Madison Medical Center

All Charges

Charge

Type

Setting

Price

TOURNIQUET 18

Facility

$125.00

Hospital Charge Code	2822247
Hospital Revenue Code	271
Rate for Payer: Cash Price	$112.50

TOURNIQUET 24 ZIMMER#60707010400

Facility

$125.00

Hospital Charge Code	2822249
Hospital Revenue Code	271
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$89.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: UnitedHealthcare Commercial	$83.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

TOURNIQUET 24 ZIMMER#60707010400

Facility

$125.00

Hospital Charge Code	2822249
Hospital Revenue Code	271
Rate for Payer: Cash Price	$112.50

TOWELS

Facility

$22.00

Hospital Charge Code	2820676
Hospital Revenue Code	271
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

TOWELS

Facility

$22.00

Hospital Charge Code	2820676
Hospital Revenue Code	271
Rate for Payer: Cash Price	$19.80

TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES

Facility

$10,494.35

Service Code	APR-DRG 8163
Min. Negotiated Rate	$10,494.35
Max. Negotiated Rate	$10,494.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$10,494.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10,494.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$10,494.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10,494.35

TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES

Facility

$6,078.61

Service Code	APR-DRG 8161
Min. Negotiated Rate	$6,078.61
Max. Negotiated Rate	$6,078.61
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,078.61
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,078.61
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,078.61
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,078.61

TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES

Facility

$39,934.26

Service Code	APR-DRG 8164
Min. Negotiated Rate	$39,934.26
Max. Negotiated Rate	$39,934.26
Rate for Payer: Aetna Better Health Medicaid/QHP	$39,934.26
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$39,934.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$39,934.26
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$39,934.26

TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES

Facility

$6,926.39

Service Code	APR-DRG 8162
Min. Negotiated Rate	$6,926.39
Max. Negotiated Rate	$6,926.39
Rate for Payer: Aetna Better Health Medicaid/QHP	$6,926.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6,926.39
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6,926.39
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6,926.39

TOXOPLASMA ANTIBODY IGG

Facility

$129.00

Service Code	CPT 86777
Hospital Charge Code	2286777
Hospital Revenue Code	302
Rate for Payer: Cash Price	$116.10

TOXOPLASMA ANTIBODY IGG

Facility

$129.00

Service Code	CPT 86777
Hospital Charge Code	2286777
Hospital Revenue Code	302
Min. Negotiated Rate	$12.95
Max. Negotiated Rate	$92.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.95
Rate for Payer: Aetna Medicare Advantage	$14.39
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: Cash Price	$116.10
Rate for Payer: Cash Price	$116.10
Rate for Payer: Cigna Commercial HMO & PPO	$14.39
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.86
Rate for Payer: Home State Health Plan Medicare Advantage	$14.39
Rate for Payer: Humana Commercial	$28.78
Rate for Payer: Humana Medicare Advantage	$14.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

TOXOPLASMA ANTIBODY IGM

Facility

$190.00

Service Code	CPT 86778
Hospital Charge Code	2286778
Hospital Revenue Code	302
Rate for Payer: Cash Price	$171.00

TOXOPLASMA ANTIBODY IGM

Facility

$190.00

Service Code	CPT 86778
Hospital Charge Code	2286778
Hospital Revenue Code	302
Min. Negotiated Rate	$12.97
Max. Negotiated Rate	$135.66
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.97
Rate for Payer: Aetna Medicare Advantage	$14.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$112.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$135.66
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cash Price	$171.00
Rate for Payer: Cigna Commercial HMO & PPO	$14.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.97
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.88
Rate for Payer: Home State Health Plan Medicare Advantage	$14.41
Rate for Payer: Humana Commercial	$28.82
Rate for Payer: Humana Medicare Advantage	$14.41
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.97
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.40

TPMT ACTIVITY

Facility

$790.00

Service Code	CPT 83789
Hospital Charge Code	220378
Hospital Revenue Code	301
Rate for Payer: Cash Price	$711.00

TPMT ACTIVITY

Facility

$790.00

Service Code	CPT 83789
Hospital Charge Code	220378
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$564.06
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.70
Rate for Payer: Aetna Medicare Advantage	$24.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$467.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$564.06
Rate for Payer: Cash Price	$711.00
Rate for Payer: Cash Price	$711.00
Rate for Payer: Cash Price	$711.00
Rate for Payer: Cigna Commercial HMO & PPO	$24.11
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$21.70
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.22
Rate for Payer: Home State Health Plan Medicare Advantage	$24.11
Rate for Payer: Humana Commercial	$48.22
Rate for Payer: Humana Medicare Advantage	$24.11
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$284.40

TPMT GENOTYPE

Facility

$703.00

Service Code	CPT 81335
Hospital Charge Code	2281404
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$501.94
Rate for Payer: Aetna Better Health Medicaid/QHP	$157.33
Rate for Payer: Aetna Medicare Advantage	$174.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$416.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$501.94
Rate for Payer: Cash Price	$632.70
Rate for Payer: Cash Price	$632.70
Rate for Payer: Cash Price	$632.70
Rate for Payer: Cigna Commercial HMO & PPO	$174.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$157.33
Rate for Payer: Home State Health Plan Medicaid Managed Care	$168.34
Rate for Payer: Home State Health Plan Medicare Advantage	$174.81
Rate for Payer: Humana Commercial	$349.62
Rate for Payer: Humana Medicare Advantage	$174.81
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$157.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$253.08

TPMT GENOTYPE

Facility

$703.00

Service Code	CPT 81335
Hospital Charge Code	2281404
Hospital Revenue Code	301
Rate for Payer: Cash Price	$632.70

TPO THYROID PEROXIDASE

Facility

$165.00

Service Code	CPT 86376
Hospital Charge Code	2286376
Hospital Revenue Code	301
Min. Negotiated Rate	$13.10
Max. Negotiated Rate	$117.81
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.10
Rate for Payer: Aetna Medicare Advantage	$14.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$97.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$117.81
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cash Price	$148.50
Rate for Payer: Cigna Commercial HMO & PPO	$14.55
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$13.10
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.02
Rate for Payer: Home State Health Plan Medicare Advantage	$14.55
Rate for Payer: Humana Commercial	$29.10
Rate for Payer: Humana Medicare Advantage	$14.55
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.10
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.40

TPO THYROID PEROXIDASE

Facility

$165.00

Service Code	CPT 86376
Hospital Charge Code	2286376
Hospital Revenue Code	301
Rate for Payer: Cash Price	$148.50

TP RANDOM URINE

Facility

$112.00

Service Code	CPT 84156
Hospital Charge Code	2221216
Hospital Revenue Code	307
Rate for Payer: Cash Price	$100.80

TP RANDOM URINE

Facility

$112.00

Service Code	CPT 84156
Hospital Charge Code	2221216
Hospital Revenue Code	307
Min. Negotiated Rate	$3.30
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.30
Rate for Payer: Aetna Medicare Advantage	$3.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$3.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.30
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.53
Rate for Payer: Home State Health Plan Medicare Advantage	$3.67
Rate for Payer: Humana Commercial	$7.34
Rate for Payer: Humana Medicare Advantage	$3.67
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.30
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

TRACH CLEANING TRAY

Facility

$39.00

Hospital Charge Code	2820522
Hospital Revenue Code	271
Rate for Payer: Cash Price	$35.10

TRACH CLEANING TRAY

Facility

$39.00

Hospital Charge Code	2820522
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

TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMB

Facility

$1,193.00

Service Code	CPT 31605
Hospital Charge Code	4131605
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$851.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$213.51
Rate for Payer: Aetna Medicare Advantage	$241.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$706.26
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$851.80
Rate for Payer: Cash Price	$1,073.70
Rate for Payer: Cash Price	$1,073.70
Rate for Payer: Cash Price	$1,073.70
Rate for Payer: Cash Price	$1,073.70
Rate for Payer: Cigna Commercial HMO & PPO	$241.98
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$192.16
Rate for Payer: Home State Health Plan Medicaid Managed Care	$228.46
Rate for Payer: Home State Health Plan Medicare Advantage	$241.98
Rate for Payer: Humana Commercial	$483.96
Rate for Payer: Humana Medicare Advantage	$241.98
Rate for Payer: UnitedHealthcare Commercial	$795.73
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$213.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMB

Facility

$1,193.00

Service Code	CPT 31605
Hospital Charge Code	4131605
Hospital Revenue Code	521
Rate for Payer: Cash Price	$1,073.70

Know your out-of-pocket cost for care.

All Charges