Madison Medical Center

All Charges

Charge

Type

Setting

Price

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$6,872.87

Service Code	APR-DRG 9302
Min. Negotiated Rate	$6,872.87
Max. Negotiated Rate	$6,872.87
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,872.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,872.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,872.87
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,872.87

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$15,851.80

Service Code	APR-DRG 9303
Min. Negotiated Rate	$15,851.80
Max. Negotiated Rate	$15,851.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$15,851.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15,851.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15,851.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15,851.80

MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE

Facility

$6,872.87

Service Code	APR-DRG 9301
Min. Negotiated Rate	$6,872.87
Max. Negotiated Rate	$6,872.87
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,872.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,872.87
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,872.87
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,872.87

MULTIVITAMIN+MINERALS LIQUID 236ML

Facility

$56.00

Service Code	NDC 5434462
Hospital Charge Code	2622512
Hospital Revenue Code	250
Rate for Payer: Cash Price	$50.40

MULTIVITAMIN+MINERALS LIQUID 236ML

Facility

$56.00

Service Code	NDC 5434462
Hospital Charge Code	2622512
Hospital Revenue Code	250
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$39.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$33.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.98
Rate for Payer: Cash Price	$50.40
Rate for Payer: UnitedHealthcare Commercial	$37.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.16

MULTIVITAMIN+MINERALS TABLET

Facility

$20.00

Service Code	NDC 904549261
Hospital Charge Code	2656530
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

MULTIVITAMIN+MINERALS TABLET

Facility

$20.00

Service Code	NDC 904549261
Hospital Charge Code	2656530
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

MULTIVITAMIN (MVI 12) 10ML INJ

Facility

$141.00

Service Code	NDC 5.4644E+10
Hospital Charge Code	2656540
Hospital Revenue Code	250
Min. Negotiated Rate	$50.76
Max. Negotiated Rate	$100.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$83.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$100.67
Rate for Payer: Cash Price	$126.90
Rate for Payer: UnitedHealthcare Commercial	$94.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$50.76

MULTIVITAMIN (MVI 12) 10ML INJ

Facility

$141.00

Service Code	NDC 5.4644E+10
Hospital Charge Code	2656540
Hospital Revenue Code	250
Rate for Payer: Cash Price	$126.90

MULTIVITAMIN (THERA) TAB

Facility

$20.00

Service Code	NDC 5.1645E+10
Hospital Charge Code	2697108
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

MULTIVITAMIN (THERA) TAB

Facility

$20.00

Service Code	NDC 5.1645E+10
Hospital Charge Code	2697108
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

MUMPS AB IGG

Facility

$110.00

Service Code	CPT 86735
Hospital Charge Code	22867351
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

MUMPS AB IGG

Facility

$110.00

Service Code	CPT 86735
Hospital Charge Code	22867351
Hospital Revenue Code	301
Min. Negotiated Rate	$11.75
Max. Negotiated Rate	$78.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.75
Rate for Payer: Aetna Medicare Advantage	$13.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$13.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.57
Rate for Payer: Home State Health Plan Medicare Advantage	$13.05
Rate for Payer: Humana Commercial	$26.10
Rate for Payer: Humana Medicare Advantage	$13.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

MUMPS AB IGM

Facility

$110.00

Service Code	CPT 86735
Hospital Charge Code	2286735
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

MUMPS AB IGM

Facility

$110.00

Service Code	CPT 86735
Hospital Charge Code	2286735
Hospital Revenue Code	301
Min. Negotiated Rate	$11.75
Max. Negotiated Rate	$78.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.75
Rate for Payer: Aetna Medicare Advantage	$13.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$78.54
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cash Price	$99.00
Rate for Payer: Cigna Commercial HMO & PPO	$13.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.75
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.57
Rate for Payer: Home State Health Plan Medicare Advantage	$13.05
Rate for Payer: Humana Commercial	$26.10
Rate for Payer: Humana Medicare Advantage	$13.05
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.60

MUPIROCIN (BACTROBAN) 2% OINT 22GM

Facility

$166.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2654266
Hospital Revenue Code	250
Min. Negotiated Rate	$59.76
Max. Negotiated Rate	$118.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$118.52
Rate for Payer: Cash Price	$149.40
Rate for Payer: UnitedHealthcare Commercial	$110.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

MUPIROCIN (BACTROBAN) 2% OINT 22GM

Facility

$166.00

Service Code	NDC 6.8462E+10
Hospital Charge Code	2654266
Hospital Revenue Code	250
Rate for Payer: Cash Price	$149.40

MUPIROCIN (BACTROBAN) 2% OINT 22GM EMP

Facility

$166.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2622750
Hospital Revenue Code	250
Min. Negotiated Rate	$59.76
Max. Negotiated Rate	$118.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$118.52
Rate for Payer: Cash Price	$149.40
Rate for Payer: UnitedHealthcare Commercial	$110.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

MUPIROCIN (BACTROBAN) 2% OINT 22GM EMP

Facility

$166.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2622750
Hospital Revenue Code	250
Rate for Payer: Cash Price	$149.40

MUSCLE RUB CREAM 113GM

Facility

$35.00

Service Code	NDC 1E+11
Hospital Charge Code	2622534
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

MUSCLE RUB CREAM 113GM

Facility

$35.00

Service Code	NDC 1E+11
Hospital Charge Code	2622534
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

MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$29,624.36

Service Code	APR-DRG 9123
Min. Negotiated Rate	$29,624.36
Max. Negotiated Rate	$29,624.36
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,624.36
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,624.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,624.36
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,624.36

MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$21,263.01

Service Code	APR-DRG 9122
Min. Negotiated Rate	$21,263.01
Max. Negotiated Rate	$21,263.01
Rate for Payer: Aetna Better Health Medicaid/QHP	$21,263.01
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21,263.01
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21,263.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21,263.01

MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$62,680.54

Service Code	APR-DRG 9124
Min. Negotiated Rate	$62,680.54
Max. Negotiated Rate	$62,680.54
Rate for Payer: Aetna Better Health Medicaid/QHP	$62,680.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$62,680.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$62,680.54
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$62,680.54

MUSCULOSKELETAL AND OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA

Facility

$20,878.41

Service Code	APR-DRG 9121
Min. Negotiated Rate	$20,878.41
Max. Negotiated Rate	$20,878.41
Rate for Payer: Aetna Better Health Medicaid/QHP	$20,878.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$20,878.41
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20,878.41
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$20,878.41

Know your out-of-pocket cost for care.

All Charges