Madison Medical Center

All Charges

Charge

Type

Setting

Price

GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9682962
Hospital Revenue Code	301
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$21.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.95
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$3.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.16
Rate for Payer: Home State Health Plan Medicare Advantage	$3.28
Rate for Payer: Humana Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.28
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.80

GLUCOSE BY MONITOR

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9682962
Hospital Revenue Code	301
Rate for Payer: Cash Price	$27.00

GLUCOSE BY MONITOR BAILEY

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9182962
Hospital Revenue Code	521
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$173.53
Rate for Payer: Cigna Commercial HMO & PPO	$3.28
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.95
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.16
Rate for Payer: Home State Health Plan Medicare Advantage	$3.28
Rate for Payer: Humana Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.28
Rate for Payer: UnitedHealthcare Commercial	$20.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

GLUCOSE BY MONITOR BAILEY

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	9182962
Hospital Revenue Code	521
Rate for Payer: Cash Price	$27.00

GLUCOSE BY MONITOR OUTPT PHY

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	4182962
Hospital Revenue Code	521
Rate for Payer: Cash Price	$27.00

GLUCOSE BY MONITOR OUTPT PHY

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	4182962
Hospital Revenue Code	521
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.95
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$3.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.16
Rate for Payer: Home State Health Plan Medicare Advantage	$3.28
Rate for Payer: Humana Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.28
Rate for Payer: UnitedHealthcare Commercial	$20.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

GLUCOSE FINGER STICK

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	5282962
Hospital Revenue Code	521
Min. Negotiated Rate	$2.65
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.95
Rate for Payer: Aetna Medicare Advantage	$3.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$17.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$21.42
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cash Price	$27.00
Rate for Payer: Cigna Commercial HMO & PPO	$3.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.65
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.16
Rate for Payer: Home State Health Plan Medicare Advantage	$3.28
Rate for Payer: Humana Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.28
Rate for Payer: UnitedHealthcare Commercial	$20.01
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

GLUCOSE FINGER STICK

Facility

$30.00

Service Code	CPT 82962
Hospital Charge Code	5282962
Hospital Revenue Code	521
Rate for Payer: Cash Price	$27.00

GLUCOSE GEL 15GM

Facility

$32.00

Service Code	NDC 574007030
Hospital Charge Code	2698345
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

GLUCOSE GEL 15GM

Facility

$32.00

Service Code	NDC 574007030
Hospital Charge Code	2698345
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

GLUCOSE GEL ORAL 31GM

Facility

$15.00

Service Code	NDC 187074633
Hospital Charge Code	2697086
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

GLUCOSE GEL ORAL 31GM

Facility

$15.00

Service Code	NDC 187074633
Hospital Charge Code	2697086
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

GLUCOSE (GLUCOMETER) TEST

Facility

$65.00

Service Code	CPT 82948
Hospital Charge Code	1882948
Hospital Revenue Code	301
Min. Negotiated Rate	$4.54
Max. Negotiated Rate	$46.41
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.54
Rate for Payer: Aetna Medicare Advantage	$5.04
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: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cigna Commercial HMO & PPO	$5.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.86
Rate for Payer: Home State Health Plan Medicare Advantage	$5.04
Rate for Payer: Humana Commercial	$10.08
Rate for Payer: Humana Medicare Advantage	$5.04
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.54

GLUCOSE (GLUCOMETER) TEST

Facility

$65.00

Service Code	CPT 82948
Hospital Charge Code	1882948
Hospital Revenue Code	301
Rate for Payer: Cash Price	$58.50

GLUCOSE MONITORING

Facility

$21.00

Service Code	CPT 82962
Hospital Charge Code	2882962
Hospital Revenue Code	300
Min. Negotiated Rate	$2.95
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$2.95
Rate for Payer: Aetna Medicare Advantage	$3.28
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: Cash Price	$18.90
Rate for Payer: Cash Price	$18.90
Rate for Payer: Cigna Commercial HMO & PPO	$3.28
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$2.95
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.16
Rate for Payer: Home State Health Plan Medicare Advantage	$3.28
Rate for Payer: Humana Commercial	$6.56
Rate for Payer: Humana Medicare Advantage	$3.28
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$2.95
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

GLUCOSE MONITORING

Facility

$21.00

Service Code	CPT 82962
Hospital Charge Code	2882962
Hospital Revenue Code	300
Rate for Payer: Cash Price	$18.90

.GLUCOSE, SERUM CPT 82947

Facility

$55.00

Service Code	CPT 82947
Hospital Charge Code	22282947
Hospital Revenue Code	307
Rate for Payer: Cash Price	$49.50

.GLUCOSE, SERUM CPT 82947

Facility

$55.00

Service Code	CPT 82947
Hospital Charge Code	22282947
Hospital Revenue Code	307
Min. Negotiated Rate	$3.54
Max. Negotiated Rate	$39.27
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	$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	$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	$19.80

GLUCOSE TESTING, FINGER STICK

Facility

$12.00

Service Code	CPT 82948
Hospital Charge Code	4482948
Hospital Revenue Code	307
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.54
Rate for Payer: Aetna Medicare Advantage	$5.04
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$8.57
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cash Price	$10.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.04
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.86
Rate for Payer: Home State Health Plan Medicare Advantage	$5.04
Rate for Payer: Humana Commercial	$10.08
Rate for Payer: Humana Medicare Advantage	$5.04
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

GLUCOSE TESTING, FINGER STICK

Facility

$12.00

Service Code	CPT 82948
Hospital Charge Code	4482948
Hospital Revenue Code	307
Rate for Payer: Cash Price	$10.80

GLUCOSE TOL 2 HR

Facility

$236.00

Service Code	CPT 82951
Hospital Charge Code	227229
Hospital Revenue Code	301
Rate for Payer: Cash Price	$212.40

GLUCOSE TOL 2 HR

Facility

$236.00

Service Code	CPT 82951
Hospital Charge Code	227229
Hospital Revenue Code	301
Min. Negotiated Rate	$11.58
Max. Negotiated Rate	$168.50
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	$139.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$168.50
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cash Price	$212.40
Rate for Payer: Cigna Commercial HMO & PPO	$12.87
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.58
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	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.58
Rate for Payer: UnitedHealthcare Medicare Advantage	$84.96

GLUCOSE TOL ADDITIONAL SPEC

Facility

$67.00

Service Code	CPT 82952
Hospital Charge Code	227232
Hospital Revenue Code	301
Rate for Payer: Cash Price	$60.30

GLUCOSE TOL ADDITIONAL SPEC

Facility

$67.00

Service Code	CPT 82952
Hospital Charge Code	227232
Hospital Revenue Code	301
Min. Negotiated Rate	$3.53
Max. Negotiated Rate	$47.84
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.53
Rate for Payer: Aetna Medicare Advantage	$3.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cash Price	$60.30
Rate for Payer: Cigna Commercial HMO & PPO	$3.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.53
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.78
Rate for Payer: Home State Health Plan Medicare Advantage	$3.92
Rate for Payer: Humana Commercial	$7.84
Rate for Payer: Humana Medicare Advantage	$3.92
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

GLUCOSE TOLERANCE TEST (82952)

Facility

$19.00

Service Code	CPT 82952
Hospital Charge Code	4282952
Hospital Revenue Code	521
Min. Negotiated Rate	$3.18
Max. Negotiated Rate	$173.53
Rate for Payer: Aetna Better Health Medicaid/QHP	$3.53
Rate for Payer: Aetna Medicare Advantage	$3.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cash Price	$17.10
Rate for Payer: Cigna Commercial HMO & PPO	$3.92
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$3.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$3.78
Rate for Payer: Home State Health Plan Medicare Advantage	$3.92
Rate for Payer: Humana Commercial	$7.84
Rate for Payer: Humana Medicare Advantage	$3.92
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$3.53
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

Know your out-of-pocket cost for care.

All Charges