Madison Medical Center

All Charges

Charge

Type

Setting

Price

MONITOR O.R.

Facility

$217.00

Hospital Charge Code	2813035
Hospital Revenue Code	271
Rate for Payer: Cash Price	$195.30

MONOLINYAH 35MCG-0.25MG 6X28 TAB PAK EMP

Facility

$113.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2624056
Hospital Revenue Code	250
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$80.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: UnitedHealthcare Commercial	$75.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

MONOLINYAH 35MCG-0.25MG 6X28 TAB PAK EMP

Facility

$113.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2624056
Hospital Revenue Code	250
Rate for Payer: Cash Price	$101.70

MONONESSA 0.25/0.035MG 6X28 TAB PAK EMP

Facility

$106.00

Service Code	NDC 5.2544E+10
Hospital Charge Code	2622452
Hospital Revenue Code	250
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$75.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: UnitedHealthcare Commercial	$70.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

MONONESSA 0.25/0.035MG 6X28 TAB PAK EMP

Facility

$106.00

Service Code	NDC 5.2544E+10
Hospital Charge Code	2622452
Hospital Revenue Code	250
Rate for Payer: Cash Price	$95.40

MONO SCREEN

Facility

$101.00

Service Code	CPT 86308
Hospital Charge Code	2213149
Hospital Revenue Code	306
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$72.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.66
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cigna Commercial HMO & PPO	$5.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.99
Rate for Payer: Home State Health Plan Medicare Advantage	$5.18
Rate for Payer: Humana Commercial	$10.36
Rate for Payer: Humana Medicare Advantage	$5.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

MONO SCREEN

Facility

$101.00

Service Code	CPT 86308
Hospital Charge Code	2213149
Hospital Revenue Code	306
Rate for Payer: Cash Price	$90.90

MONOSPOT

Facility

$24.00

Service Code	CPT 86308
Hospital Charge Code	4286308
Hospital Revenue Code	301
Rate for Payer: Cash Price	$21.60

MONOSPOT

Facility

$24.00

Service Code	CPT 86308
Hospital Charge Code	4286308
Hospital Revenue Code	301
Min. Negotiated Rate	$4.66
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.66
Rate for Payer: Aetna Medicare Advantage	$5.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cigna Commercial HMO & PPO	$5.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.99
Rate for Payer: Home State Health Plan Medicare Advantage	$5.18
Rate for Payer: Humana Commercial	$10.36
Rate for Payer: Humana Medicare Advantage	$5.18
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

MONOVISC

Facility

$1,500.00

Service Code	HCPCS J7325
Hospital Charge Code	91007325
Hospital Revenue Code	636
Min. Negotiated Rate	$1,000.50
Max. Negotiated Rate	$1,000.50
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: UnitedHealthcare Commercial	$1,000.50

MONOVISC

Facility

$1,500.00

Service Code	HCPCS J7325
Hospital Charge Code	91007325
Hospital Revenue Code	636
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$1,071.00
Rate for Payer: Aetna Medicare Advantage	$6.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$888.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,071.00
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Cash Price	$1,350.00
Rate for Payer: Cigna Commercial HMO & PPO	$6.02
Rate for Payer: Home State Health Plan Medicare Advantage	$6.02
Rate for Payer: Humana Commercial	$12.04
Rate for Payer: Humana Medicare Advantage	$6.02
Rate for Payer: UnitedHealthcare Commercial	$6.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$540.00

MONOVISC 88MG INJ 4ML

Facility

$7,995.00

Service Code	HCPCS J7325
Hospital Charge Code	2621698
Hospital Revenue Code	250
Rate for Payer: Cash Price	$7,195.50

MONOVISC 88MG INJ 4ML

Facility

$7,995.00

Service Code	HCPCS J7325
Hospital Charge Code	2621698
Hospital Revenue Code	250
Min. Negotiated Rate	$6.02
Max. Negotiated Rate	$5,708.43
Rate for Payer: Aetna Medicare Advantage	$6.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4,733.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5,708.43
Rate for Payer: Cash Price	$7,195.50
Rate for Payer: Cash Price	$7,195.50
Rate for Payer: Cigna Commercial HMO & PPO	$6.02
Rate for Payer: Home State Health Plan Medicare Advantage	$6.02
Rate for Payer: Humana Commercial	$12.04
Rate for Payer: Humana Medicare Advantage	$6.02
Rate for Payer: UnitedHealthcare Commercial	$5,332.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,878.20

MONTELUKAST 10MG TAB EMP

Facility

$42.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2698224
Hospital Revenue Code	250
Rate for Payer: Cash Price	$37.80

MONTELUKAST 10MG TAB EMP

Facility

$42.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2698224
Hospital Revenue Code	250
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

MONTELUKAST 4MG CHEW TAB EMP

Facility

$42.00

Service Code	NDC 2.7241E+10
Hospital Charge Code	2622463
Hospital Revenue Code	250
Rate for Payer: Cash Price	$37.80

MONTELUKAST 4MG CHEW TAB EMP

Facility

$42.00

Service Code	NDC 2.7241E+10
Hospital Charge Code	2622463
Hospital Revenue Code	250
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

MONTELUKAST 5MG CHEW TAB EMP

Facility

$42.00

Service Code	NDC 2.7241E+10
Hospital Charge Code	2621615
Hospital Revenue Code	250
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

MONTELUKAST 5MG CHEW TAB EMP

Facility

$42.00

Service Code	NDC 2.7241E+10
Hospital Charge Code	2621615
Hospital Revenue Code	250
Rate for Payer: Cash Price	$37.80

MONTELUKAST (SINGULAIR) 10MG TAB

Facility

$42.00

Service Code	NDC 603465502
Hospital Charge Code	2626302
Hospital Revenue Code	250
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$29.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$24.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$29.99
Rate for Payer: Cash Price	$37.80
Rate for Payer: UnitedHealthcare Commercial	$28.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.12

MONTELUKAST (SINGULAIR) 10MG TAB

Facility

$42.00

Service Code	NDC 603465502
Hospital Charge Code	2626302
Hospital Revenue Code	250
Rate for Payer: Cash Price	$37.80

MORPHINE 10 MG/ML INJ 1ML C2

Facility

$87.00

Service Code	HCPCS J2270
Hospital Charge Code	2655600
Hospital Revenue Code	250
Rate for Payer: Cash Price	$78.30

MORPHINE 10 MG/ML INJ 1ML C2

Facility

$87.00

Service Code	HCPCS J2270
Hospital Charge Code	2655600
Hospital Revenue Code	250
Min. Negotiated Rate	$31.32
Max. Negotiated Rate	$62.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$51.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.12
Rate for Payer: Cash Price	$78.30
Rate for Payer: UnitedHealthcare Commercial	$58.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$31.32

MORPHINE 20MG/ML CONC.ORAL SOL 30MLC2

Facility

$169.00

Service Code	NDC 406800330
Hospital Charge Code	2626509
Hospital Revenue Code	250
Rate for Payer: Cash Price	$152.10

MORPHINE 20MG/ML CONC.ORAL SOL 30MLC2

Facility

$169.00

Service Code	NDC 406800330
Hospital Charge Code	2626509
Hospital Revenue Code	250
Min. Negotiated Rate	$60.84
Max. Negotiated Rate	$120.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$120.67
Rate for Payer: Cash Price	$152.10
Rate for Payer: UnitedHealthcare Commercial	$112.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.84

Know your out-of-pocket cost for care.

All Charges