Madison Medical Center

All Charges

Charge

Type

Setting

Price

TEGRETOL-LABCORP

Facility

$47.00

Service Code	CPT 80156
Hospital Charge Code	224303
Hospital Revenue Code	301
Min. Negotiated Rate	$13.11
Max. Negotiated Rate	$33.56
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.11
Rate for Payer: Aetna Medicare Advantage	$14.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$27.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$33.56
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cigna Commercial HMO & PPO	$14.57
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.11
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.03
Rate for Payer: Home State Health Plan Medicare Advantage	$14.57
Rate for Payer: Humana Commercial	$29.14
Rate for Payer: Humana Medicare Advantage	$14.57
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.92

TEGRETOL-LABCORP

Facility

$47.00

Service Code	CPT 80156
Hospital Charge Code	224303
Hospital Revenue Code	301
Rate for Payer: Cash Price	$42.30

TEGRETOL-XR 400MG TAB EMP

Facility

$24.00

Service Code	NDC 78051205
Hospital Charge Code	2622845
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

TEGRETOL-XR 400MG TAB EMP

Facility

$24.00

Service Code	NDC 78051205
Hospital Charge Code	2622845
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

TELEHEALTH ORIGINATING SITE FEE

Facility

$56.00

Service Code	CPT Q3014
Hospital Charge Code	4003014
Hospital Revenue Code	510
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

TELEHEALTH ORIGINATING SITE FEE

Facility

$56.00

Service Code	CPT Q3014
Hospital Charge Code	4003014
Hospital Revenue Code	510
Rate for Payer: Cash Price	$50.40

TELEMETRY & ELECTRODES

Facility

$624.00

Hospital Charge Code	2820745
Hospital Revenue Code	271
Min. Negotiated Rate	$224.64
Max. Negotiated Rate	$445.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$369.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$445.54
Rate for Payer: Cash Price	$561.60
Rate for Payer: UnitedHealthcare Commercial	$416.21
Rate for Payer: UnitedHealthcare Medicare Advantage	$224.64

TELEMETRY & ELECTRODES

Facility

$624.00

Hospital Charge Code	2820745
Hospital Revenue Code	271
Rate for Payer: Cash Price	$561.60

TELFA 3 X 4

Facility

$16.00

Hospital Charge Code	2820740
Hospital Revenue Code	271
Rate for Payer: Cash Price	$14.40

TELFA 3 X 4

Facility

$16.00

Hospital Charge Code	2820740
Hospital Revenue Code	271
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

TEMAZEPAM 15MG CAP EMP C4

Facility

$18.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2622170
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

TEMAZEPAM 15MG CAP EMP C4

Facility

$18.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2622170
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

TEMAZEPAM (RESTORIL) 15MG CAP C4

Facility

$18.00

Service Code	NDC 378401001
Hospital Charge Code	2656261
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

TEMAZEPAM (RESTORIL) 15MG CAP C4

Facility

$18.00

Service Code	NDC 378401001
Hospital Charge Code	2656261
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

TEMPERATURE PROBE

Facility

$141.00

Service Code	CPT Y7506
Hospital Charge Code	2024481
Hospital Revenue Code	271
Rate for Payer: Cash Price	$126.90

TEMPERATURE PROBE

Facility

$141.00

Service Code	CPT Y7506
Hospital Charge Code	2024481
Hospital Revenue Code	271
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

TEMP MONITOR

Facility

$21.00

Hospital Charge Code	2024478
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

TEMP MONITOR

Facility

$21.00

Hospital Charge Code	2024478
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

TEMP STRIP

Facility

$45.00

Hospital Charge Code	2820010
Hospital Revenue Code	271
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
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: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

TEMP STRIP

Facility

$45.00

Hospital Charge Code	2820010
Hospital Revenue Code	271
Rate for Payer: Cash Price	$40.50

TENDON AND MUSCLE REPAIR

Professional

Both

$4,894.00

Service Code	CPT 25260
Hospital Charge Code	1825260
Hospital Revenue Code	981
Min. Negotiated Rate	$480.62
Max. Negotiated Rate	$1,712.90
Rate for Payer: Aetna Commercial/Medicare Advantage	$558.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$480.62
Rate for Payer: Cash Price	$4,404.60
Rate for Payer: Cash Price	$4,404.60
Rate for Payer: Cigna Commercial HMO & PPO	$558.31
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$480.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$528.68
Rate for Payer: Home State Health Plan Medicare Advantage	$558.31
Rate for Payer: Optum Medicare Advantage	$1,712.90
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$480.62

TENDONITIS, MYOSITIS AND BURSITIS WITH MCC

Facility

$26,918.72

Service Code	MSDRG 557
Min. Negotiated Rate	$13,459.36
Max. Negotiated Rate	$26,918.72
Rate for Payer: Aetna Medicare Advantage	$13,459.36
Rate for Payer: Cigna Commercial HMO & PPO	$13,459.36
Rate for Payer: Home State Health Plan Medicare Advantage	$13,459.36
Rate for Payer: Humana Commercial	$26,918.72
Rate for Payer: Humana Medicare Advantage	$13,459.36

TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC

Facility

$17,622.54

Service Code	MSDRG 558
Min. Negotiated Rate	$8,811.27
Max. Negotiated Rate	$17,622.54
Rate for Payer: Aetna Medicare Advantage	$8,811.27
Rate for Payer: Cigna Commercial HMO & PPO	$8,811.27
Rate for Payer: Home State Health Plan Medicare Advantage	$8,811.27
Rate for Payer: Humana Commercial	$17,622.54
Rate for Payer: Humana Medicare Advantage	$8,811.27

TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES

Facility

$10,608.86

Service Code	APR-DRG 3172
Min. Negotiated Rate	$10,608.86
Max. Negotiated Rate	$10,608.86
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,608.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,608.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,608.86
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,608.86

TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES

Facility

$7,990.62

Service Code	APR-DRG 3171
Min. Negotiated Rate	$7,990.62
Max. Negotiated Rate	$7,990.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$7,990.62
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$7,990.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$7,990.62
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$7,990.62

Know your out-of-pocket cost for care.

All Charges