Madison Medical Center

All Charges

Charge

Type

Setting

Price

TRIAL KIT

Facility

$416.00

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

TRIAL LEAD KIT (50CM 8)

Facility

$3,405.00

Hospital Charge Code	1216039
Hospital Revenue Code	278
Min. Negotiated Rate	$2,271.14
Max. Negotiated Rate	$2,764.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,308.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,764.86
Rate for Payer: Cash Price	$3,064.50
Rate for Payer: UnitedHealthcare Commercial	$2,271.14

TRIAL LEAD KIT (50CM 8)

Facility

$3,405.00

Hospital Charge Code	1216039
Hospital Revenue Code	278
Min. Negotiated Rate	$1,225.80
Max. Negotiated Rate	$2,764.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,308.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,764.86
Rate for Payer: Cash Price	$3,064.50
Rate for Payer: UnitedHealthcare Commercial	$2,271.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,225.80

TRIAMACILONE ACETONID 20 MG

Facility

$105.00

Service Code	CPT J3301
Hospital Charge Code	4103301
Hospital Revenue Code	636
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$74.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: UnitedHealthcare Commercial	$70.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.80

TRIAMACILONE ACETONID 20 MG

Facility

$105.00

Service Code	CPT J3301
Hospital Charge Code	4103301
Hospital Revenue Code	636
Min. Negotiated Rate	$70.03
Max. Negotiated Rate	$70.03
Rate for Payer: Cash Price	$94.50
Rate for Payer: UnitedHealthcare Commercial	$70.03

TRIAMACILONE ACETONID 20 MG

Facility

$105.00

Service Code	HCPCS J3301
Hospital Charge Code	9103301
Hospital Revenue Code	521
Rate for Payer: Cash Price	$94.50

TRIAMACILONE ACETONID 20 MG

Facility

$105.00

Service Code	HCPCS J3301
Hospital Charge Code	9103301
Hospital Revenue Code	521
Min. Negotiated Rate	$62.16
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: Cash Price	$94.50
Rate for Payer: UnitedHealthcare Commercial	$70.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRIAMCINOLONE 0.025% CRM 15GM EMP

Facility

$34.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2627169
Hospital Revenue Code	250
Rate for Payer: Cash Price	$30.60

TRIAMCINOLONE 0.025% CRM 15GM EMP

Facility

$34.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2627169
Hospital Revenue Code	250
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$24.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.28
Rate for Payer: Cash Price	$30.60
Rate for Payer: UnitedHealthcare Commercial	$22.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.24

TRIAMCINOLONE 0.025% TOP OINT 80GM EMP

Facility

$34.00

Service Code	NDC 168000580
Hospital Charge Code	2626226
Hospital Revenue Code	250
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$24.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.28
Rate for Payer: Cash Price	$30.60
Rate for Payer: UnitedHealthcare Commercial	$22.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.24

TRIAMCINOLONE 0.025% TOP OINT 80GM EMP

Facility

$34.00

Service Code	NDC 168000580
Hospital Charge Code	2626226
Hospital Revenue Code	250
Rate for Payer: Cash Price	$30.60

TRIAMCINOLONE 0.1% CRM 15GM EMP

Facility

$45.00

Service Code	NDC 168000415
Hospital Charge Code	2622473
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

TRIAMCINOLONE 0.1% CRM 15GM EMP

Facility

$45.00

Service Code	NDC 168000415
Hospital Charge Code	2622473
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

TRIAMCINOLONE 0.1% CRM 30GM EMP

Facility

$63.00

Service Code	NDC 168000380
Hospital Charge Code	2626166
Hospital Revenue Code	250
Rate for Payer: Cash Price	$56.70

TRIAMCINOLONE 0.1% CRM 30GM EMP

Facility

$63.00

Service Code	NDC 168000380
Hospital Charge Code	2626166
Hospital Revenue Code	250
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

TRIAMCINOLONE 0.1% CRM 454GM EMP

Facility

$63.00

Service Code	NDC 168000416
Hospital Charge Code	2623078
Hospital Revenue Code	250
Rate for Payer: Cash Price	$56.70

TRIAMCINOLONE 0.1% CRM 454GM EMP

Facility

$63.00

Service Code	NDC 168000416
Hospital Charge Code	2623078
Hospital Revenue Code	250
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

TRIAMCINOLONE 0.1% CRM 80GM EMP

Facility

$63.00

Service Code	NDC 168000380
Hospital Charge Code	2622608
Hospital Revenue Code	250
Rate for Payer: Cash Price	$56.70

TRIAMCINOLONE 0.1% CRM 80GM EMP

Facility

$63.00

Service Code	NDC 168000380
Hospital Charge Code	2622608
Hospital Revenue Code	250
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

TRIAMCINOLONE 0.1% TOP DENTAL 5GM EMP

Facility

$34.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2624728
Hospital Revenue Code	250
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$24.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.28
Rate for Payer: Cash Price	$30.60
Rate for Payer: UnitedHealthcare Commercial	$22.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.24

TRIAMCINOLONE 0.1% TOP DENTAL 5GM EMP

Facility

$34.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2624728
Hospital Revenue Code	250
Rate for Payer: Cash Price	$30.60

TRIAMCINOLONE 0.1% TOP OINT 80GM EMP

Facility

$34.00

Service Code	NDC 1E+11
Hospital Charge Code	2622258
Hospital Revenue Code	250
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$24.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.28
Rate for Payer: Cash Price	$30.60
Rate for Payer: UnitedHealthcare Commercial	$22.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.24

TRIAMCINOLONE 0.1% TOP OINT 80GM EMP

Facility

$34.00

Service Code	NDC 1E+11
Hospital Charge Code	2622258
Hospital Revenue Code	250
Rate for Payer: Cash Price	$30.60

TRIAMCINOLONE ACETONID 40 MG

Facility

$102.00

Service Code	HCPCS J3301
Hospital Charge Code	9303301
Hospital Revenue Code	636
Min. Negotiated Rate	$68.03
Max. Negotiated Rate	$68.03
Rate for Payer: Cash Price	$91.80
Rate for Payer: UnitedHealthcare Commercial	$68.03

TRIAMCINOLONE ACETONID 40 MG

Facility

$102.00

Service Code	HCPCS J3301
Hospital Charge Code	9303301
Hospital Revenue Code	636
Min. Negotiated Rate	$36.72
Max. Negotiated Rate	$72.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$60.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.83
Rate for Payer: Cash Price	$91.80
Rate for Payer: UnitedHealthcare Commercial	$68.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.72

Know your out-of-pocket cost for care.

All Charges