Madison Medical Center

All Charges

Charge

Type

Setting

Price

GLIPIZIDE XL 5MG TAB EMP

Facility

$20.00

Service Code	NDC 591084401
Hospital Charge Code	2621961
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

GLOCOSE TOLERANCE TEST (82951)

Facility

$47.00

Service Code	CPT 82951
Hospital Charge Code	4282951
Hospital Revenue Code	521
Min. Negotiated Rate	$10.42
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.58
Rate for Payer: Aetna Medicare Advantage	$12.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$27.82
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$33.56
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cash Price	$42.30
Rate for Payer: Cigna Commercial HMO & PPO	$12.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.42
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.39
Rate for Payer: Home State Health Plan Medicare Advantage	$12.87
Rate for Payer: Humana Commercial	$25.74
Rate for Payer: Humana Medicare Advantage	$12.87
Rate for Payer: UnitedHealthcare Commercial	$31.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

GLOCOSE TOLERANCE TEST (82951)

Facility

$47.00

Service Code	CPT 82951
Hospital Charge Code	4282951
Hospital Revenue Code	521
Rate for Payer: Cash Price	$42.30

GLOMERULAR BASEMENT MEMBRANE IGA

Facility

$335.00

Service Code	CPT 83516
Hospital Charge Code	2283525
Hospital Revenue Code	302
Rate for Payer: Cash Price	$301.50

GLOMERULAR BASEMENT MEMBRANE IGA

Facility

$335.00

Service Code	CPT 83516
Hospital Charge Code	2283525
Hospital Revenue Code	302
Min. Negotiated Rate	$10.38
Max. Negotiated Rate	$239.19
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	$198.32
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$239.19
Rate for Payer: Cash Price	$301.50
Rate for Payer: Cash Price	$301.50
Rate for Payer: Cash Price	$301.50
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	$120.60

GLOVES

Facility

$20.00

Hospital Charge Code	1269110
Hospital Revenue Code	271
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

GLOVES

Facility

$20.00

Hospital Charge Code	1269110
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.00

GLOVES PF LATEX LARGE

Facility

$27.00

Hospital Charge Code	287382
Hospital Revenue Code	271
Rate for Payer: Cash Price	$24.30

GLOVES PF LATEX LARGE

Facility

$27.00

Hospital Charge Code	287382
Hospital Revenue Code	271
Min. Negotiated Rate	$9.72
Max. Negotiated Rate	$19.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$15.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.28
Rate for Payer: Cash Price	$24.30
Rate for Payer: UnitedHealthcare Commercial	$18.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.72

GLOVES PF LATEX MEDIUM

Facility

$24.00

Hospital Charge Code	287381
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

GLOVES PF LATEX MEDIUM

Facility

$24.00

Hospital Charge Code	287381
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

GLOVES PF LATEX SMALL

Facility

$24.00

Hospital Charge Code	287383
Hospital Revenue Code	271
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

GLOVES PF LATEX SMALL

Facility

$24.00

Hospital Charge Code	287383
Hospital Revenue Code	271
Rate for Payer: Cash Price	$21.60

GLUCAGON

Facility

$155.00

Service Code	CPT 82943
Hospital Charge Code	2282943
Hospital Revenue Code	301
Rate for Payer: Cash Price	$139.50

GLUCAGON

Facility

$155.00

Service Code	CPT 82943
Hospital Charge Code	2282943
Hospital Revenue Code	301
Min. Negotiated Rate	$12.86
Max. Negotiated Rate	$110.67
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.86
Rate for Payer: Aetna Medicare Advantage	$14.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$91.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$110.67
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cash Price	$139.50
Rate for Payer: Cigna Commercial HMO & PPO	$14.29
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.86
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.76
Rate for Payer: Home State Health Plan Medicare Advantage	$14.29
Rate for Payer: Humana Commercial	$28.58
Rate for Payer: Humana Medicare Advantage	$14.29
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.86
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.80

GLUCAGON (GLUCAGEN) 1MG KIT INJ

Facility

$1,104.00

Service Code	HCPCS J1610
Hospital Charge Code	2655095
Hospital Revenue Code	250
Rate for Payer: Cash Price	$993.60

GLUCAGON (GLUCAGEN) 1MG KIT INJ

Facility

$1,104.00

Service Code	HCPCS J1610
Hospital Charge Code	2655095
Hospital Revenue Code	250
Min. Negotiated Rate	$117.33
Max. Negotiated Rate	$788.26
Rate for Payer: Aetna Medicare Advantage	$117.33
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$653.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$788.26
Rate for Payer: Cash Price	$993.60
Rate for Payer: Cash Price	$993.60
Rate for Payer: Cigna Commercial HMO & PPO	$117.33
Rate for Payer: Home State Health Plan Medicare Advantage	$117.33
Rate for Payer: Humana Commercial	$234.66
Rate for Payer: Humana Medicare Advantage	$117.33
Rate for Payer: UnitedHealthcare Commercial	$736.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$397.44

GLUCAGON HYPOKIT 1MG INJ EMP

Facility

$453.00

Service Code	NDC 169706515
Hospital Charge Code	2624491
Hospital Revenue Code	250
Min. Negotiated Rate	$163.08
Max. Negotiated Rate	$323.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$268.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$323.44
Rate for Payer: Cash Price	$407.70
Rate for Payer: UnitedHealthcare Commercial	$302.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$163.08

GLUCAGON HYPOKIT 1MG INJ EMP

Facility

$453.00

Service Code	NDC 169706515
Hospital Charge Code	2624491
Hospital Revenue Code	250
Rate for Payer: Cash Price	$407.70

GLUCOSE

Facility

$119.00

Service Code	CPT 82947
Hospital Charge Code	227111
Hospital Revenue Code	301
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$84.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.54
Rate for Payer: Aetna Medicare Advantage	$3.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$70.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$84.97
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cigna Commercial HMO & PPO	$3.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.79
Rate for Payer: Home State Health Plan Medicare Advantage	$3.93
Rate for Payer: Humana Commercial	$7.86
Rate for Payer: Humana Medicare Advantage	$3.93
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84

GLUCOSE

Facility

$119.00

Service Code	CPT 82947
Hospital Charge Code	227111
Hospital Revenue Code	301
Rate for Payer: Cash Price	$107.10

GLUCOSE 2HR POST PRAN

Facility

$119.00

Service Code	CPT 82947
Hospital Charge Code	227115
Hospital Revenue Code	301
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$84.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.54
Rate for Payer: Aetna Medicare Advantage	$3.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$70.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$84.97
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cash Price	$107.10
Rate for Payer: Cigna Commercial HMO & PPO	$3.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.79
Rate for Payer: Home State Health Plan Medicare Advantage	$3.93
Rate for Payer: Humana Commercial	$7.86
Rate for Payer: Humana Medicare Advantage	$3.93
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$42.84

GLUCOSE 2HR POST PRAN

Facility

$119.00

Service Code	CPT 82947
Hospital Charge Code	227115
Hospital Revenue Code	301
Rate for Payer: Cash Price	$107.10

GLUCOSE BODY FLUID

Facility

$24.00

Service Code	CPT 82945
Hospital Charge Code	2282945
Hospital Revenue Code	301
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.54
Rate for Payer: Aetna Medicare Advantage	$3.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cigna Commercial HMO & PPO	$3.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.79
Rate for Payer: Home State Health Plan Medicare Advantage	$3.93
Rate for Payer: Humana Commercial	$7.86
Rate for Payer: Humana Medicare Advantage	$3.93
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

GLUCOSE BODY FLUID

Facility

$24.00

Service Code	CPT 82945
Hospital Charge Code	2282945
Hospital Revenue Code	301
Rate for Payer: Cash Price	$21.60

Know your out-of-pocket cost for care.

All Charges