Madison Medical Center

All Charges

Charge

Type

Setting

Price

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC

Facility

$70,061.98

Service Code	MSDRG 012
Min. Negotiated Rate	$35,030.99
Max. Negotiated Rate	$70,061.98
Rate for Payer: Aetna Medicare Advantage	$35,030.99
Rate for Payer: Cigna Commercial HMO & PPO	$35,030.99
Rate for Payer: Home State Health Plan Medicare Advantage	$35,030.99
Rate for Payer: Humana Commercial	$70,061.98
Rate for Payer: Humana Medicare Advantage	$35,030.99

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC

Facility

$89,716.42

Service Code	MSDRG 011
Min. Negotiated Rate	$44,858.21
Max. Negotiated Rate	$89,716.42
Rate for Payer: Aetna Medicare Advantage	$44,858.21
Rate for Payer: Cigna Commercial HMO & PPO	$44,858.21
Rate for Payer: Home State Health Plan Medicare Advantage	$44,858.21
Rate for Payer: Humana Commercial	$89,716.42
Rate for Payer: Humana Medicare Advantage	$44,858.21

TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC

Facility

$48,917.36

Service Code	MSDRG 013
Min. Negotiated Rate	$24,458.68
Max. Negotiated Rate	$48,917.36
Rate for Payer: Aetna Medicare Advantage	$24,458.68
Rate for Payer: Cigna Commercial HMO & PPO	$24,458.68
Rate for Payer: Home State Health Plan Medicare Advantage	$24,458.68
Rate for Payer: Humana Commercial	$48,917.36
Rate for Payer: Humana Medicare Advantage	$24,458.68

TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES

Facility

$223,020.80

Service Code	MSDRG 004
Min. Negotiated Rate	$111,510.40
Max. Negotiated Rate	$223,020.80
Rate for Payer: Aetna Medicare Advantage	$111,510.40
Rate for Payer: Cigna Commercial HMO & PPO	$111,510.40
Rate for Payer: Home State Health Plan Medicare Advantage	$111,510.40
Rate for Payer: Humana Commercial	$223,020.80
Rate for Payer: Humana Medicare Advantage	$111,510.40

TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE

Facility

$60,256.45

Service Code	APR-DRG 0041
Min. Negotiated Rate	$60,256.45
Max. Negotiated Rate	$60,256.45
Rate for Payer: Aetna Better Health Medicaid/QHP	$60,256.45
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$60,256.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$60,256.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$60,256.45

TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE

Facility

$85,048.35

Service Code	APR-DRG 0042
Min. Negotiated Rate	$85,048.35
Max. Negotiated Rate	$85,048.35
Rate for Payer: Aetna Better Health Medicaid/QHP	$85,048.35
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$85,048.35
Rate for Payer: Home State Health Plan Medicaid Managed Care	$85,048.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$85,048.35

TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE

Facility

$192,277.76

Service Code	APR-DRG 0044
Min. Negotiated Rate	$192,277.76
Max. Negotiated Rate	$192,277.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$192,277.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$192,277.76
Rate for Payer: Home State Health Plan Medicaid Managed Care	$192,277.76
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$192,277.76

TRACHEOSTOMY WITH MV >96 HOURS WITH EXTENSIVE PROCEDURE

Facility

$117,863.23

Service Code	APR-DRG 0043
Min. Negotiated Rate	$117,863.23
Max. Negotiated Rate	$117,863.23
Rate for Payer: Aetna Better Health Medicaid/QHP	$117,863.23
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$117,863.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$117,863.23
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$117,863.23

TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE

Facility

$69,142.00

Service Code	APR-DRG 0052
Min. Negotiated Rate	$69,142.00
Max. Negotiated Rate	$69,142.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$69,142.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$69,142.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$69,142.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$69,142.00

TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE

Facility

$34,834.03

Service Code	APR-DRG 0051
Min. Negotiated Rate	$34,834.03
Max. Negotiated Rate	$34,834.03
Rate for Payer: Aetna Better Health Medicaid/QHP	$34,834.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$34,834.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$34,834.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$34,834.03

TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE

Facility

$85,581.80

Service Code	APR-DRG 0053
Min. Negotiated Rate	$85,581.80
Max. Negotiated Rate	$85,581.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$85,581.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$85,581.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$85,581.80
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$85,581.80

TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE

Facility

$131,155.04

Service Code	APR-DRG 0054
Min. Negotiated Rate	$131,155.04
Max. Negotiated Rate	$131,155.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$131,155.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$131,155.04
Rate for Payer: Home State Health Plan Medicaid Managed Care	$131,155.04
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$131,155.04

TRACH PLUG

Facility

$62.00

Hospital Charge Code	2820011
Hospital Revenue Code	271
Rate for Payer: Cash Price	$55.80

TRACH PLUG

Facility

$62.00

Hospital Charge Code	2820011
Hospital Revenue Code	271
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$44.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: UnitedHealthcare Commercial	$41.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

TRACH SPONGE

Facility

$21.00

Hospital Charge Code	2820012
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

TRACH SPONGE

Facility

$21.00

Hospital Charge Code	2820012
Hospital Revenue Code	271
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

TRACH, TUBE, DISP.

Facility

$330.00

Hospital Charge Code	2820015
Hospital Revenue Code	271
Rate for Payer: Cash Price	$297.00

TRACH, TUBE, DISP.

Facility

$330.00

Hospital Charge Code	2820015
Hospital Revenue Code	271
Min. Negotiated Rate	$118.80
Max. Negotiated Rate	$235.62
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$195.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$235.62
Rate for Payer: Cash Price	$297.00
Rate for Payer: UnitedHealthcare Commercial	$220.11
Rate for Payer: UnitedHealthcare Medicare Advantage	$118.80

TRAMADOL 200MG ER TAB EMP C4 EMP

Facility

$21.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2627325
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

TRAMADOL 200MG ER TAB EMP C4 EMP

Facility

$21.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2627325
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

TRAMADOL 50MG TAB EMP C4

Facility

$21.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2698392
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

TRAMADOL 50MG TAB EMP C4

Facility

$21.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2698392
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

TRAMADOL/ACET 37.5/325MG TAB EMP C4

Facility

$16.00

Service Code	NDC 5.7664E+10
Hospital Charge Code	2697970
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

TRAMADOL/ACET 37.5/325MG TAB EMP C4

Facility

$16.00

Service Code	NDC 5.7664E+10
Hospital Charge Code	2697970
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

.TRAMADOL REFLEX CONFIRMATION

Facility

$110.00

Service Code	CPT 80373
Hospital Charge Code	220373
Hospital Revenue Code	301
Rate for Payer: Cash Price	$99.00

Know your out-of-pocket cost for care.

All Charges