Madison Medical Center

All Charges

Charge

Type

Setting

Price

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

TRIGGER POINT INJECTION

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	9820550
Hospital Revenue Code	521
Min. Negotiated Rate	$142.08
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$142.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$171.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$160.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRIGGER POINT INJECTION

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	4420550
Hospital Revenue Code	521
Min. Negotiated Rate	$142.08
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$142.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$171.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$160.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRIGGER POINT INJECTION

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	9320550
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

TRIGGER POINT INJECTION

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	9820550
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

TRIGGER POINT INJECTION

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	4420550
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

TRIGGER POINT INJECTION

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	5420550
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

TRIGGER POINT INJECTION

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	9320550
Hospital Revenue Code	521
Min. Negotiated Rate	$142.08
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$142.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$171.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$160.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRIGGER POINT INJECTION

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	4220550
Hospital Revenue Code	521
Min. Negotiated Rate	$142.08
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$142.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$171.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$160.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRIGGER POINT INJECTION

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	4220550
Hospital Revenue Code	521
Rate for Payer: Cash Price	$216.00

TRIGGER POINT INJECTION

Facility

$240.00

Service Code	CPT 20550
Hospital Charge Code	5420550
Hospital Revenue Code	521
Min. Negotiated Rate	$142.08
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$142.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$171.36
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cash Price	$216.00
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$160.08
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRIGGER POINT INJECTION 1 OR 2 MUSCLES

Facility

$210.00

Service Code	CPT 20552
Hospital Charge Code	4120552
Hospital Revenue Code	521
Rate for Payer: Cash Price	$189.00

TRIGGER POINT INJECTION 1 OR 2 MUSCLES

Facility

$210.00

Service Code	CPT 20552
Hospital Charge Code	4120552
Hospital Revenue Code	521
Min. Negotiated Rate	$124.32
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$124.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$149.94
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cash Price	$189.00
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$140.07
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRIGGER POINT INJECTION 1 OR 2 MUSCLES

Facility

$250.00

Service Code	CPT 20552
Hospital Charge Code	5420552
Hospital Revenue Code	521
Min. Negotiated Rate	$148.00
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
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: Cash Price	$225.00
Rate for Payer: Cash Price	$225.00
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$166.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRIGGER POINT INJECTION 1 OR 2 MUSCLES

Facility

$250.00

Service Code	CPT 20552
Hospital Charge Code	5420552
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.00

TRIGGER POINT INJECTION 3 OR MOREMUSCLES

Facility

$350.00

Service Code	CPT 20553
Hospital Charge Code	5420553
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$627.20
Rate for Payer: Aetna Better Health Medicaid/QHP	$276.70
Rate for Payer: Aetna Medicare Advantage	$313.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$207.20
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$249.90
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cash Price	$315.00
Rate for Payer: Cigna Commercial HMO & PPO	$313.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$249.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$296.07
Rate for Payer: Home State Health Plan Medicare Advantage	$313.60
Rate for Payer: Humana Commercial	$627.20
Rate for Payer: Humana Medicare Advantage	$313.60
Rate for Payer: UnitedHealthcare Commercial	$233.45
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$276.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRIGGER POINT INJECTION 3 OR MOREMUSCLES

Facility

$350.00

Service Code	CPT 20553
Hospital Charge Code	5420553
Hospital Revenue Code	521
Rate for Payer: Cash Price	$315.00

TRIGLYCERIDES

Facility

$105.00

Service Code	CPT 84478
Hospital Charge Code	2220154
Hospital Revenue Code	301
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$74.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.17
Rate for Payer: Aetna Medicare Advantage	$5.74
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: Cash Price	$94.50
Rate for Payer: Cigna Commercial HMO & PPO	$5.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.53
Rate for Payer: Home State Health Plan Medicare Advantage	$5.74
Rate for Payer: Humana Commercial	$11.48
Rate for Payer: Humana Medicare Advantage	$5.74
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.80

TRIGLYCERIDES

Facility

$105.00

Service Code	CPT 84478
Hospital Charge Code	2220154
Hospital Revenue Code	301
Rate for Payer: Cash Price	$94.50

.TRIGLYCERIDES CPT 84478

Facility

$55.00

Service Code	CPT 84478
Hospital Charge Code	22284478
Hospital Revenue Code	307
Rate for Payer: Cash Price	$49.50

.TRIGLYCERIDES CPT 84478

Facility

$55.00

Service Code	CPT 84478
Hospital Charge Code	22284478
Hospital Revenue Code	307
Min. Negotiated Rate	$5.17
Max. Negotiated Rate	$39.27
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.17
Rate for Payer: Aetna Medicare Advantage	$5.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cash Price	$49.50
Rate for Payer: Cigna Commercial HMO & PPO	$5.74
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.17
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.53
Rate for Payer: Home State Health Plan Medicare Advantage	$5.74
Rate for Payer: Humana Commercial	$11.48
Rate for Payer: Humana Medicare Advantage	$5.74
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.17
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

TRILENE

Facility

$70.00

Hospital Charge Code	2820009
Hospital Revenue Code	271
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$49.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$41.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$49.98
Rate for Payer: Cash Price	$63.00
Rate for Payer: UnitedHealthcare Commercial	$46.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$25.20

TRILENE

Facility

$70.00

Hospital Charge Code	2820009
Hospital Revenue Code	271
Rate for Payer: Cash Price	$63.00

TRI-LINYAH TAB 6X28 TAB EMP

Facility

$113.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2623198
Hospital Revenue Code	250
Rate for Payer: Cash Price	$101.70

TRI-LINYAH TAB 6X28 TAB EMP

Facility

$113.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2623198
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

Know your out-of-pocket cost for care.

All Charges