Madison Medical Center

All Charges

Charge

Type

Setting

Price

GLIDESCOPE MILLER 1 BLADE

Facility

$59.00

Hospital Charge Code	2810043
Hospital Revenue Code	271
Min. Negotiated Rate	$21.24
Max. Negotiated Rate	$42.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$42.13
Rate for Payer: Cash Price	$53.10
Rate for Payer: UnitedHealthcare Commercial	$39.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$21.24

GLIDESCOPE MILLER 1 BLADE

Facility

$59.00

Hospital Charge Code	2810043
Hospital Revenue Code	271
Rate for Payer: Cash Price	$53.10

GLIDEWIRE

Facility

$1,105.00

Hospital Charge Code	1299103
Hospital Revenue Code	271
Min. Negotiated Rate	$397.80
Max. Negotiated Rate	$788.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$654.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$788.97
Rate for Payer: Cash Price	$994.50
Rate for Payer: UnitedHealthcare Commercial	$737.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$397.80

GLIDEWIRE

Facility

$1,105.00

Hospital Charge Code	1299103
Hospital Revenue Code	271
Rate for Payer: Cash Price	$994.50

GLIMEPIRIDE (AMARYL) 2MG TAB

Facility

$20.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2620594
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

GLIMEPIRIDE (AMARYL) 2MG TAB

Facility

$20.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2620594
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

GLIMEPIRIDE (AMARYL) 2MG TAB EMP

Facility

$20.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2622594
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

GLIMEPIRIDE (AMARYL) 2MG TAB EMP

Facility

$20.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2622594
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

GLIMEPIRIDE (AMARYL) 4MG TAB

Facility

$20.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2626269
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

GLIMEPIRIDE (AMARYL) 4MG TAB

Facility

$20.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2626269
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

GLIMEPIRIDE (AMARYL) 4MG TAB EMP

Facility

$20.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2624222
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

GLIMEPIRIDE (AMARYL) 4MG TAB EMP

Facility

$20.00

Service Code	NDC 5.5111E+10
Hospital Charge Code	2624222
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

GLIPIZIDE 10MG TAB EMP

Facility

$15.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2697419
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

GLIPIZIDE 10MG TAB EMP

Facility

$15.00

Service Code	NDC 6.0505E+10
Hospital Charge Code	2697419
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

GLIPIZIDE (GLUCOTROL) 2.5MG XL TAB EMP

Facility

$21.00

Service Code	NDC 5.9651E+10
Hospital Charge Code	2624542
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

GLIPIZIDE (GLUCOTROL) 2.5MG XL TAB EMP

Facility

$21.00

Service Code	NDC 5.9651E+10
Hospital Charge Code	2624542
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

GLIPIZIDE (GLUCOTROL) 5MG TAB

Facility

$21.00

Service Code	NDC 904663761
Hospital Charge Code	2655092
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

GLIPIZIDE (GLUCOTROL) 5MG TAB

Facility

$21.00

Service Code	NDC 904663761
Hospital Charge Code	2655092
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

GLIPIZIDE (GLUCOTROL) 5MG TAB EMP

Facility

$21.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2698014
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

GLIPIZIDE (GLUCOTROL) 5MG TAB EMP

Facility

$21.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2698014
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

GLIPIZIDE (GLUCOTROL) XL 5MG TAB

Facility

$20.00

Service Code	NDC 591084401
Hospital Charge Code	2626291
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

GLIPIZIDE (GLUCOTROL) XL 5MG TAB

Facility

$20.00

Service Code	NDC 591084401
Hospital Charge Code	2626291
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

GLIPIZIDE XL 10MG TAB EMP

Facility

$70.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2697518
Hospital Revenue Code	250
Rate for Payer: Cash Price	$63.00

GLIPIZIDE XL 10MG TAB EMP

Facility

$70.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2697518
Hospital Revenue Code	250
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

GLIPIZIDE XL 5MG TAB EMP

Facility

$20.00

Service Code	NDC 591084401
Hospital Charge Code	2621961
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

Know your out-of-pocket cost for care.

All Charges