Madison Medical Center

All Charges

Charge

Type

Setting

Price

TAMOXIFEN CIT 20MG TAB EMP

Facility

$18.00

Service Code	NDC 5.1862E+10
Hospital Charge Code	2697746
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

TAMOXIFEN CIT 20MG TAB EMP

Facility

$18.00

Service Code	NDC 5.1862E+10
Hospital Charge Code	2697746
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

TAMSULOSIN (FLOMAX) 0.4MG CAP EMP

Facility

$44.00

Service Code	NDC 597005801
Hospital Charge Code	2623209
Hospital Revenue Code	250
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

TAMSULOSIN (FLOMAX) 0.4MG CAP EMP

Facility

$44.00

Service Code	NDC 597005801
Hospital Charge Code	2623209
Hospital Revenue Code	250
Rate for Payer: Cash Price	$39.60

TAMSULOSIN (FLOMAX) 0.4MG CAP UD

Facility

$25.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2656259
Hospital Revenue Code	250
Rate for Payer: Cash Price	$22.50

TAMSULOSIN (FLOMAX) 0.4MG CAP UD

Facility

$25.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2656259
Hospital Revenue Code	250
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$17.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.85
Rate for Payer: Cash Price	$22.50
Rate for Payer: UnitedHealthcare Commercial	$16.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.00

T&A PACK MEDLINE#DYNJS0701

Facility

$190.00

Hospital Charge Code	1216030
Hospital Revenue Code	271
Rate for Payer: Cash Price	$171.00

T&A PACK MEDLINE#DYNJS0701

Facility

$190.00

Hospital Charge Code	1216030
Hospital Revenue Code	271
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$135.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: UnitedHealthcare Commercial	$126.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.40

TAPE DURAPORE 1

Facility

$21.00

Hospital Charge Code	80000344
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

TAPE DURAPORE 1

Facility

$21.00

Hospital Charge Code	80000344
Hospital Revenue Code	271
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

TAPE DURAPORE 2

Facility

$21.00

Hospital Charge Code	80000345
Hospital Revenue Code	271
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

TAPE DURAPORE 2

Facility

$21.00

Hospital Charge Code	80000345
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

TAPE MICRO 2

Facility

$28.00

Hospital Charge Code	2820466
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

TAPE MICRO 2

Facility

$28.00

Hospital Charge Code	2820466
Hospital Revenue Code	271
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

TAPE MICROPORE 1

Facility

$21.00

Hospital Charge Code	2820465
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

TAPE MICROPORE 1

Facility

$21.00

Hospital Charge Code	2820465
Hospital Revenue Code	271
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

TAPENTADOL, SCREEN URINE

Facility

$182.00

Service Code	CPT 80307
Hospital Charge Code	2280306
Hospital Revenue Code	301
Rate for Payer: Cash Price	$163.80

TAPENTADOL, SCREEN URINE

Facility

$182.00

Service Code	CPT 80307
Hospital Charge Code	2280306
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$129.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$55.93
Rate for Payer: Aetna Medicare Advantage	$62.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$107.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$129.95
Rate for Payer: Cash Price	$163.80
Rate for Payer: Cash Price	$163.80
Rate for Payer: Cash Price	$163.80
Rate for Payer: Cigna Commercial HMO & PPO	$62.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$55.93
Rate for Payer: Home State Health Plan Medicaid Managed Care	$59.85
Rate for Payer: Home State Health Plan Medicare Advantage	$62.14
Rate for Payer: Humana Commercial	$124.28
Rate for Payer: Humana Medicare Advantage	$62.14
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$55.93
Rate for Payer: UnitedHealthcare Medicare Advantage	$65.52

T A STAPLES

Facility

$773.00

Hospital Charge Code	2820004
Hospital Revenue Code	271
Rate for Payer: Cash Price	$695.70

T A STAPLES

Facility

$773.00

Hospital Charge Code	2820004
Hospital Revenue Code	271
Min. Negotiated Rate	$278.28
Max. Negotiated Rate	$551.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$457.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$551.92
Rate for Payer: Cash Price	$695.70
Rate for Payer: UnitedHealthcare Commercial	$515.59
Rate for Payer: UnitedHealthcare Medicare Advantage	$278.28

TBO-FILGRASTIM 300MCG/0.5ML INJ

Facility

$2,772.00

Service Code	NDC 6.3459E+10
Hospital Charge Code	2698102
Hospital Revenue Code	335
Min. Negotiated Rate	$997.92
Max. Negotiated Rate	$1,979.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,641.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,979.21
Rate for Payer: Cash Price	$2,494.80
Rate for Payer: UnitedHealthcare Commercial	$1,848.92
Rate for Payer: UnitedHealthcare Medicare Advantage	$997.92

TBO-FILGRASTIM 300MCG/0.5ML INJ

Facility

$2,772.00

Service Code	NDC 6.3459E+10
Hospital Charge Code	2698102
Hospital Revenue Code	335
Rate for Payer: Cash Price	$2,494.80

TB PPD

Facility

$45.00

Service Code	CPT 86580
Hospital Charge Code	5286580
Hospital Revenue Code	521
Rate for Payer: Cash Price	$40.50

TB PPD

Facility

$45.00

Service Code	CPT 86580
Hospital Charge Code	5286580
Hospital Revenue Code	521
Min. Negotiated Rate	$23.46
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$26.07
Rate for Payer: Aetna Medicare Advantage	$29.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna Commercial HMO & PPO	$29.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23.46
Rate for Payer: Home State Health Plan Medicaid Managed Care	$27.89
Rate for Payer: Home State Health Plan Medicare Advantage	$29.55
Rate for Payer: Humana Commercial	$59.10
Rate for Payer: Humana Medicare Advantage	$29.55
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TB PPD INTRADERMAL

Facility

$45.00

Service Code	CPT 86580
Hospital Charge Code	9686580
Hospital Revenue Code	636
Min. Negotiated Rate	$30.02
Max. Negotiated Rate	$30.02
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02

Know your out-of-pocket cost for care.

All Charges