Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

TB PPD INTRADERMAL

Facility

$45.00

Service Code	CPT 86580
Hospital Charge Code	4186580
Hospital Revenue Code	636
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$59.10
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: Cigna Commercial HMO & PPO	$29.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26.07
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	$29.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

TB PPD INTRADERMAL

Facility

$45.00

Service Code	CPT 86580
Hospital Charge Code	9186580
Hospital Revenue Code	521
Rate for Payer: Cash Price	$40.50

TB PPD INTRADERMAL

Facility

$45.00

Service Code	CPT 86580
Hospital Charge Code	9186580
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	$16.20
Max. Negotiated Rate	$59.10
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: Cigna Commercial HMO & PPO	$29.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26.07
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	$29.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

TB PPD INTRADERMAL

Facility

$45.00

Service Code	CPT 86580
Hospital Charge Code	5486580
Hospital Revenue Code	636
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$59.10
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: Cigna Commercial HMO & PPO	$29.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$26.07
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	$29.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$26.07
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

TB PPD INTRADERMAL

Facility

$45.00

Service Code	CPT 86580
Hospital Charge Code	5486580
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

TB SYRINGE

Facility

$20.00

Hospital Charge Code	80000336
Hospital Revenue Code	272
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

TB SYRINGE

Facility

$20.00

Hospital Charge Code	80000336
Hospital Revenue Code	272
Rate for Payer: Cash Price	$18.00

TCD-10 ELECTRODE 10CM

Facility

$302.00

Hospital Charge Code	1216044
Hospital Revenue Code	360
Min. Negotiated Rate	$108.72
Max. Negotiated Rate	$201.43
Rate for Payer: Cash Price	$271.80
Rate for Payer: UnitedHealthcare Commercial	$201.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.72

TCD-10 ELECTRODE 10CM

Facility

$302.00

Hospital Charge Code	1216044
Hospital Revenue Code	360
Rate for Payer: Cash Price	$271.80

TCD-15-P 15CM 28GA ELECTRODE

Facility

$302.00

Hospital Charge Code	1216046
Hospital Revenue Code	360
Rate for Payer: Cash Price	$271.80

TCD-15-P 15CM 28GA ELECTRODE

Facility

$302.00

Hospital Charge Code	1216046
Hospital Revenue Code	360
Min. Negotiated Rate	$108.72
Max. Negotiated Rate	$201.43
Rate for Payer: Cash Price	$271.80
Rate for Payer: UnitedHealthcare Commercial	$201.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.72

T-EASY PLUG 4 SURGIMESH

Facility

$1,058.00

Hospital Charge Code	1269146
Hospital Revenue Code	271
Min. Negotiated Rate	$380.88
Max. Negotiated Rate	$755.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$626.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$755.41
Rate for Payer: Cash Price	$952.20
Rate for Payer: UnitedHealthcare Commercial	$705.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$380.88

T-EASY PLUG 4 SURGIMESH

Facility

$1,058.00

Hospital Charge Code	1269146
Hospital Revenue Code	271
Rate for Payer: Cash Price	$952.20

TECHNI-CARE

Facility

$21.00

Hospital Charge Code	287860
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

TECHNI-CARE

Facility

$21.00

Hospital Charge Code	287860
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

TEGADERM ABSORB

Facility

$40.00

Hospital Charge Code	2890801
Hospital Revenue Code	271
Rate for Payer: Cash Price	$36.00

TEGADERM ABSORB

Facility

$40.00

Hospital Charge Code	2890801
Hospital Revenue Code	271
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

TEGADERM DRESSING 4X4

Facility

$24.00

Hospital Charge Code	2820460
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
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: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

TEGADERM DRESSING 4X4

Facility

$24.00

Hospital Charge Code	2820460
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

TEGADERM DRESSING 8X12

Facility

$28.00

Hospital Charge Code	2820462
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

TEGADERM DRESSING 8X12

Facility

$28.00

Hospital Charge Code	2820462
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

TEGRETOL 200MG TAB EMP

Facility

$24.00

Service Code	NDC 78050905
Hospital Charge Code	2625618
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

TEGRETOL 200MG TAB EMP

Facility

$24.00

Service Code	NDC 78050905
Hospital Charge Code	2625618
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
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: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

Know your out-of-pocket cost for care.

All Charges