Madison Medical Center

All Charges

Charge

Type

Setting

Price

MICAFUNGIN 50MG IVPB

Facility

$565.00

Service Code	NDC 469325010
Hospital Charge Code	2619345
Hospital Revenue Code	250
Rate for Payer: Cash Price	$508.50

MICAFUNGIN 50MG IVPB

Facility

$565.00

Service Code	NDC 469325010
Hospital Charge Code	2619345
Hospital Revenue Code	250
Min. Negotiated Rate	$203.40
Max. Negotiated Rate	$403.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$334.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$403.41
Rate for Payer: Cash Price	$508.50
Rate for Payer: UnitedHealthcare Commercial	$376.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$203.40

MICONAZOLE 2% VAG CRM 45GM EMP

Facility

$67.00

Service Code	NDC 6.3736E+10
Hospital Charge Code	2626418
Hospital Revenue Code	250
Rate for Payer: Cash Price	$60.30

MICONAZOLE 2% VAG CRM 45GM EMP

Facility

$67.00

Service Code	NDC 6.3736E+10
Hospital Charge Code	2626418
Hospital Revenue Code	250
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

MICONAZOLE NIT 2% CRM 28G

Facility

$32.00

Service Code	NDC 472073556
Hospital Charge Code	2697087
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

MICONAZOLE NIT 2% CRM 28G

Facility

$32.00

Service Code	NDC 472073556
Hospital Charge Code	2697087
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

MICONAZOLE NITRATE 2% TOP PWDR 3OZ EMP

Facility

$35.00

Service Code	NDC 1.1701E+10
Hospital Charge Code	2625822
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

MICONAZOLE NITRATE 2% TOP PWDR 3OZ EMP

Facility

$35.00

Service Code	NDC 1.1701E+10
Hospital Charge Code	2625822
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

MICONAZOLE TOP POWDER 71GM

Facility

$37.00

Service Code	NDC 7E+10
Hospital Charge Code	2622519
Hospital Revenue Code	250
Min. Negotiated Rate	$13.32
Max. Negotiated Rate	$26.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$26.42
Rate for Payer: Cash Price	$33.30
Rate for Payer: UnitedHealthcare Commercial	$24.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.32

MICONAZOLE TOP POWDER 71GM

Facility

$37.00

Service Code	NDC 7E+10
Hospital Charge Code	2622519
Hospital Revenue Code	250
Rate for Payer: Cash Price	$33.30

MICROAIRE SAW BLADE#SP111

Facility

$131.00

Hospital Charge Code	1220725
Hospital Revenue Code	271
Min. Negotiated Rate	$47.16
Max. Negotiated Rate	$93.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$77.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$93.53
Rate for Payer: Cash Price	$117.90
Rate for Payer: UnitedHealthcare Commercial	$87.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$47.16

MICROAIRE SAW BLADE#SP111

Facility

$131.00

Hospital Charge Code	1220725
Hospital Revenue Code	271
Rate for Payer: Cash Price	$117.90

.MICROALBUMIN URINE RANDOM

Facility

$34.00

Service Code	CPT 82043
Hospital Charge Code	2282043
Hospital Revenue Code	301
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$24.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.20
Rate for Payer: Aetna Medicare Advantage	$5.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.28
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cash Price	$30.60
Rate for Payer: Cigna Commercial HMO & PPO	$5.78
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.56
Rate for Payer: Home State Health Plan Medicare Advantage	$5.78
Rate for Payer: Humana Commercial	$11.56
Rate for Payer: Humana Medicare Advantage	$5.78
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.24

.MICROALBUMIN URINE RANDOM

Facility

$34.00

Service Code	CPT 82043
Hospital Charge Code	2282043
Hospital Revenue Code	301
Rate for Payer: Cash Price	$30.60

MICRO EXAM (WETMOUNT)

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	5287210
Hospital Revenue Code	521
Rate for Payer: Cash Price	$36.00

MICRO EXAM (WETMOUNT)

Facility

$40.00

Service Code	CPT 87210
Hospital Charge Code	5287210
Hospital Revenue Code	521
Min. Negotiated Rate	$4.72
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.24
Rate for Payer: Aetna Medicare Advantage	$5.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$5.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.72
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.61
Rate for Payer: Home State Health Plan Medicare Advantage	$5.82
Rate for Payer: Humana Commercial	$11.64
Rate for Payer: Humana Medicare Advantage	$5.82
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

MICRO-MONTH SHIELD

Facility

$58.00

Hospital Charge Code	2813852
Hospital Revenue Code	271
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

MICRO-MONTH SHIELD

Facility

$58.00

Hospital Charge Code	2813852
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

MICROPOLY FAENI AB

Facility

$88.00

Service Code	CPT 86609
Hospital Charge Code	2286596
Hospital Revenue Code	305
Min. Negotiated Rate	$11.59
Max. Negotiated Rate	$62.83
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.59
Rate for Payer: Aetna Medicare Advantage	$12.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$52.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.83
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cigna Commercial HMO & PPO	$12.88
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.59
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.40
Rate for Payer: Home State Health Plan Medicare Advantage	$12.88
Rate for Payer: Humana Commercial	$25.76
Rate for Payer: Humana Medicare Advantage	$12.88
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.68

MICROPOLY FAENI AB

Facility

$88.00

Service Code	CPT 86609
Hospital Charge Code	2286596
Hospital Revenue Code	305
Rate for Payer: Cash Price	$79.20

MICROSCOPE

Facility

$1,142.00

Hospital Charge Code	1269040
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,027.80

MICROSCOPE

Facility

$1,142.00

Hospital Charge Code	1269040
Hospital Revenue Code	360
Min. Negotiated Rate	$411.12
Max. Negotiated Rate	$761.71
Rate for Payer: Cash Price	$1,027.80
Rate for Payer: UnitedHealthcare Commercial	$761.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$411.12

MICROSURGICAL TECHNIQUES REQ USE OF OF M

Professional

Both

$1,200.00

Service Code	CPT 69990
Hospital Charge Code	9369990
Hospital Revenue Code	975
Min. Negotiated Rate	$161.36
Max. Negotiated Rate	$420.00
Rate for Payer: Aetna Commercial/Medicare Advantage	$191.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$161.36
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cigna Commercial HMO & PPO	$191.47
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$161.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$177.50
Rate for Payer: Home State Health Plan Medicare Advantage	$191.47
Rate for Payer: Optum Medicare Advantage	$420.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$161.36

MIDAZOLAM INJ

Facility

$89.00

Service Code	HCPCS J2250
Hospital Charge Code	2058070
Hospital Revenue Code	370
Rate for Payer: Cash Price	$80.10

MIDAZOLAM INJ

Facility

$89.00

Service Code	HCPCS J2250
Hospital Charge Code	2058070
Hospital Revenue Code	370
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

Know your out-of-pocket cost for care.

All Charges