Madison Medical Center

All Charges

Charge

Type

Setting

Price

TSH

Facility

$264.00

Service Code	CPT 84443
Hospital Charge Code	2220101
Hospital Revenue Code	301
Rate for Payer: Cash Price	$237.60

TSH

Facility

$61.00

Service Code	CPT 84443
Hospital Charge Code	4284443
Hospital Revenue Code	521
Rate for Payer: Cash Price	$54.90

TSH (LABCORP)

Facility

$11.00

Service Code	CPT 84443
Hospital Charge Code	2224259
Hospital Revenue Code	301
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$33.60
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.12
Rate for Payer: Aetna Medicare Advantage	$16.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.85
Rate for Payer: Cash Price	$9.90
Rate for Payer: Cash Price	$9.90
Rate for Payer: Cash Price	$9.90
Rate for Payer: Cigna Commercial HMO & PPO	$16.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.18
Rate for Payer: Home State Health Plan Medicare Advantage	$16.80
Rate for Payer: Humana Commercial	$33.60
Rate for Payer: Humana Medicare Advantage	$16.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.96

TSH (LABCORP)

Facility

$11.00

Service Code	CPT 84443
Hospital Charge Code	2224259
Hospital Revenue Code	301
Rate for Payer: Cash Price	$9.90

TSH REFLEX FT4

Facility

$264.00

Service Code	CPT 84443
Hospital Charge Code	2220109
Hospital Revenue Code	301
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$188.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.12
Rate for Payer: Aetna Medicare Advantage	$16.80
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: Cash Price	$237.60
Rate for Payer: Cigna Commercial HMO & PPO	$16.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.18
Rate for Payer: Home State Health Plan Medicare Advantage	$16.80
Rate for Payer: Humana Commercial	$33.60
Rate for Payer: Humana Medicare Advantage	$16.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.04

TSH REFLEX FT4

Facility

$264.00

Service Code	CPT 84443
Hospital Charge Code	2220109
Hospital Revenue Code	301
Rate for Payer: Cash Price	$237.60

TSH REFLEX TT4

Facility

$264.00

Service Code	CPT 84443
Hospital Charge Code	2220103
Hospital Revenue Code	301
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$188.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.12
Rate for Payer: Aetna Medicare Advantage	$16.80
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: Cash Price	$237.60
Rate for Payer: Cigna Commercial HMO & PPO	$16.80
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.12
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.18
Rate for Payer: Home State Health Plan Medicare Advantage	$16.80
Rate for Payer: Humana Commercial	$33.60
Rate for Payer: Humana Medicare Advantage	$16.80
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.12
Rate for Payer: UnitedHealthcare Medicare Advantage	$95.04

TSH REFLEX TT4

Facility

$264.00

Service Code	CPT 84443
Hospital Charge Code	2220103
Hospital Revenue Code	301
Rate for Payer: Cash Price	$237.60

TSI (THYROID STIMULATING IMMUNOGLOBULIN)

Facility

$244.00

Service Code	CPT 84445
Hospital Charge Code	2284445
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$174.22
Rate for Payer: Aetna Better Health Medicaid/QHP	$45.77
Rate for Payer: Aetna Medicare Advantage	$50.86
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$144.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$174.22
Rate for Payer: Cash Price	$219.60
Rate for Payer: Cash Price	$219.60
Rate for Payer: Cash Price	$219.60
Rate for Payer: Cigna Commercial HMO & PPO	$50.86
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$45.77
Rate for Payer: Home State Health Plan Medicaid Managed Care	$48.97
Rate for Payer: Home State Health Plan Medicare Advantage	$50.86
Rate for Payer: Humana Commercial	$101.72
Rate for Payer: Humana Medicare Advantage	$50.86
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$45.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$87.84

TSI (THYROID STIMULATING IMMUNOGLOBULIN)

Facility

$244.00

Service Code	CPT 84445
Hospital Charge Code	2284445
Hospital Revenue Code	301
Rate for Payer: Cash Price	$219.60

.TTG IGG

Facility

$235.00

Service Code	CPT 86364
Hospital Charge Code	221956
Hospital Revenue Code	302
Rate for Payer: Cash Price	$211.50

.TTG IGG

Facility

$235.00

Service Code	CPT 86364
Hospital Charge Code	221956
Hospital Revenue Code	302
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$167.79
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.38
Rate for Payer: Aetna Medicare Advantage	$11.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$139.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$167.79
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cash Price	$211.50
Rate for Payer: Cigna Commercial HMO & PPO	$11.53
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.38
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.11
Rate for Payer: Home State Health Plan Medicare Advantage	$11.53
Rate for Payer: Humana Commercial	$23.06
Rate for Payer: Humana Medicare Advantage	$11.53
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.60

T TUBE

Facility

$272.00

Hospital Charge Code	1220146
Hospital Revenue Code	271
Rate for Payer: Cash Price	$244.80

T TUBE

Facility

$272.00

Hospital Charge Code	2820146
Hospital Revenue Code	271
Min. Negotiated Rate	$97.92
Max. Negotiated Rate	$194.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$161.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$194.21
Rate for Payer: Cash Price	$244.80
Rate for Payer: UnitedHealthcare Commercial	$181.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.92

T TUBE

Facility

$272.00

Hospital Charge Code	1220146
Hospital Revenue Code	271
Min. Negotiated Rate	$97.92
Max. Negotiated Rate	$194.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$161.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$194.21
Rate for Payer: Cash Price	$244.80
Rate for Payer: UnitedHealthcare Commercial	$181.42
Rate for Payer: UnitedHealthcare Medicare Advantage	$97.92

T TUBE

Facility

$272.00

Hospital Charge Code	2820146
Hospital Revenue Code	271
Rate for Payer: Cash Price	$244.80

TUBAL LIGATION AT CESAREAN

Facility

$534.00

Service Code	CPT 58611
Hospital Charge Code	4258611
Rate for Payer: Cash Price	$480.60

TUBAL LIGATION W/C-SECTION

Facility

$811.00

Service Code	CPT 58611
Hospital Charge Code	5258611
Hospital Revenue Code	521
Min. Negotiated Rate	$173.53
Max. Negotiated Rate	$579.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$480.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$579.05
Rate for Payer: Cash Price	$729.90
Rate for Payer: Cash Price	$729.90
Rate for Payer: UnitedHealthcare Commercial	$540.94
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

TUBAL LIGATION W/C-SECTION

Facility

$811.00

Service Code	CPT 58611
Hospital Charge Code	5258611
Hospital Revenue Code	521
Rate for Payer: Cash Price	$729.90

TUBAL W/C-SECTION

Professional

Both

$811.00

Service Code	CPT 58611
Hospital Charge Code	4158611
Hospital Revenue Code	975
Min. Negotiated Rate	$63.54
Max. Negotiated Rate	$283.85
Rate for Payer: Aetna Commercial/Medicare Advantage	$63.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$71.94
Rate for Payer: Cash Price	$729.90
Rate for Payer: Cash Price	$729.90
Rate for Payer: Cigna Commercial HMO & PPO	$63.54
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$71.94
Rate for Payer: Home State Health Plan Medicaid Managed Care	$79.13
Rate for Payer: Home State Health Plan Medicare Advantage	$63.54
Rate for Payer: Optum Medicare Advantage	$283.85
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$71.94

TUBE CANTOR

Facility

$106.00

Hospital Charge Code	2820100
Hospital Revenue Code	271
Rate for Payer: Cash Price	$95.40

TUBE CANTOR

Facility

$106.00

Hospital Charge Code	2820100
Hospital Revenue Code	271
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$75.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: UnitedHealthcare Commercial	$70.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

TUBE CONNECT CONDUCT 8888301622

Facility

$58.00

Hospital Charge Code	2820723
Hospital Revenue Code	271
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

TUBE CONNECT CONDUCT 8888301622

Facility

$58.00

Hospital Charge Code	2820723
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

TUBE GAUZE PER IN.

Facility

$10.00

Hospital Charge Code	2820510
Hospital Revenue Code	271
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$7.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.14
Rate for Payer: Cash Price	$9.00
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

Know your out-of-pocket cost for care.

All Charges