare Advantage	$95.80
Rate for Payer: UnitedHealthcare Commercial	$82.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$86.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges