Madison Medical Center

All Charges

Charge

Type

Setting

Price

MILNACIPRAN (SAVELLA) 4 WK TITRTN PK EMP

Facility

$34.00

Service Code	NDC 456150055
Hospital Charge Code	2624579
Hospital Revenue Code	250
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$24.28
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: UnitedHealthcare Commercial	$22.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.24

MILNACIPRAN (SAVELLA) 50MG TAB EMP

Facility

$34.00

Service Code	NDC 456151060
Hospital Charge Code	2624650
Hospital Revenue Code	250
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$24.28
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: UnitedHealthcare Commercial	$22.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.24

MILNACIPRAN (SAVELLA) 50MG TAB EMP

Facility

$34.00

Service Code	NDC 456151060
Hospital Charge Code	2624650
Hospital Revenue Code	250
Rate for Payer: Cash Price	$30.60

MINDRAY ADULT PULSE OX PROBE

Facility

$54.00

Service Code	CPT 94760
Hospital Charge Code	4500401
Hospital Revenue Code	460
Min. Negotiated Rate	$19.44
Max. Negotiated Rate	$38.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$31.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$38.56
Rate for Payer: Cash Price	$48.60
Rate for Payer: UnitedHealthcare Commercial	$36.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.44

MINDRAY ADULT PULSE OX PROBE

Facility

$54.00

Service Code	CPT 94760
Hospital Charge Code	4500401
Hospital Revenue Code	460
Rate for Payer: Cash Price	$48.60

MINDRAY PADS PULSE OX

Facility

$61.00

Service Code	CPT 94760
Hospital Charge Code	4500402
Hospital Revenue Code	460
Min. Negotiated Rate	$21.96
Max. Negotiated Rate	$43.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$43.55
Rate for Payer: Cash Price	$54.90
Rate for Payer: UnitedHealthcare Commercial	$40.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.96

MINDRAY PADS PULSE OX

Facility

$61.00

Service Code	CPT 94760
Hospital Charge Code	4500402
Hospital Revenue Code	460
Rate for Payer: Cash Price	$54.90

MINERAL OIL 10ML

Facility

$19.00

Hospital Charge Code	2655590
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

MINERAL OIL 10ML

Facility

$19.00

Hospital Charge Code	2655590
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

MINERAL OIL HEAVY 16OZ BOTTLE

Facility

$22.00

Hospital Charge Code	2623252
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

MINERAL OIL HEAVY 16OZ BOTTLE

Facility

$22.00

Hospital Charge Code	2623252
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

MINOCYCLINE 50MG CAP

Facility

$21.00

Service Code	NDC 591569460
Hospital Charge Code	2621500
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

MINOCYCLINE 50MG CAP

Facility

$21.00

Service Code	NDC 591569460
Hospital Charge Code	2621500
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

MINOCYCLINE 50MG CAP EMP

Facility

$21.00

Service Code	NDC 591569460
Hospital Charge Code	2621330
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

MINOCYCLINE 50MG CAP EMP

Facility

$21.00

Service Code	NDC 591569460
Hospital Charge Code	2621330
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

MINOR BLADDER PROCEDURES WITH CC

Facility

$27,441.10

Service Code	MSDRG 663
Min. Negotiated Rate	$13,720.55
Max. Negotiated Rate	$27,441.10
Rate for Payer: Aetna Medicare Advantage	$13,720.55
Rate for Payer: Cigna Commercial HMO & PPO	$13,720.55
Rate for Payer: Home State Health Plan Medicare Advantage	$13,720.55
Rate for Payer: Humana Commercial	$27,441.10
Rate for Payer: Humana Medicare Advantage	$13,720.55

MINOR BLADDER PROCEDURES WITH MCC

Facility

$51,760.22

Service Code	MSDRG 662
Min. Negotiated Rate	$25,880.11
Max. Negotiated Rate	$51,760.22
Rate for Payer: Aetna Medicare Advantage	$25,880.11
Rate for Payer: Cigna Commercial HMO & PPO	$25,880.11
Rate for Payer: Home State Health Plan Medicare Advantage	$25,880.11
Rate for Payer: Humana Commercial	$51,760.22
Rate for Payer: Humana Medicare Advantage	$25,880.11

MINOR BLADDER PROCEDURES WITHOUT CC/MCC

Facility

$20,027.82

Service Code	MSDRG 664
Min. Negotiated Rate	$10,013.91
Max. Negotiated Rate	$20,027.82
Rate for Payer: Aetna Medicare Advantage	$10,013.91
Rate for Payer: Cigna Commercial HMO & PPO	$10,013.91
Rate for Payer: Home State Health Plan Medicare Advantage	$10,013.91
Rate for Payer: Humana Commercial	$20,027.82
Rate for Payer: Humana Medicare Advantage	$10,013.91

MINOR SKIN DISORDERS WITH MCC

Facility

$27,331.28

Service Code	MSDRG 606
Min. Negotiated Rate	$13,665.64
Max. Negotiated Rate	$27,331.28
Rate for Payer: Aetna Medicare Advantage	$13,665.64
Rate for Payer: Cigna Commercial HMO & PPO	$13,665.64
Rate for Payer: Home State Health Plan Medicare Advantage	$13,665.64
Rate for Payer: Humana Commercial	$27,331.28
Rate for Payer: Humana Medicare Advantage	$13,665.64

MINOR SKIN DISORDERS WITHOUT MCC

Facility

$17,829.10

Service Code	MSDRG 607
Min. Negotiated Rate	$8,914.55
Max. Negotiated Rate	$17,829.10
Rate for Payer: Aetna Medicare Advantage	$8,914.55
Rate for Payer: Cigna Commercial HMO & PPO	$8,914.55
Rate for Payer: Home State Health Plan Medicare Advantage	$8,914.55
Rate for Payer: Humana Commercial	$17,829.10
Rate for Payer: Humana Medicare Advantage	$8,914.55

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC

Facility

$27,197.96

Service Code	MSDRG 345
Min. Negotiated Rate	$13,598.98
Max. Negotiated Rate	$27,197.96
Rate for Payer: Aetna Medicare Advantage	$13,598.98
Rate for Payer: Cigna Commercial HMO & PPO	$13,598.98
Rate for Payer: Home State Health Plan Medicare Advantage	$13,598.98
Rate for Payer: Humana Commercial	$27,197.96
Rate for Payer: Humana Medicare Advantage	$13,598.98

MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC

Facility

$44,187.14

Service Code	MSDRG 344
Min. Negotiated Rate	$22,093.57
Max. Negotiated Rate	$44,187.14
Rate for Payer: Aetna Medicare Advantage	$22,093.57
Rate for Payer: Cigna Commercial HMO & PPO	$22,093.57
Rate for Payer: Home State Health Plan Medicare Advantage	$22,093.57
Rate for Payer: Humana Commercial	$44,187.14
Rate for Payer: Humana Medicare Advantage	$22,093.57

MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC

Facility

$22,207.78

Service Code	MSDRG 346
Min. Negotiated Rate	$11,103.89
Max. Negotiated Rate	$22,207.78
Rate for Payer: Aetna Medicare Advantage	$11,103.89
Rate for Payer: Cigna Commercial HMO & PPO	$11,103.89
Rate for Payer: Home State Health Plan Medicare Advantage	$11,103.89
Rate for Payer: Humana Commercial	$22,207.78
Rate for Payer: Humana Medicare Advantage	$11,103.89

MINOXIDIL 2.5MG TAB EMP

Facility

$22.00

Service Code	NDC 4.9884E+10
Hospital Charge Code	2627306
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

MINOXIDIL 2.5MG TAB EMP

Facility

$22.00

Service Code	NDC 4.9884E+10
Hospital Charge Code	2627306
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

Know your out-of-pocket cost for care.

All Charges