Madison Medical Center

All Charges

Charge

Type

Setting

Price

TRAZODONE (DESYREL) 150MG TAB EMP

Facility

$20.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2624064
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

TRAZODONE (DESYREL) 50MG TAB UD

Facility

$20.00

Service Code	NDC 904686861
Hospital Charge Code	2656430
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) 50MG TAB UD

Facility

$20.00

Service Code	NDC 904686861
Hospital Charge Code	2656430
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

TREADMILL EKG, PHY INTERPRETATION&REPORT

Professional

Both

$355.00

Service Code	CPT 93018
Hospital Charge Code	4593018
Hospital Revenue Code	976
Min. Negotiated Rate	$13.18
Max. Negotiated Rate	$124.25
Rate for Payer: Aetna Commercial/Medicare Advantage	$13.18
Rate for Payer: Cash Price	$319.50
Rate for Payer: Cash Price	$319.50
Rate for Payer: Cigna Commercial HMO & PPO	$13.18
Rate for Payer: Home State Health Plan Medicare Advantage	$13.18
Rate for Payer: Optum Medicare Advantage	$124.25

TREADMILL EKG, TRACING ONLY

Facility

$1,846.00

Service Code	CPT 93017
Hospital Charge Code	4500380
Hospital Revenue Code	482
Rate for Payer: Cash Price	$1,661.40

TREADMILL EKG, TRACING ONLY

Facility

$1,846.00

Service Code	CPT 93017
Hospital Charge Code	4500380
Hospital Revenue Code	482
Min. Negotiated Rate	$194.65
Max. Negotiated Rate	$1,318.04
Rate for Payer: Aetna Better Health Medicaid/QHP	$194.65
Rate for Payer: Aetna Medicare Advantage	$220.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,092.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,318.04
Rate for Payer: Cash Price	$1,661.40
Rate for Payer: Cash Price	$1,661.40
Rate for Payer: Cash Price	$1,661.40
Rate for Payer: Cigna Commercial HMO & PPO	$220.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$194.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$208.28
Rate for Payer: Home State Health Plan Medicare Advantage	$220.60
Rate for Payer: Humana Commercial	$441.20
Rate for Payer: Humana Medicare Advantage	$220.60
Rate for Payer: UnitedHealthcare Commercial	$1,231.28
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$194.65
Rate for Payer: UnitedHealthcare Medicare Advantage	$664.56

TREAT CLAVIC FX W/O MANIPULATI

Professional

Both

$1,385.00

Service Code	CPT 23500
Hospital Charge Code	1823500
Hospital Revenue Code	981
Min. Negotiated Rate	$169.90
Max. Negotiated Rate	$484.75
Rate for Payer: Aetna Commercial/Medicare Advantage	$222.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$169.90
Rate for Payer: Cash Price	$1,246.50
Rate for Payer: Cash Price	$1,246.50
Rate for Payer: Cigna Commercial HMO & PPO	$222.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$169.90
Rate for Payer: Home State Health Plan Medicaid Managed Care	$186.89
Rate for Payer: Home State Health Plan Medicare Advantage	$222.92
Rate for Payer: Optum Medicare Advantage	$484.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$169.90

TREAT DISTAL RD FX EPIO W/O MA

Professional

Both

$1,803.00

Service Code	CPT 25600
Hospital Charge Code	1825600
Hospital Revenue Code	981
Min. Negotiated Rate	$258.62
Max. Negotiated Rate	$631.05
Rate for Payer: Aetna Commercial/Medicare Advantage	$309.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$258.62
Rate for Payer: Cash Price	$1,622.70
Rate for Payer: Cash Price	$1,622.70
Rate for Payer: Cigna Commercial HMO & PPO	$309.37
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$258.62
Rate for Payer: Home State Health Plan Medicaid Managed Care	$284.48
Rate for Payer: Home State Health Plan Medicare Advantage	$309.37
Rate for Payer: Optum Medicare Advantage	$631.05
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$258.62

TREATMENT OF COLLAPSED LUNG

Professional

Both

$625.00

Service Code	CPT 32554
Hospital Charge Code	1832002
Hospital Revenue Code	981
Min. Negotiated Rate	$77.18
Max. Negotiated Rate	$392.10
Rate for Payer: Aetna Commercial/Medicare Advantage	$77.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$356.45
Rate for Payer: Cash Price	$562.50
Rate for Payer: Cash Price	$562.50
Rate for Payer: Cigna Commercial HMO & PPO	$77.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$356.45
Rate for Payer: Home State Health Plan Medicaid Managed Care	$392.10
Rate for Payer: Home State Health Plan Medicare Advantage	$77.18
Rate for Payer: Optum Medicare Advantage	$218.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$356.45

TREATMENT OF TOE FRACTURE

Professional

Both

$951.00

Service Code	CPT 28515
Hospital Charge Code	1828515
Hospital Revenue Code	981
Min. Negotiated Rate	$123.43
Max. Negotiated Rate	$332.85
Rate for Payer: Aetna Commercial/Medicare Advantage	$132.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$123.43
Rate for Payer: Cash Price	$855.90
Rate for Payer: Cash Price	$855.90
Rate for Payer: Cigna Commercial HMO & PPO	$132.63
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$123.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$135.77
Rate for Payer: Home State Health Plan Medicare Advantage	$132.63
Rate for Payer: Optum Medicare Advantage	$332.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$123.43

TREATMENT W/O ANEST-FACE

Professional

Both

$673.00

Service Code	CPT 16025
Hospital Charge Code	1816025
Hospital Revenue Code	981
Min. Negotiated Rate	$96.66
Max. Negotiated Rate	$235.55
Rate for Payer: Aetna Commercial/Medicare Advantage	$96.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$119.03
Rate for Payer: Cash Price	$605.70
Rate for Payer: Cash Price	$605.70
Rate for Payer: Cigna Commercial HMO & PPO	$96.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$119.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$130.93
Rate for Payer: Home State Health Plan Medicare Advantage	$96.66
Rate for Payer: Optum Medicare Advantage	$235.55
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$119.03

TREAT PIALANQEAL FX WITH MANIP

Professional

Both

$1,951.00

Service Code	CPT 26725
Hospital Charge Code	1826725
Hospital Revenue Code	981
Min. Negotiated Rate	$261.57
Max. Negotiated Rate	$682.85
Rate for Payer: Aetna Commercial/Medicare Advantage	$295.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$261.57
Rate for Payer: Cash Price	$1,755.90
Rate for Payer: Cash Price	$1,755.90
Rate for Payer: Cigna Commercial HMO & PPO	$295.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$261.57
Rate for Payer: Home State Health Plan Medicaid Managed Care	$287.73
Rate for Payer: Home State Health Plan Medicare Advantage	$295.87
Rate for Payer: Optum Medicare Advantage	$682.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$261.57

TREAT PIALANQEAL FX W/O MAN-EA

Professional

Both

$1,072.00

Service Code	CPT 26720
Hospital Charge Code	1826720
Hospital Revenue Code	981
Min. Negotiated Rate	$152.83
Max. Negotiated Rate	$375.20
Rate for Payer: Aetna Commercial/Medicare Advantage	$186.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$152.83
Rate for Payer: Cash Price	$964.80
Rate for Payer: Cash Price	$964.80
Rate for Payer: Cigna Commercial HMO & PPO	$186.06
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$152.83
Rate for Payer: Home State Health Plan Medicaid Managed Care	$168.11
Rate for Payer: Home State Health Plan Medicare Advantage	$186.06
Rate for Payer: Optum Medicare Advantage	$375.20
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$152.83

TREAT RIB FX CLOSED UNCOMP-EA.

Professional

Both

$697.00

Service Code	CPT 21800
Hospital Charge Code	1821800
Hospital Revenue Code	981
Min. Negotiated Rate	$243.95
Max. Negotiated Rate	$243.95
Rate for Payer: Cash Price	$627.30
Rate for Payer: Optum Medicare Advantage	$243.95

TRESIBA FLXTCH 200U/ML 3X3ML PFS

Facility

$1,089.00

Service Code	NDC 1E+11
Hospital Charge Code	2622102
Hospital Revenue Code	250
Min. Negotiated Rate	$392.04
Max. Negotiated Rate	$777.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$644.69
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$777.55
Rate for Payer: Cash Price	$980.10
Rate for Payer: UnitedHealthcare Commercial	$726.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$392.04

TRESIBA FLXTCH 200U/ML 3X3ML PFS

Facility

$1,089.00

Service Code	NDC 1E+11
Hospital Charge Code	2622102
Hospital Revenue Code	250
Rate for Payer: Cash Price	$980.10

TRETINOIN 0.05% CRM 45GM EMP

Facility

$75.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2625737
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

TRETINOIN 0.05% CRM 45GM EMP

Facility

$75.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2625737
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

TRETINOIN 0.05% LOT 20GM EMP

Facility

$75.00

Service Code	NDC 187000520
Hospital Charge Code	2624984
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

TRETINOIN 0.05% LOT 20GM EMP

Facility

$75.00

Service Code	NDC 187000520
Hospital Charge Code	2624984
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

TRIAD HYDROPHILIC WOUND DRSG 6OZ

Facility

$91.00

Service Code	NDC 1E+11
Hospital Charge Code	2619304
Hospital Revenue Code	250
Rate for Payer: Cash Price	$81.90

TRIAD HYDROPHILIC WOUND DRSG 6OZ

Facility

$91.00

Service Code	NDC 1E+11
Hospital Charge Code	2619304
Hospital Revenue Code	250
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$64.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: UnitedHealthcare Commercial	$60.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

TRIAL CABLE AND EXTENTION

Facility

$1,258.00

Hospital Charge Code	1216036
Hospital Revenue Code	360
Rate for Payer: Cash Price	$1,132.20

TRIAL CABLE AND EXTENTION

Facility

$1,258.00

Hospital Charge Code	1216036
Hospital Revenue Code	360
Min. Negotiated Rate	$452.88
Max. Negotiated Rate	$839.09
Rate for Payer: Cash Price	$1,132.20
Rate for Payer: UnitedHealthcare Commercial	$839.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$452.88

TRIAL KIT

Facility

$416.00

Hospital Charge Code	1216037
Hospital Revenue Code	360
Rate for Payer: Cash Price	$374.40

Know your out-of-pocket cost for care.

All Charges