Madison Medical Center

All Charges

Charge

Type

Setting

Price

TISSUE TACKER, STAT TACK

Facility

$697.00

Hospital Charge Code	2819274
Hospital Revenue Code	271
Min. Negotiated Rate	$250.92
Max. Negotiated Rate	$497.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$412.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$497.66
Rate for Payer: Cash Price	$627.30
Rate for Payer: UnitedHealthcare Commercial	$464.90
Rate for Payer: UnitedHealthcare Medicare Advantage	$250.92

TISSUE TACKER, STAT TACK

Facility

$697.00

Hospital Charge Code	2819274
Hospital Revenue Code	271
Rate for Payer: Cash Price	$627.30

TISSUE THROMBOPLASTIN INHIBITION

Facility

$309.00

Service Code	CPT 85705
Hospital Charge Code	2285705
Hospital Revenue Code	305
Min. Negotiated Rate	$8.67
Max. Negotiated Rate	$220.63
Rate for Payer: Aetna Better Health Medicaid/QHP	$8.67
Rate for Payer: Aetna Medicare Advantage	$9.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$182.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$220.63
Rate for Payer: Cash Price	$278.10
Rate for Payer: Cash Price	$278.10
Rate for Payer: Cash Price	$278.10
Rate for Payer: Cigna Commercial HMO & PPO	$9.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9.28
Rate for Payer: Home State Health Plan Medicare Advantage	$9.63
Rate for Payer: Humana Commercial	$19.26
Rate for Payer: Humana Medicare Advantage	$9.63
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$111.24

TISSUE THROMBOPLASTIN INHIBITION

Facility

$309.00

Service Code	CPT 85705
Hospital Charge Code	2285705
Hospital Revenue Code	305
Rate for Payer: Cash Price	$278.10

TISSUE TRANSGLUTAMINASE IGA

Facility

$236.00

Service Code	CPT 83516
Hospital Charge Code	2283512
Hospital Revenue Code	301
Rate for Payer: Cash Price	$212.40

TISSUE TRANSGLUTAMINASE IGA

Facility

$236.00

Service Code	CPT 83516
Hospital Charge Code	2283512
Hospital Revenue Code	301
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$168.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$168.50
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.96

TISSUE TRANSGLUTAMINASE IGG

Facility

$236.00

Service Code	CPT 83516
Hospital Charge Code	2283511
Hospital Revenue Code	301
Rate for Payer: Cash Price	$212.40

TISSUE TRANSGLUTAMINASE IGG

Facility

$236.00

Service Code	CPT 83516
Hospital Charge Code	2283511
Hospital Revenue Code	301
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$168.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$168.50
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.96

TISSUE TRANS/REARRANGEMENT-ADJACENT

Facility

$1,891.00

Service Code	CPT 14060
Hospital Charge Code	4114060
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$4,215.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,859.94
Rate for Payer: Aetna Medicare Advantage	$2,107.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,119.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,350.17
Rate for Payer: Cash Price	$1,701.90
Rate for Payer: Cash Price	$1,701.90
Rate for Payer: Cash Price	$1,701.90
Rate for Payer: Cash Price	$1,701.90
Rate for Payer: Cigna Commercial HMO & PPO	$2,107.97
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,673.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,990.14
Rate for Payer: Home State Health Plan Medicare Advantage	$2,107.97
Rate for Payer: Humana Commercial	$4,215.94
Rate for Payer: Humana Medicare Advantage	$2,107.97
Rate for Payer: UnitedHealthcare Commercial	$1,261.30
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,859.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TISSUE TRANS/REARRANGEMENT-ADJACENT

Facility

$1,891.00

Service Code	CPT 14060
Hospital Charge Code	4114060
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,701.90

TISSUE TRANS/REARRANGEMENT-ADJACENT

Facility

$1,138.00

Service Code	CPT 14020
Hospital Charge Code	4114020
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$4,215.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,859.94
Rate for Payer: Aetna Medicare Advantage	$2,107.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$673.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$812.53
Rate for Payer: Cash Price	$1,024.20
Rate for Payer: Cash Price	$1,024.20
Rate for Payer: Cash Price	$1,024.20
Rate for Payer: Cash Price	$1,024.20
Rate for Payer: Cigna Commercial HMO & PPO	$2,107.97
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,673.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,990.14
Rate for Payer: Home State Health Plan Medicare Advantage	$2,107.97
Rate for Payer: Humana Commercial	$4,215.94
Rate for Payer: Humana Medicare Advantage	$2,107.97
Rate for Payer: UnitedHealthcare Commercial	$759.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,859.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TISSUE TRANS/REARRANGEMENT-ADJACENT

Facility

$1,138.00

Service Code	CPT 14020
Hospital Charge Code	4114020
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,024.20

TIZANIDINE 2MG TAB EMP

Facility

$10.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2623940
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$7.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.14
Rate for Payer: Cash Price	$9.00
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

TIZANIDINE 2MG TAB EMP

Facility

$10.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2623940
Hospital Revenue Code	250
Rate for Payer: Cash Price	$9.00

TIZANIDINE 4MG TAB EMP

Facility

$10.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2622729
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$7.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.14
Rate for Payer: Cash Price	$9.00
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

TIZANIDINE 4MG TAB EMP

Facility

$10.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2622729
Hospital Revenue Code	250
Rate for Payer: Cash Price	$9.00

TMAO

Facility

$139.00

Service Code	CPT 84999
Hospital Charge Code	2288499
Hospital Revenue Code	301
Rate for Payer: Cash Price	$125.10

TMAO

Facility

$139.00

Service Code	CPT 84999
Hospital Charge Code	2288499
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$99.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$82.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$99.25
Rate for Payer: Cash Price	$125.10
Rate for Payer: Cash Price	$125.10
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$50.04

TM JOINT

Facility

$494.00

Service Code	CPT 70330
Hospital Charge Code	3220107
Hospital Revenue Code	320
Rate for Payer: Cash Price	$444.60

TM JOINT

Facility

$494.00

Service Code	CPT 70330
Hospital Charge Code	3220107
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$352.72
Rate for Payer: Aetna Better Health Medicaid/QHP	$78.45
Rate for Payer: Aetna Medicare Advantage	$88.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$292.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$352.72
Rate for Payer: Cash Price	$444.60
Rate for Payer: Cash Price	$444.60
Rate for Payer: Cash Price	$444.60
Rate for Payer: Cigna Commercial HMO & PPO	$88.91
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$78.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$83.94
Rate for Payer: Home State Health Plan Medicare Advantage	$88.91
Rate for Payer: Humana Commercial	$177.82
Rate for Payer: Humana Medicare Advantage	$88.91
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$78.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$177.84

TOBRADEX OP SUSP 5ML EMP

Facility

$129.00

Service Code	NDC 65064705
Hospital Charge Code	2623898
Hospital Revenue Code	250
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

TOBRADEX OP SUSP 5ML EMP

Facility

$129.00

Service Code	NDC 65064705
Hospital Charge Code	2623898
Hospital Revenue Code	250
Rate for Payer: Cash Price	$116.10

TOBRAMYC/DEXAMETH (TOBRADEX) OP OINT

Facility

$657.00

Service Code	NDC 65064835
Hospital Charge Code	2656393
Hospital Revenue Code	250
Min. Negotiated Rate	$236.52
Max. Negotiated Rate	$469.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$388.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$469.10
Rate for Payer: Cash Price	$591.30
Rate for Payer: UnitedHealthcare Commercial	$438.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$236.52

TOBRAMYC/DEXAMETH (TOBRADEX) OP OINT

Facility

$657.00

Service Code	NDC 65064835
Hospital Charge Code	2656393
Hospital Revenue Code	250
Rate for Payer: Cash Price	$591.30

TOBRAMYC/DEXAMETH (TOBRADEX) OP OINT EMP

Facility

$657.00

Service Code	NDC 78087601
Hospital Charge Code	2624729
Hospital Revenue Code	250
Min. Negotiated Rate	$236.52
Max. Negotiated Rate	$469.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$388.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$469.10
Rate for Payer: Cash Price	$591.30
Rate for Payer: UnitedHealthcare Commercial	$438.22
Rate for Payer: UnitedHealthcare Medicare Advantage	$236.52

Know your out-of-pocket cost for care.

All Charges