Madison Medical Center

All Charges

Charge

Type

Setting

Price

.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

TRAMADOL (ULTRAM) 50MG TAB UD C4

Facility

$21.00

Service Code	NDC 904636561
Hospital Charge Code	2656523
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

TRAMADOL (ULTRAM) 50MG TAB UD C4

Facility

$21.00

Service Code	NDC 904636561
Hospital Charge Code	2656523
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

TRANEXAMIC ACID 1000MG INJ SDV 10ML

Facility

$364.00

Service Code	NDC 517096010
Hospital Charge Code	2620706
Hospital Revenue Code	250
Rate for Payer: Cash Price	$327.60

TRANEXAMIC ACID 1000MG INJ SDV 10ML

Facility

$364.00

Service Code	NDC 517096010
Hospital Charge Code	2620706
Hospital Revenue Code	250
Min. Negotiated Rate	$131.04
Max. Negotiated Rate	$259.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$215.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$259.90
Rate for Payer: Cash Price	$327.60
Rate for Payer: UnitedHealthcare Commercial	$242.79
Rate for Payer: UnitedHealthcare Medicare Advantage	$131.04

TRANS BLOC

Facility

$60.00

Hospital Charge Code	202026
Hospital Revenue Code	370
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$42.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$35.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.84
Rate for Payer: Cash Price	$54.00
Rate for Payer: UnitedHealthcare Commercial	$40.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.60

TRANS BLOC

Facility

$60.00

Hospital Charge Code	202026
Hospital Revenue Code	370
Rate for Payer: Cash Price	$54.00

TRANSFERRIN

Facility

$126.00

Service Code	CPT 84466
Hospital Charge Code	2220304
Hospital Revenue Code	301
Rate for Payer: Cash Price	$113.40

TRANSFERRIN

Facility

$126.00

Service Code	CPT 84466
Hospital Charge Code	2220304
Hospital Revenue Code	301
Min. Negotiated Rate	$11.48
Max. Negotiated Rate	$89.96
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.48
Rate for Payer: Aetna Medicare Advantage	$12.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cash Price	$113.40
Rate for Payer: Cigna Commercial HMO & PPO	$12.76
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.48
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.28
Rate for Payer: Home State Health Plan Medicare Advantage	$12.76
Rate for Payer: Humana Commercial	$25.52
Rate for Payer: Humana Medicare Advantage	$12.76
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.48
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

TRANSIENT ISCHEMIA

Facility

$17,294.05

Service Code	APR-DRG 0474
Min. Negotiated Rate	$17,294.05
Max. Negotiated Rate	$17,294.05
Rate for Payer: Aetna Better Health Medicaid/QHP	$17,294.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$17,294.05
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17,294.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$17,294.05

TRANSIENT ISCHEMIA

Facility

$9,713.00

Service Code	APR-DRG 0473
Min. Negotiated Rate	$9,713.00
Max. Negotiated Rate	$9,713.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$9,713.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$9,713.00
Rate for Payer: Home State Health Plan Medicaid Managed Care	$9,713.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$9,713.00

TRANSIENT ISCHEMIA

Facility

$3,726.74

Service Code	APR-DRG 0471
Min. Negotiated Rate	$3,726.74
Max. Negotiated Rate	$3,726.74
Rate for Payer: Aetna Better Health Medicaid/QHP	$3,726.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3,726.74
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3,726.74
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3,726.74

TRANSIENT ISCHEMIA

Facility

$5,483.32

Service Code	APR-DRG 0472
Min. Negotiated Rate	$5,483.32
Max. Negotiated Rate	$5,483.32
Rate for Payer: Aetna Better Health Medicaid/QHP	$5,483.32
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5,483.32
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5,483.32
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5,483.32

TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC

Facility

$16,145.24

Service Code	MSDRG 069
Min. Negotiated Rate	$8,072.62
Max. Negotiated Rate	$16,145.24
Rate for Payer: Aetna Medicare Advantage	$8,072.62
Rate for Payer: Cigna Commercial HMO & PPO	$8,072.62
Rate for Payer: Home State Health Plan Medicare Advantage	$8,072.62
Rate for Payer: Humana Commercial	$16,145.24
Rate for Payer: Humana Medicare Advantage	$8,072.62

TRANSURETHRAL PROCEDURES WITH CC

Facility

$27,941.72

Service Code	MSDRG 669
Min. Negotiated Rate	$13,970.86
Max. Negotiated Rate	$27,941.72
Rate for Payer: Aetna Medicare Advantage	$13,970.86
Rate for Payer: Cigna Commercial HMO & PPO	$13,970.86
Rate for Payer: Home State Health Plan Medicare Advantage	$13,970.86
Rate for Payer: Humana Commercial	$27,941.72
Rate for Payer: Humana Medicare Advantage	$13,970.86

TRANSURETHRAL PROCEDURES WITH MCC

Facility

$49,521.68

Service Code	MSDRG 668
Min. Negotiated Rate	$24,760.84
Max. Negotiated Rate	$49,521.68
Rate for Payer: Aetna Medicare Advantage	$24,760.84
Rate for Payer: Cigna Commercial HMO & PPO	$24,760.84
Rate for Payer: Home State Health Plan Medicare Advantage	$24,760.84
Rate for Payer: Humana Commercial	$49,521.68
Rate for Payer: Humana Medicare Advantage	$24,760.84

TRANSURETHRAL PROCEDURES WITHOUT CC/MCC

Facility

$18,938.64

Service Code	MSDRG 670
Min. Negotiated Rate	$9,469.32
Max. Negotiated Rate	$18,938.64
Rate for Payer: Aetna Medicare Advantage	$9,469.32
Rate for Payer: Cigna Commercial HMO & PPO	$9,469.32
Rate for Payer: Home State Health Plan Medicare Advantage	$9,469.32
Rate for Payer: Humana Commercial	$18,938.64
Rate for Payer: Humana Medicare Advantage	$9,469.32

TRANSURETHRAL PROSTATECTOMY

Facility

$29,326.67

Service Code	APR-DRG 4824
Min. Negotiated Rate	$29,326.67
Max. Negotiated Rate	$29,326.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$29,326.67
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$29,326.67
Rate for Payer: Home State Health Plan Medicaid Managed Care	$29,326.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$29,326.67

TRANSURETHRAL PROSTATECTOMY

Facility

$11,278.21

Service Code	APR-DRG 4822
Min. Negotiated Rate	$11,278.21
Max. Negotiated Rate	$11,278.21
Rate for Payer: Aetna Better Health Medicaid/QHP	$11,278.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11,278.21
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11,278.21
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11,278.21

TRANSURETHRAL PROSTATECTOMY

Facility

$8,812.52

Service Code	APR-DRG 4821
Min. Negotiated Rate	$8,812.52
Max. Negotiated Rate	$8,812.52
Rate for Payer: Aetna Better Health Medicaid/QHP	$8,812.52
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$8,812.52
Rate for Payer: Home State Health Plan Medicaid Managed Care	$8,812.52
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$8,812.52

TRANSURETHRAL PROSTATECTOMY

Facility

$19,143.09

Service Code	APR-DRG 4823
Min. Negotiated Rate	$19,143.09
Max. Negotiated Rate	$19,143.09
Rate for Payer: Aetna Better Health Medicaid/QHP	$19,143.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19,143.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$19,143.09
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19,143.09

TRANSURETHRAL PROSTATECTOMY WITH CC/MCC

Facility

$27,177.54

Service Code	MSDRG 713
Min. Negotiated Rate	$13,588.77
Max. Negotiated Rate	$27,177.54
Rate for Payer: Aetna Medicare Advantage	$13,588.77
Rate for Payer: Cigna Commercial HMO & PPO	$13,588.77
Rate for Payer: Home State Health Plan Medicare Advantage	$13,588.77
Rate for Payer: Humana Commercial	$27,177.54
Rate for Payer: Humana Medicare Advantage	$13,588.77

TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC

Facility

$20,192.16

Service Code	MSDRG 714
Min. Negotiated Rate	$10,096.08
Max. Negotiated Rate	$20,192.16
Rate for Payer: Aetna Medicare Advantage	$10,096.08
Rate for Payer: Cigna Commercial HMO & PPO	$10,096.08
Rate for Payer: Home State Health Plan Medicare Advantage	$10,096.08
Rate for Payer: Humana Commercial	$20,192.16
Rate for Payer: Humana Medicare Advantage	$10,096.08

TRAPEZOID

Facility

$1,002.00

Hospital Charge Code	1200001
Hospital Revenue Code	271
Min. Negotiated Rate	$360.72
Max. Negotiated Rate	$715.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$593.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$715.43
Rate for Payer: Cash Price	$901.80
Rate for Payer: UnitedHealthcare Commercial	$668.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$360.72

TRAPEZOID

Facility

$1,002.00

Hospital Charge Code	1200001
Hospital Revenue Code	271
Rate for Payer: Cash Price	$901.80

Know your out-of-pocket cost for care.

All Charges