Madison Medical Center

All Charges

Charge

Type

Setting

Price

TETRACAINE 0.5% OP SOL DRPPRET 4ML EMP

Facility

$76.00

Service Code	NDC 6.8682E+10
Hospital Charge Code	2626786
Hospital Revenue Code	250
Min. Negotiated Rate	$27.36
Max. Negotiated Rate	$54.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$54.26
Rate for Payer: Cash Price	$68.40
Rate for Payer: UnitedHealthcare Commercial	$50.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.36

TETRACAINE 0.5% OP SOL DRPPRET 4ML EMP

Facility

$76.00

Service Code	NDC 6.8682E+10
Hospital Charge Code	2626786
Hospital Revenue Code	250
Rate for Payer: Cash Price	$68.40

THALLIUM URINE

Facility

$207.00

Service Code	CPT 83018
Hospital Charge Code	2283181
Hospital Revenue Code	301
Rate for Payer: Cash Price	$186.30

THALLIUM URINE

Facility

$207.00

Service Code	CPT 83018
Hospital Charge Code	2283181
Hospital Revenue Code	301
Min. Negotiated Rate	$19.76
Max. Negotiated Rate	$147.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.76
Rate for Payer: Aetna Medicare Advantage	$21.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$122.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$147.80
Rate for Payer: Cash Price	$186.30
Rate for Payer: Cash Price	$186.30
Rate for Payer: Cash Price	$186.30
Rate for Payer: Cigna Commercial HMO & PPO	$21.96
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$21.14
Rate for Payer: Home State Health Plan Medicare Advantage	$21.96
Rate for Payer: Humana Commercial	$43.92
Rate for Payer: Humana Medicare Advantage	$21.96
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$74.52

THC CONF W/ CBD RATIO URINE

Facility

$201.00

Service Code	CPT 80349
Hospital Charge Code	2282207
Hospital Revenue Code	305
Rate for Payer: Cash Price	$180.90

THC CONF W/ CBD RATIO URINE

Facility

$201.00

Service Code	CPT 80349
Hospital Charge Code	2282207
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$143.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$118.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$143.51
Rate for Payer: Cash Price	$180.90
Rate for Payer: Cash Price	$180.90
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$72.36

THC SCREEN, WHOLE BLOOD

Facility

$144.00

Service Code	CPT 80307
Hospital Charge Code	227915
Hospital Revenue Code	301
Rate for Payer: Cash Price	$129.60

THC SCREEN, WHOLE BLOOD

Facility

$144.00

Service Code	CPT 80307
Hospital Charge Code	227915
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$124.28
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	$85.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$102.82
Rate for Payer: Cash Price	$129.60
Rate for Payer: Cash Price	$129.60
Rate for Payer: Cash Price	$129.60
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	$51.84

THEOPHYLLINE

Facility

$155.00

Service Code	CPT 80198
Hospital Charge Code	2220165
Hospital Revenue Code	301
Min. Negotiated Rate	$12.73
Max. Negotiated Rate	$110.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.73
Rate for Payer: Aetna Medicare Advantage	$14.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$91.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$110.67
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cigna Commercial HMO & PPO	$14.14
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.73
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.62
Rate for Payer: Home State Health Plan Medicare Advantage	$14.14
Rate for Payer: Humana Commercial	$28.28
Rate for Payer: Humana Medicare Advantage	$14.14
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.80

THEOPHYLLINE

Facility

$155.00

Service Code	CPT 80198
Hospital Charge Code	2220165
Hospital Revenue Code	301
Rate for Payer: Cash Price	$139.50

THEOPHYLLINE (THEODUR) ER 100MG TAB

Facility

$21.00

Hospital Charge Code	2626601
Hospital Revenue Code	250
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

THEOPHYLLINE (THEODUR) ER 100MG TAB

Facility

$21.00

Hospital Charge Code	2626601
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

THERAPEUTIC DIAG INJECT

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	5290782
Hospital Revenue Code	521
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

THERAPEUTIC DIAG INJECT

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	5290782
Hospital Revenue Code	521
Rate for Payer: Cash Price	$45.00

THERAPEUTIC DIAG INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	5490782
Hospital Revenue Code	636
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$33.35
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35

THERAPEUTIC DIAG INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	5490782
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$147.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$73.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

THERAPEUTIC/DIAG INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	5296372
Hospital Revenue Code	521
Rate for Payer: Cash Price	$45.00

THERAPEUTIC/DIAG INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9896372
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$147.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$73.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

THERAPEUTIC/DIAG INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	5296372
Hospital Revenue Code	521
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

THERAPEUTIC/DIAG INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9896372
Hospital Revenue Code	636
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$33.35
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35

THERAPEUTIC/DIAG INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9890782
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$147.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$73.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

THERAPEUTIC/DIAG INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9890782
Hospital Revenue Code	636
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$33.35
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9290782
Hospital Revenue Code	636
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$147.12
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$64.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$73.56
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.00

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	3996372
Hospital Revenue Code	521
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$64.91
Rate for Payer: Aetna Medicare Advantage	$73.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$73.56
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$58.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69.45
Rate for Payer: Home State Health Plan Medicare Advantage	$73.56
Rate for Payer: Humana Commercial	$147.12
Rate for Payer: Humana Medicare Advantage	$73.56
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$64.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

THERAPEUTIC/DIAGNOSTIC INJECTION

Facility

$50.00

Service Code	CPT 96372
Hospital Charge Code	9290782
Hospital Revenue Code	636
Min. Negotiated Rate	$33.35
Max. Negotiated Rate	$33.35
Rate for Payer: Cash Price	$45.00
Rate for Payer: UnitedHealthcare Commercial	$33.35

Know your out-of-pocket cost for care.

All Charges