Madison Medical Center

All Charges

Charge

Type

Setting

Price

TRAUMATIC INJURY WITH MCC

Facility

$29,242.98

Service Code	MSDRG 913
Min. Negotiated Rate	$14,621.49
Max. Negotiated Rate	$29,242.98
Rate for Payer: Aetna Medicare Advantage	$14,621.49
Rate for Payer: Cigna Commercial HMO & PPO	$14,621.49
Rate for Payer: Home State Health Plan Medicare Advantage	$14,621.49
Rate for Payer: Humana Commercial	$29,242.98
Rate for Payer: Humana Medicare Advantage	$14,621.49

TRAUMATIC INJURY WITHOUT MCC

Facility

$17,502.02

Service Code	MSDRG 914
Min. Negotiated Rate	$8,751.01
Max. Negotiated Rate	$17,502.02
Rate for Payer: Aetna Medicare Advantage	$8,751.01
Rate for Payer: Cigna Commercial HMO & PPO	$8,751.01
Rate for Payer: Home State Health Plan Medicare Advantage	$8,751.01
Rate for Payer: Humana Commercial	$17,502.02
Rate for Payer: Humana Medicare Advantage	$8,751.01

TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC

Facility

$24,030.92

Service Code	MSDRG 086
Min. Negotiated Rate	$12,015.46
Max. Negotiated Rate	$24,030.92
Rate for Payer: Aetna Medicare Advantage	$12,015.46
Rate for Payer: Cigna Commercial HMO & PPO	$12,015.46
Rate for Payer: Home State Health Plan Medicare Advantage	$12,015.46
Rate for Payer: Humana Commercial	$24,030.92
Rate for Payer: Humana Medicare Advantage	$12,015.46

TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC

Facility

$25,489.62

Service Code	MSDRG 083
Min. Negotiated Rate	$12,744.81
Max. Negotiated Rate	$25,489.62
Rate for Payer: Aetna Medicare Advantage	$12,744.81
Rate for Payer: Cigna Commercial HMO & PPO	$12,744.81
Rate for Payer: Home State Health Plan Medicare Advantage	$12,744.81
Rate for Payer: Humana Commercial	$25,489.62
Rate for Payer: Humana Medicare Advantage	$12,744.81

TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC

Facility

$39,282.88

Service Code	MSDRG 085
Min. Negotiated Rate	$19,641.44
Max. Negotiated Rate	$39,282.88
Rate for Payer: Aetna Medicare Advantage	$19,641.44
Rate for Payer: Cigna Commercial HMO & PPO	$19,641.44
Rate for Payer: Home State Health Plan Medicare Advantage	$19,641.44
Rate for Payer: Humana Commercial	$39,282.88
Rate for Payer: Humana Medicare Advantage	$19,641.44

TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC

Facility

$39,498.70

Service Code	MSDRG 082
Min. Negotiated Rate	$19,749.35
Max. Negotiated Rate	$39,498.70
Rate for Payer: Aetna Medicare Advantage	$19,749.35
Rate for Payer: Cigna Commercial HMO & PPO	$19,749.35
Rate for Payer: Home State Health Plan Medicare Advantage	$19,749.35
Rate for Payer: Humana Commercial	$39,498.70
Rate for Payer: Humana Medicare Advantage	$19,749.35

TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC

Facility

$17,959.02

Service Code	MSDRG 087
Min. Negotiated Rate	$8,979.51
Max. Negotiated Rate	$17,959.02
Rate for Payer: Aetna Medicare Advantage	$8,979.51
Rate for Payer: Cigna Commercial HMO & PPO	$8,979.51
Rate for Payer: Home State Health Plan Medicare Advantage	$8,979.51
Rate for Payer: Humana Commercial	$17,959.02
Rate for Payer: Humana Medicare Advantage	$8,979.51

TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC

Facility

$18,602.16

Service Code	MSDRG 084
Min. Negotiated Rate	$9,301.08
Max. Negotiated Rate	$18,602.16
Rate for Payer: Aetna Medicare Advantage	$9,301.08
Rate for Payer: Cigna Commercial HMO & PPO	$9,301.08
Rate for Payer: Home State Health Plan Medicare Advantage	$9,301.08
Rate for Payer: Humana Commercial	$18,602.16
Rate for Payer: Humana Medicare Advantage	$9,301.08

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC

Facility

$26,686.54

Service Code	MSDRG 604
Min. Negotiated Rate	$13,343.27
Max. Negotiated Rate	$26,686.54
Rate for Payer: Aetna Medicare Advantage	$13,343.27
Rate for Payer: Cigna Commercial HMO & PPO	$13,343.27
Rate for Payer: Home State Health Plan Medicare Advantage	$13,343.27
Rate for Payer: Humana Commercial	$26,686.54
Rate for Payer: Humana Medicare Advantage	$13,343.27

TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC

Facility

$17,979.34

Service Code	MSDRG 605
Min. Negotiated Rate	$8,989.67
Max. Negotiated Rate	$17,979.34
Rate for Payer: Aetna Medicare Advantage	$8,989.67
Rate for Payer: Cigna Commercial HMO & PPO	$8,989.67
Rate for Payer: Home State Health Plan Medicare Advantage	$8,989.67
Rate for Payer: Humana Commercial	$17,979.34
Rate for Payer: Humana Medicare Advantage	$8,989.67

TRAY, CHEST TUBE

Facility

$106.00

Hospital Charge Code	2820851
Hospital Revenue Code	271
Rate for Payer: Cash Price	$95.40

TRAY, CHEST TUBE

Facility

$106.00

Hospital Charge Code	2820851
Hospital Revenue Code	271
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$75.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: UnitedHealthcare Commercial	$70.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

TRAY, TRACHEOTOMY

Facility

$406.00

Hospital Charge Code	2820006
Hospital Revenue Code	271
Min. Negotiated Rate	$146.16
Max. Negotiated Rate	$289.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$240.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$289.88
Rate for Payer: Cash Price	$365.40
Rate for Payer: UnitedHealthcare Commercial	$270.80
Rate for Payer: UnitedHealthcare Medicare Advantage	$146.16

TRAY, TRACHEOTOMY

Facility

$406.00

Hospital Charge Code	2820006
Hospital Revenue Code	271
Rate for Payer: Cash Price	$365.40

TRAZODONE

Facility

$250.00

Service Code	CPT 80338
Hospital Charge Code	2282491
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$178.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$178.50
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.00

TRAZODONE

Facility

$250.00

Service Code	CPT 80338
Hospital Charge Code	2282491
Hospital Revenue Code	305
Rate for Payer: Cash Price	$225.00

TRAZODONE 50MG TAB EMP

Facility

$13.00

Service Code	NDC 5.0111E+10
Hospital Charge Code	2619685
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

TRAZODONE 50MG TAB EMP

Facility

$13.00

Service Code	NDC 5.0111E+10
Hospital Charge Code	2619685
Hospital Revenue Code	250
Rate for Payer: Cash Price	$11.70

TRAZODONE (DESYREL) 100MG TAB EMP

Facility

$20.00

Service Code	NDC 904399061
Hospital Charge Code	2698186
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

TRAZODONE (DESYREL) 100MG TAB EMP

Facility

$20.00

Service Code	NDC 904399061
Hospital Charge Code	2698186
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

TRAZODONE (DESYREL) 100MG TAB UD

Facility

$20.00

Service Code	NDC 904399061
Hospital Charge Code	2621091
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

TRAZODONE (DESYREL) 100MG TAB UD

Facility

$20.00

Service Code	NDC 904399061
Hospital Charge Code	2621091
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

TRAZODONE (DESYREL) 150MG TAB

Facility

$20.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2626579
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

TRAZODONE (DESYREL) 150MG TAB

Facility

$20.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2626579
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

TRAZODONE (DESYREL) 150MG TAB EMP

Facility

$20.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2624064
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

Know your out-of-pocket cost for care.

All Charges