Madison Medical Center

All Charges

Charge

Type

Setting

Price

MIOCHOL

Facility

$156.00

Hospital Charge Code	1269109
Hospital Revenue Code	271
Min. Negotiated Rate	$56.16
Max. Negotiated Rate	$111.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: UnitedHealthcare Commercial	$104.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

MIOCHOL

Facility

$156.00

Hospital Charge Code	1269109
Hospital Revenue Code	271
Rate for Payer: Cash Price	$140.40

MIRTAZAPINE (REMERON) 15MG TAB

Facility

$35.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2626313
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

MIRTAZAPINE (REMERON) 15MG TAB

Facility

$35.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2626313
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

MIRTAZAPINE (REMERON) 15MG TAB EMP

Facility

$35.00

Service Code	NDC 5.7237E+10
Hospital Charge Code	2623416
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

MIRTAZAPINE (REMERON) 15MG TAB EMP

Facility

$35.00

Service Code	NDC 5.7237E+10
Hospital Charge Code	2623416
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

MIRTAZAPINE (REMERON) 30MG TAB EMP

Facility

$35.00

Service Code	NDC 5.7237E+10
Hospital Charge Code	2625883
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

MIRTAZAPINE (REMERON) 30MG TAB EMP

Facility

$35.00

Service Code	NDC 5.7237E+10
Hospital Charge Code	2625883
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

MIRTAZAPINE (REMERON) 45MG TAB EMP

Facility

$35.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2627239
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

MIRTAZAPINE (REMERON) 45MG TAB EMP

Facility

$35.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2627239
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

MIRVASO 0.33% TOPICAL GEL PUMP 30GM EMP

Facility

$9.00

Service Code	NDC 299598035
Hospital Charge Code	2623660
Hospital Revenue Code	250
Rate for Payer: Cash Price	$8.10

MIRVASO 0.33% TOPICAL GEL PUMP 30GM EMP

Facility

$9.00

Service Code	NDC 299598035
Hospital Charge Code	2623660
Hospital Revenue Code	250
Min. Negotiated Rate	$3.24
Max. Negotiated Rate	$6.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$6.43
Rate for Payer: Cash Price	$8.10
Rate for Payer: UnitedHealthcare Commercial	$6.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.24

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC

Facility

$24,545.80

Service Code	MSDRG 640
Min. Negotiated Rate	$12,272.90
Max. Negotiated Rate	$24,545.80
Rate for Payer: Aetna Medicare Advantage	$12,272.90
Rate for Payer: Cigna Commercial HMO & PPO	$12,272.90
Rate for Payer: Home State Health Plan Medicare Advantage	$12,272.90
Rate for Payer: Humana Commercial	$24,545.80
Rate for Payer: Humana Medicare Advantage	$12,272.90

MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC

Facility

$15,822.86

Service Code	MSDRG 641
Min. Negotiated Rate	$7,911.43
Max. Negotiated Rate	$15,822.86
Rate for Payer: Aetna Medicare Advantage	$7,911.43
Rate for Payer: Cigna Commercial HMO & PPO	$7,911.43
Rate for Payer: Home State Health Plan Medicare Advantage	$7,911.43
Rate for Payer: Humana Commercial	$15,822.86
Rate for Payer: Humana Medicare Advantage	$7,911.43

MITEK ANCHOR 3.5MM

Facility

$952.00

Hospital Charge Code	123333
Hospital Revenue Code	271
Rate for Payer: Cash Price	$856.80

MITEK ANCHOR 3.5MM

Facility

$952.00

Hospital Charge Code	123333
Hospital Revenue Code	271
Min. Negotiated Rate	$342.72
Max. Negotiated Rate	$679.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$563.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$679.73
Rate for Payer: Cash Price	$856.80
Rate for Payer: UnitedHealthcare Commercial	$634.98
Rate for Payer: UnitedHealthcare Medicare Advantage	$342.72

MITOCHONDRIAL AB

Facility

$107.00

Service Code	CPT 86255
Hospital Charge Code	22862551
Hospital Revenue Code	301
Rate for Payer: Cash Price	$96.30

MITOCHONDRIAL AB

Facility

$107.00

Service Code	CPT 86255
Hospital Charge Code	22862551
Hospital Revenue Code	301
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$76.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.85
Rate for Payer: Aetna Medicare Advantage	$12.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cash Price	$96.30
Rate for Payer: Cigna Commercial HMO & PPO	$12.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.85
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.61
Rate for Payer: Home State Health Plan Medicare Advantage	$12.05
Rate for Payer: Humana Commercial	$24.10
Rate for Payer: Humana Medicare Advantage	$12.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.85
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

MITTEN CONTROL

Facility

$89.00

Hospital Charge Code	2813745
Hospital Revenue Code	271
Rate for Payer: Cash Price	$80.10

MITTEN CONTROL

Facility

$89.00

Hospital Charge Code	2813745
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

MIVACRON INJ 2MG/ML

Facility

$48.00

Hospital Charge Code	2058071
Hospital Revenue Code	370
Rate for Payer: Cash Price	$43.20

MIVACRON INJ 2MG/ML

Facility

$48.00

Hospital Charge Code	2058071
Hospital Revenue Code	370
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

MIVACURIUM INJ 2MG/ML(MIVACRON)VIAL

Facility

$41.00

Hospital Charge Code	2657172
Hospital Revenue Code	250
Min. Negotiated Rate	$14.76
Max. Negotiated Rate	$29.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.27
Rate for Payer: Cash Price	$36.90
Rate for Payer: UnitedHealthcare Commercial	$27.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.76

MIVACURIUM INJ 2MG/ML(MIVACRON)VIAL

Facility

$41.00

Hospital Charge Code	2657172
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.90

MOBILITY EVALUATION

Facility

$50.00

Service Code	CPT G0372
Hospital Charge Code	9700372
Hospital Revenue Code	521
Rate for Payer: Cash Price	$45.00

Know your out-of-pocket cost for care.

All Charges