Madison Medical Center

All Charges

Charge

Type

Setting

Price

TRI-LO-MARZIA TAB EMP 3X28TABS

Facility

$113.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2622723
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-LO-MARZIA TAB EMP 3X28TABS

Facility

$113.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2622723
Hospital Revenue Code	250
Rate for Payer: Cash Price	$101.70

TRI-LUMEN VENOUS CATH #AK-15703-A

Facility

$302.00

Hospital Charge Code	2820007
Hospital Revenue Code	271
Min. Negotiated Rate	$108.72
Max. Negotiated Rate	$215.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$178.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$215.63
Rate for Payer: Cash Price	$271.80
Rate for Payer: UnitedHealthcare Commercial	$201.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$108.72

TRI-LUMEN VENOUS CATH #AK-15703-A

Facility

$302.00

Hospital Charge Code	2820007
Hospital Revenue Code	271
Rate for Payer: Cash Price	$271.80

TRIMETHABENXAMIDE INJ

Facility

$65.00

Service Code	HCPCS J3250
Hospital Charge Code	2058066
Hospital Revenue Code	370
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

TRIMETHABENXAMIDE INJ

Facility

$65.00

Service Code	HCPCS J3250
Hospital Charge Code	2058066
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

TRIMMING OF NONDYSTROPHIC NAILS

Facility

$45.00

Service Code	CPT 11719
Hospital Charge Code	4211719
Hospital Revenue Code	521
Min. Negotiated Rate	$26.64
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
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: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cash Price	$40.50
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRIMMING OF NONDYSTROPHIC NAILS

Facility

$45.00

Service Code	CPT 11719
Hospital Charge Code	4211719
Hospital Revenue Code	521
Rate for Payer: Cash Price	$40.50

TRIMMING OF NONDYSTROPHIC NAILS ANY NUMB

Facility

$50.00

Service Code	CPT 11719
Hospital Charge Code	9311719
Hospital Revenue Code	521
Min. Negotiated Rate	$29.60
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$53.18
Rate for Payer: Aetna Medicare Advantage	$60.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$29.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$35.70
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cash Price	$45.00
Rate for Payer: Cigna Commercial HMO & PPO	$60.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$47.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$56.90
Rate for Payer: Home State Health Plan Medicare Advantage	$60.27
Rate for Payer: Humana Commercial	$120.54
Rate for Payer: Humana Medicare Advantage	$60.27
Rate for Payer: UnitedHealthcare Commercial	$33.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$53.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRIMMING OF NONDYSTROPHIC NAILS ANY NUMB

Facility

$50.00

Service Code	CPT 11719
Hospital Charge Code	9311719
Hospital Revenue Code	521
Rate for Payer: Cash Price	$45.00

TRINTELLIX 20MG TAB EMP

Facility

$15.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2623504
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

TRINTELLIX 20MG TAB EMP

Facility

$15.00

Service Code	NDC 6.818E+10
Hospital Charge Code	2623504
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

TRIPPLE SCREEN (82677)

Facility

$87.00

Service Code	CPT 82677
Hospital Charge Code	4282677
Hospital Revenue Code	521
Min. Negotiated Rate	$19.58
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$21.76
Rate for Payer: Aetna Medicare Advantage	$24.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$51.50
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$62.12
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cash Price	$78.30
Rate for Payer: Cigna Commercial HMO & PPO	$24.18
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19.58
Rate for Payer: Home State Health Plan Medicaid Managed Care	$23.28
Rate for Payer: Home State Health Plan Medicare Advantage	$24.18
Rate for Payer: Humana Commercial	$48.36
Rate for Payer: Humana Medicare Advantage	$24.18
Rate for Payer: UnitedHealthcare Commercial	$58.03
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$21.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRIPPLE SCREEN (82677)

Facility

$87.00

Service Code	CPT 82677
Hospital Charge Code	4282677
Hospital Revenue Code	521
Rate for Payer: Cash Price	$78.30

TRIPPLE SCREEN (84702)

Facility

$54.00

Service Code	CPT 84702
Hospital Charge Code	4284702
Hospital Revenue Code	521
Rate for Payer: Cash Price	$48.60

TRIPPLE SCREEN (84702)

Facility

$54.00

Service Code	CPT 84702
Hospital Charge Code	4284702
Hospital Revenue Code	521
Min. Negotiated Rate	$12.20
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$13.55
Rate for Payer: Aetna Medicare Advantage	$15.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$31.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$38.56
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cash Price	$48.60
Rate for Payer: Cigna Commercial HMO & PPO	$15.05
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.20
Rate for Payer: Home State Health Plan Medicaid Managed Care	$14.50
Rate for Payer: Home State Health Plan Medicare Advantage	$15.05
Rate for Payer: Humana Commercial	$30.10
Rate for Payer: Humana Medicare Advantage	$15.05
Rate for Payer: UnitedHealthcare Commercial	$36.02
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$13.55
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TRI-SPRINTEC TAB 6X28 TAB EMP

Facility

$113.00

Service Code	NDC 555901858
Hospital Charge Code	2624060
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-SPRINTEC TAB 6X28 TAB EMP

Facility

$113.00

Service Code	NDC 555901858
Hospital Charge Code	2624060
Hospital Revenue Code	250
Rate for Payer: Cash Price	$101.70

TROCAR 12MM

Facility

$551.00

Hospital Charge Code	2820856
Hospital Revenue Code	271
Rate for Payer: Cash Price	$495.90

TROCAR 12MM

Facility

$487.00

Hospital Charge Code	1220856
Hospital Revenue Code	271
Min. Negotiated Rate	$175.32
Max. Negotiated Rate	$347.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$288.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$347.72
Rate for Payer: Cash Price	$438.30
Rate for Payer: UnitedHealthcare Commercial	$324.83
Rate for Payer: UnitedHealthcare Medicare Advantage	$175.32

TROCAR 12MM

Facility

$487.00

Hospital Charge Code	1220856
Hospital Revenue Code	271
Rate for Payer: Cash Price	$438.30

TROCAR 12MM

Facility

$551.00

Hospital Charge Code	2820856
Hospital Revenue Code	271
Min. Negotiated Rate	$198.36
Max. Negotiated Rate	$393.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$326.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$393.41
Rate for Payer: Cash Price	$495.90
Rate for Payer: UnitedHealthcare Commercial	$367.52
Rate for Payer: UnitedHealthcare Medicare Advantage	$198.36

TROCAR, 12MM BLUNT TIP XCEL H12LP

Facility

$542.00

Hospital Charge Code	125356
Hospital Revenue Code	271
Min. Negotiated Rate	$195.12
Max. Negotiated Rate	$386.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$320.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$386.99
Rate for Payer: Cash Price	$487.80
Rate for Payer: UnitedHealthcare Commercial	$361.51
Rate for Payer: UnitedHealthcare Medicare Advantage	$195.12

TROCAR, 12MM BLUNT TIP XCEL H12LP

Facility

$542.00

Hospital Charge Code	125356
Hospital Revenue Code	271
Rate for Payer: Cash Price	$487.80

TROCAR-5MM

Facility

$320.00

Hospital Charge Code	1219104
Hospital Revenue Code	271
Min. Negotiated Rate	$115.20
Max. Negotiated Rate	$228.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$189.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$228.48
Rate for Payer: Cash Price	$288.00
Rate for Payer: UnitedHealthcare Commercial	$213.44
Rate for Payer: UnitedHealthcare Medicare Advantage	$115.20

Know your out-of-pocket cost for care.

All Charges