Madison Medical Center

All Charges

Charge

Type

Setting

Price

TRIAMCINOLONE(KENALOG)0.1% CRM 15GM

Facility

$45.00

Service Code	NDC 6.7877E+10
Hospital Charge Code	2656435
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(KENALOG)0.1% CRM 15GM

Facility

$45.00

Service Code	NDC 6.7877E+10
Hospital Charge Code	2656435
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

TRIAMCINOLONE(KENALOG)0.1% CRM 80GM

Facility

$63.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2697088
Hospital Revenue Code	250
Rate for Payer: Cash Price	$56.70

TRIAMCINOLONE(KENALOG)0.1% CRM 80GM

Facility

$63.00

Service Code	NDC 4.5802E+10
Hospital Charge Code	2697088
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 (KENALOG) 40MG/ML INJ 10ML

Facility

$293.00

Service Code	HCPCS J3301
Hospital Charge Code	2626733
Hospital Revenue Code	250
Min. Negotiated Rate	$105.48
Max. Negotiated Rate	$209.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$173.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$209.20
Rate for Payer: Cash Price	$263.70
Rate for Payer: UnitedHealthcare Commercial	$195.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$105.48

TRIAMCINOLONE (KENALOG) 40MG/ML INJ 10ML

Facility

$293.00

Service Code	HCPCS J3301
Hospital Charge Code	2626733
Hospital Revenue Code	250
Rate for Payer: Cash Price	$263.70

TRIAMCINOLONE (KENALOG) 40MG/ML INJ 1ML

Facility

$293.00

Service Code	HCPCS J3301
Hospital Charge Code	2626734
Hospital Revenue Code	250
Min. Negotiated Rate	$105.48
Max. Negotiated Rate	$209.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$173.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$209.20
Rate for Payer: Cash Price	$263.70
Rate for Payer: UnitedHealthcare Commercial	$195.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$105.48

TRIAMCINOLONE (KENALOG) 40MG/ML INJ 1ML

Facility

$293.00

Service Code	HCPCS J3301
Hospital Charge Code	2626734
Hospital Revenue Code	250
Rate for Payer: Cash Price	$263.70

TRIAMCINOLONE (KENALOG) 40MG/ML INJ 5ML

Facility

$293.00

Service Code	HCPCS J3301
Hospital Charge Code	2654263
Hospital Revenue Code	250
Min. Negotiated Rate	$105.48
Max. Negotiated Rate	$209.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$173.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$209.20
Rate for Payer: Cash Price	$263.70
Rate for Payer: UnitedHealthcare Commercial	$195.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$105.48

TRIAMCINOLONE (KENALOG) 40MG/ML INJ 5ML

Facility

$293.00

Service Code	HCPCS J3301
Hospital Charge Code	2654263
Hospital Revenue Code	250
Rate for Payer: Cash Price	$263.70

TRIAMTERENE/HCTZ 75/50 TAB EMP

Facility

$21.00

Service Code	NDC 378135501
Hospital Charge Code	2622496
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

TRIAMTERENE/HCTZ 75/50 TAB EMP

Facility

$21.00

Service Code	NDC 378135501
Hospital Charge Code	2622496
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

TRIAMTERENE/HCTZ (MAXIDE) 37.5/25 TAB

Facility

$21.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2656452
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

TRIAMTERENE/HCTZ (MAXIDE) 37.5/25 TAB

Facility

$21.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2656452
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

TRIAMTER/HCTZ 37.5/25 CAP HE

Facility

$21.00

Service Code	NDC 527163201
Hospital Charge Code	2627102
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

TRIAMTER/HCTZ 37.5/25 CAP HE

Facility

$21.00

Service Code	NDC 527163201
Hospital Charge Code	2627102
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

TRIAMTER/HCTZ (DYAZIDE) 37.5/25 CAP EMP

Facility

$21.00

Service Code	NDC 781207401
Hospital Charge Code	2620902
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

TRIAMTER/HCTZ (DYAZIDE) 37.5/25 CAP EMP

Facility

$21.00

Service Code	NDC 781207401
Hospital Charge Code	2620902
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

TRICHOMONAS BY NAA

Facility

$340.00

Service Code	CPT 87661
Hospital Charge Code	2287210
Hospital Revenue Code	306
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$242.76
Rate for Payer: Aetna Better Health Medicaid/QHP	$31.58
Rate for Payer: Aetna Medicare Advantage	$35.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$201.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$242.76
Rate for Payer: Cash Price	$306.00
Rate for Payer: Cash Price	$306.00
Rate for Payer: Cash Price	$306.00
Rate for Payer: Cigna Commercial HMO & PPO	$35.09
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$31.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$33.79
Rate for Payer: Home State Health Plan Medicare Advantage	$35.09
Rate for Payer: Humana Commercial	$70.18
Rate for Payer: Humana Medicare Advantage	$35.09
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$31.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$122.40

TRICHOMONAS BY NAA

Facility

$340.00

Service Code	CPT 87661
Hospital Charge Code	2287210
Hospital Revenue Code	306
Rate for Payer: Cash Price	$306.00

TRICYCLIC ANTIDEPRESSANT UR

Facility

$264.00

Service Code	CPT 80335
Hospital Charge Code	2280302
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$188.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$156.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$188.50
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.04

TRICYCLIC ANTIDEPRESSANT UR

Facility

$264.00

Service Code	CPT 80335
Hospital Charge Code	2280302
Hospital Revenue Code	301
Rate for Payer: Cash Price	$237.60

TRI-ESTARYLLA TAB 3X28 TAB EMP

Facility

$113.00

Service Code	NDC 7.07E+10
Hospital Charge Code	2626094
Hospital Revenue Code	250
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$80.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$80.68
Rate for Payer: Cash Price	$101.70
Rate for Payer: UnitedHealthcare Commercial	$75.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.68

TRI-ESTARYLLA TAB 3X28 TAB EMP

Facility

$113.00

Service Code	NDC 7.07E+10
Hospital Charge Code	2626094
Hospital Revenue Code	250
Rate for Payer: Cash Price	$101.70

TRIGGER POINT INJECT 1 OR 2 MUSCLES

Facility

$300.00

Service Code	CPT 20550
Hospital Charge Code	9120552
Hospital Revenue Code	521
Rate for Payer: Cash Price	$270.00

Know your out-of-pocket cost for care.

All Charges