Madison Medical Center

All Charges

Charge

Type

Setting

Price

TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES

Facility

$17,129.49

Service Code	APR-DRG 3173
Min. Negotiated Rate	$17,129.49
Max. Negotiated Rate	$17,129.49
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,129.49
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,129.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,129.49
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,129.49

TENDON, MUSCLE AND OTHER SOFT TISSUE PROCEDURES

Facility

$40,955.27

Service Code	APR-DRG 3174
Min. Negotiated Rate	$40,955.27
Max. Negotiated Rate	$40,955.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$40,955.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$40,955.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$40,955.27
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$40,955.27

TENDON SHEATH INC FOR TRIGGER FINGER

Facility

$2,100.00

Service Code	CPT 26055
Hospital Charge Code	9326055
Hospital Revenue Code	525
Rate for Payer: Cash Price	$1,890.00

TENDON SHEATH INC FOR TRIGGER FINGER

Facility

$2,100.00

Service Code	CPT 26055
Hospital Charge Code	9326055
Hospital Revenue Code	525
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$3,285.64
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,449.52
Rate for Payer: Aetna Medicare Advantage	$1,642.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,243.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,499.40
Rate for Payer: Cash Price	$1,890.00
Rate for Payer: Cash Price	$1,890.00
Rate for Payer: Cash Price	$1,890.00
Rate for Payer: Cash Price	$1,890.00
Rate for Payer: Cigna Commercial HMO & PPO	$1,642.82
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,304.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,550.99
Rate for Payer: Home State Health Plan Medicare Advantage	$1,642.82
Rate for Payer: Humana Commercial	$3,285.64
Rate for Payer: Humana Medicare Advantage	$1,642.82
Rate for Payer: UnitedHealthcare Commercial	$1,400.70
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,449.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TENECTEPLASE (TNKASE) 50MG INJ

Facility

$28,777.00

Service Code	HCPCS J3101
Hospital Charge Code	2626305
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25,899.30

TENECTEPLASE (TNKASE) 50MG INJ

Facility

$28,777.00

Service Code	HCPCS J3101
Hospital Charge Code	2626305
Hospital Revenue Code	250
Min. Negotiated Rate	$217.42
Max. Negotiated Rate	$20,546.78
Rate for Payer: Aetna Medicare Advantage	$217.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17,035.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$20,546.78
Rate for Payer: Cash Price	$25,899.30
Rate for Payer: Cash Price	$25,899.30
Rate for Payer: Cigna Commercial HMO & PPO	$217.42
Rate for Payer: Home State Health Plan Medicare Advantage	$217.42
Rate for Payer: Humana Commercial	$434.84
Rate for Payer: Humana Medicare Advantage	$217.42
Rate for Payer: UnitedHealthcare Commercial	$19,194.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$10,359.72

TERAZOSIN 1MG CAP EMP

Facility

$24.00

Service Code	NDC 5.9746E+10
Hospital Charge Code	2622960
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

TERAZOSIN 1MG CAP EMP

Facility

$24.00

Service Code	NDC 5.9746E+10
Hospital Charge Code	2622960
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

TERAZOSIN 2MG CAP EMP

Facility

$24.00

Service Code	NDC 5.9746E+10
Hospital Charge Code	2624203
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

TERAZOSIN 2MG CAP EMP

Facility

$24.00

Service Code	NDC 5.9746E+10
Hospital Charge Code	2624203
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

TERAZOSIN (HYTRIN) 10MG CAP EMP

Facility

$24.00

Service Code	NDC 781205401
Hospital Charge Code	2622414
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

TERAZOSIN (HYTRIN) 10MG CAP EMP

Facility

$24.00

Service Code	NDC 781205401
Hospital Charge Code	2622414
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

TERAZOSIN (HYTRIN) 1MG CAP

Facility

$24.00

Service Code	NDC 378226001
Hospital Charge Code	2659150
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

TERAZOSIN (HYTRIN) 1MG CAP

Facility

$24.00

Service Code	NDC 378226001
Hospital Charge Code	2659150
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

TERAZOSIN (HYTRIN) 5MG CAP

Facility

$24.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626274
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

TERAZOSIN (HYTRIN) 5MG CAP

Facility

$24.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2626274
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

TERBINAFINE 250MG TAB EMP

Facility

$15.00

Service Code	NDC 6.9097E+10
Hospital Charge Code	2622093
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

TERBINAFINE 250MG TAB EMP

Facility

$15.00

Service Code	NDC 6.9097E+10
Hospital Charge Code	2622093
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

TERBUTALINE(BRETHINE)1MG/ML INJ 1ML

Facility

$60.00

Service Code	HCPCS J3105
Hospital Charge Code	2656263
Hospital Revenue Code	250
Rate for Payer: Cash Price	$54.00

TERBUTALINE(BRETHINE)1MG/ML INJ 1ML

Facility

$60.00

Service Code	HCPCS J3105
Hospital Charge Code	2656263
Hospital Revenue Code	250
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

TESTES PROCEDURES WITH CC/MCC

Facility

$36,319.58

Service Code	MSDRG 711
Min. Negotiated Rate	$18,159.79
Max. Negotiated Rate	$36,319.58
Rate for Payer: Aetna Medicare Advantage	$18,159.79
Rate for Payer: Cigna Commercial HMO & PPO	$18,159.79
Rate for Payer: Home State Health Plan Medicare Advantage	$18,159.79
Rate for Payer: Humana Commercial	$36,319.58
Rate for Payer: Humana Medicare Advantage	$18,159.79

TESTES PROCEDURES WITHOUT CC/MCC

Facility

$20,854.10

Service Code	MSDRG 712
Min. Negotiated Rate	$10,427.05
Max. Negotiated Rate	$20,854.10
Rate for Payer: Aetna Medicare Advantage	$10,427.05
Rate for Payer: Cigna Commercial HMO & PPO	$10,427.05
Rate for Payer: Home State Health Plan Medicare Advantage	$10,427.05
Rate for Payer: Humana Commercial	$20,854.10
Rate for Payer: Humana Medicare Advantage	$10,427.05

.TESTOSTERONE CHARGE ONLY

Facility

$40.00

Service Code	CPT 84403
Hospital Charge Code	2284403
Hospital Revenue Code	301
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$51.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$23.23
Rate for Payer: Aetna Medicare Advantage	$25.81
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: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cigna Commercial HMO & PPO	$25.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$23.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$24.86
Rate for Payer: Home State Health Plan Medicare Advantage	$25.81
Rate for Payer: Humana Commercial	$51.62
Rate for Payer: Humana Medicare Advantage	$25.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$23.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

.TESTOSTERONE CHARGE ONLY

Facility

$40.00

Service Code	CPT 84403
Hospital Charge Code	2284403
Hospital Revenue Code	301
Rate for Payer: Cash Price	$36.00

.TESTOSTERONE FREE

Facility

$414.00

Service Code	CPT 84403
Hospital Charge Code	2220303
Hospital Revenue Code	301
Rate for Payer: Cash Price	$372.60

Know your out-of-pocket cost for care.

All Charges