Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

TOBRAMYCIN 0.3% OP SOL 5ML EMP

Facility

$129.00

Service Code	NDC 7.0069E+10
Hospital Charge Code	2623408
Hospital Revenue Code	250
Rate for Payer: Cash Price	$116.10

TOBRAMYCIN 0.3% OP SOL 5ML EMP

Facility

$129.00

Service Code	NDC 7.0069E+10
Hospital Charge Code	2623408
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

TOBRAMYCIN, NEBCIN

Facility

$149.00

Service Code	CPT 80200
Hospital Charge Code	2220401
Hospital Revenue Code	301
Min. Negotiated Rate	$14.52
Max. Negotiated Rate	$106.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$14.52
Rate for Payer: Aetna Medicare Advantage	$16.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$88.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$106.39
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cash Price	$134.10
Rate for Payer: Cigna Commercial HMO & PPO	$16.13
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$14.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicare Advantage	$16.13
Rate for Payer: Humana Commercial	$32.26
Rate for Payer: Humana Medicare Advantage	$16.13
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$14.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$53.64

TOBRAMYCIN, NEBCIN

Facility

$149.00

Service Code	CPT 80200
Hospital Charge Code	2220401
Hospital Revenue Code	301
Rate for Payer: Cash Price	$134.10

TOBRAMYCIN (TOBREX) 0.3% OP SOL 5ML

Facility

$129.00

Service Code	NDC 2.4208E+10
Hospital Charge Code	2659121
Hospital Revenue Code	250
Rate for Payer: Cash Price	$116.10

TOBRAMYCIN (TOBREX) 0.3% OP SOL 5ML

Facility

$129.00

Service Code	NDC 2.4208E+10
Hospital Charge Code	2659121
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

TOCILIZUMAB (ACTEMRA) 400MG 20ML VIAL

Facility

$14,661.00

Service Code	HCPCS J3262
Hospital Charge Code	2622026
Hospital Revenue Code	636
Min. Negotiated Rate	$9,778.89
Max. Negotiated Rate	$9,778.89
Rate for Payer: Cash Price	$13,194.90
Rate for Payer: UnitedHealthcare Commercial	$9,778.89

TOCILIZUMAB (ACTEMRA) 400MG 20ML VIAL

Facility

$14,661.00

Service Code	HCPCS J3262
Hospital Charge Code	2622026
Hospital Revenue Code	636
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$10,467.95
Rate for Payer: Aetna Medicare Advantage	$5.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8,679.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10,467.95
Rate for Payer: Cash Price	$13,194.90
Rate for Payer: Cash Price	$13,194.90
Rate for Payer: Cigna Commercial HMO & PPO	$5.41
Rate for Payer: Home State Health Plan Medicare Advantage	$5.41
Rate for Payer: Humana Commercial	$10.82
Rate for Payer: Humana Medicare Advantage	$5.41
Rate for Payer: UnitedHealthcare Commercial	$5.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$5,277.96

TOCILIZUMAB (ACTEMRA) 80MG 4ML VIAL

Facility

$2,146.00

Service Code	HCPCS J3262
Hospital Charge Code	2622482
Hospital Revenue Code	636
Min. Negotiated Rate	$5.41
Max. Negotiated Rate	$1,532.24
Rate for Payer: Aetna Medicare Advantage	$5.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,270.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,532.24
Rate for Payer: Cash Price	$1,931.40
Rate for Payer: Cash Price	$1,931.40
Rate for Payer: Cigna Commercial HMO & PPO	$5.41
Rate for Payer: Home State Health Plan Medicare Advantage	$5.41
Rate for Payer: Humana Commercial	$10.82
Rate for Payer: Humana Medicare Advantage	$5.41
Rate for Payer: UnitedHealthcare Commercial	$5.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$772.56

TOCILIZUMAB (ACTEMRA) 80MG 4ML VIAL

Facility

$2,146.00

Service Code	HCPCS J3262
Hospital Charge Code	2622482
Hospital Revenue Code	636
Min. Negotiated Rate	$1,431.38
Max. Negotiated Rate	$1,431.38
Rate for Payer: Cash Price	$1,931.40
Rate for Payer: UnitedHealthcare Commercial	$1,431.38

TOE REDUCTION

Professional

Both

$951.00

Service Code	CPT 28630
Hospital Charge Code	1828630
Hospital Revenue Code	981
Min. Negotiated Rate	$104.55
Max. Negotiated Rate	$332.85
Rate for Payer: Aetna Commercial/Medicare Advantage	$104.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$115.79
Rate for Payer: Cash Price	$855.90
Rate for Payer: Cash Price	$855.90
Rate for Payer: Cigna Commercial HMO & PPO	$104.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$115.79
Rate for Payer: Home State Health Plan Medicaid Managed Care	$127.37
Rate for Payer: Home State Health Plan Medicare Advantage	$104.55
Rate for Payer: Optum Medicare Advantage	$332.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$115.79

TOES XRAY LT

Facility

$449.00

Service Code	CPT 73660
Hospital Charge Code	3220133
Hospital Revenue Code	320
Rate for Payer: Cash Price	$404.10

TOES XRAY LT

Facility

$449.00

Service Code	CPT 73660
Hospital Charge Code	3220133
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$320.59
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	$265.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$320.59
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
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	$161.64

TOES XRAY RT

Facility

$449.00

Service Code	CPT 73660
Hospital Charge Code	3220132
Hospital Revenue Code	320
Min. Negotiated Rate	$78.45
Max. Negotiated Rate	$320.59
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	$265.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$320.59
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
Rate for Payer: Cash Price	$404.10
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	$161.64

TOES XRAY RT

Facility

$449.00

Service Code	CPT 73660
Hospital Charge Code	3220132
Hospital Revenue Code	320
Rate for Payer: Cash Price	$404.10

TOILET AID 12 INCH

Facility

$28.00

Hospital Charge Code	5349018
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

TOILET AID 12 INCH

Facility

$28.00

Hospital Charge Code	5349018
Hospital Revenue Code	271
Rate for Payer: Cash Price	$25.20

TOILET AID 19 INCH

Facility

$39.00

Hospital Charge Code	5349016
Hospital Revenue Code	271
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

TOILET AID 19 INCH

Facility

$39.00

Hospital Charge Code	5349016
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

TOLTERODINE (DETROL) LA 2MG CAP

Facility

$45.00

Service Code	NDC 904659204
Hospital Charge Code	2626273
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

TOLTERODINE (DETROL) LA 2MG CAP

Facility

$45.00

Service Code	NDC 904659204
Hospital Charge Code	2626273
Hospital Revenue Code	250
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

TOLTERODINE (DETROL LA) 4MG CAP

Facility

$48.00

Service Code	NDC 9519102
Hospital Charge Code	2626597
Hospital Revenue Code	250
Min. Negotiated Rate	$17.28
Max. Negotiated Rate	$34.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$28.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$34.27
Rate for Payer: Cash Price	$43.20
Rate for Payer: UnitedHealthcare Commercial	$32.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$17.28

TOLTERODINE (DETROL LA) 4MG CAP

Facility

$48.00

Service Code	NDC 9519102
Hospital Charge Code	2626597
Hospital Revenue Code	250
Rate for Payer: Cash Price	$43.20

TOLTERODINE (DETROL LA) 4MG CAP EMP

Facility

$48.00

Service Code	NDC 9519102
Hospital Charge Code	2623123
Hospital Revenue Code	250
Rate for Payer: Cash Price	$43.20

Know your out-of-pocket cost for care.

All Charges