Madison Medical Center

All Charges

Charge

Type

Setting

Price

GUAIFEN/DM SYR 237ML

Facility

$45.00

Service Code	NDC 6.1787E+10
Hospital Charge Code	2697039
Hospital Revenue Code	250
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
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: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

GUAIFEN/DM SYR 237ML

Facility

$45.00

Service Code	NDC 6.1787E+10
Hospital Charge Code	2697039
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

GUAIFENESIN/DM SYR 10ML

Facility

$20.00

Service Code	NDC 6.1787E+10
Hospital Charge Code	2625979
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

GUAIFENESIN/DM SYR 10ML

Facility

$20.00

Service Code	NDC 6.1787E+10
Hospital Charge Code	2625979
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

GUAIFENESIN/DM SYR 5ML

Facility

$20.00

Service Code	NDC 904675920
Hospital Charge Code	2655119
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

GUAIFENESIN/DM SYR 5ML

Facility

$20.00

Service Code	NDC 904675920
Hospital Charge Code	2655119
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

GUAIFENESIN (MUCINEX) XR 600MG TAB

Facility

$18.00

Service Code	NDC 6.3824E+10
Hospital Charge Code	2626346
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

GUAIFENESIN (MUCINEX) XR 600MG TAB

Facility

$18.00

Service Code	NDC 6.3824E+10
Hospital Charge Code	2626346
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

GUAIFEN (MUCINEX MAX)XR 1200MG TAB

Facility

$18.00

Service Code	NDC 6.3824E+10
Hospital Charge Code	2626481
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

GUAIFEN (MUCINEX MAX)XR 1200MG TAB

Facility

$18.00

Service Code	NDC 6.3824E+10
Hospital Charge Code	2626481
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

GUANFACINE ER 1MG TAB EMP

Facility

$13.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2625270
Hospital Revenue Code	250
Rate for Payer: Cash Price	$11.70

GUANFACINE ER 1MG TAB EMP

Facility

$13.00

Service Code	NDC 1.6714E+10
Hospital Charge Code	2625270
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

GUIDE PIN 1.2MMX100MM

Facility

$186.00

Hospital Charge Code	123334
Hospital Revenue Code	271
Min. Negotiated Rate	$66.96
Max. Negotiated Rate	$132.80
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$110.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.80
Rate for Payer: Cash Price	$167.40
Rate for Payer: UnitedHealthcare Commercial	$124.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.96

GUIDE PIN 1.2MMX100MM

Facility

$186.00

Hospital Charge Code	123334
Hospital Revenue Code	271
Rate for Payer: Cash Price	$167.40

GUIDE WIRE (.035 X 4)

Facility

$111.00

Hospital Charge Code	123314
Hospital Revenue Code	271
Rate for Payer: Cash Price	$99.90

GUIDE WIRE (.035 X 4)

Facility

$111.00

Hospital Charge Code	123314
Hospital Revenue Code	271
Min. Negotiated Rate	$39.96
Max. Negotiated Rate	$79.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$65.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.25
Rate for Payer: Cash Price	$99.90
Rate for Payer: UnitedHealthcare Commercial	$74.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$39.96

GUIDEWIRE/JAG

Facility

$673.00

Hospital Charge Code	1299102
Hospital Revenue Code	271
Rate for Payer: Cash Price	$605.70

GUIDEWIRE/JAG

Facility

$673.00

Hospital Charge Code	1299102
Hospital Revenue Code	271
Min. Negotiated Rate	$242.28
Max. Negotiated Rate	$480.52
Rate for Payer: UnitedHealthcare Commercial	$448.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$398.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$480.52
Rate for Payer: Cash Price	$605.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$242.28

GYN PELVIC ULTRA S.

Facility

$262.00

Service Code	CPT 76856
Hospital Charge Code	4276856
Hospital Revenue Code	521
Min. Negotiated Rate	$84.82
Max. Negotiated Rate	$213.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$155.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$187.07
Rate for Payer: Cash Price	$235.80
Rate for Payer: Cash Price	$235.80
Rate for Payer: Cash Price	$235.80
Rate for Payer: Cash Price	$235.80
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$84.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$174.75
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

GYN PELVIC ULTRA S.

Facility

$262.00

Service Code	CPT 76856
Hospital Charge Code	4276856
Hospital Revenue Code	521
Rate for Payer: Cash Price	$235.80

GYN TRANS VAG. U S

Facility

$251.00

Service Code	CPT 76830
Hospital Charge Code	4276830
Hospital Revenue Code	521
Rate for Payer: Cash Price	$225.90

GYN TRANS VAG. U S

Facility

$251.00

Service Code	CPT 76830
Hospital Charge Code	4276830
Hospital Revenue Code	521
Min. Negotiated Rate	$84.82
Max. Negotiated Rate	$213.62
Rate for Payer: Aetna Better Health Medicaid/QHP	$94.24
Rate for Payer: Aetna Medicare Advantage	$106.81
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$179.21
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cigna Commercial HMO & PPO	$106.81
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$84.82
Rate for Payer: Home State Health Plan Medicaid Managed Care	$100.84
Rate for Payer: Home State Health Plan Medicare Advantage	$106.81
Rate for Payer: Humana Commercial	$213.62
Rate for Payer: Humana Medicare Advantage	$106.81
Rate for Payer: UnitedHealthcare Commercial	$167.42
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$94.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

HAG HOURS

Facility

$44.00

Service Code	CPT 94665
Hospital Charge Code	4500076
Hospital Revenue Code	412
Min. Negotiated Rate	$15.84
Max. Negotiated Rate	$31.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$31.42
Rate for Payer: Cash Price	$39.60
Rate for Payer: UnitedHealthcare Commercial	$29.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

HAG HOURS

Facility

$44.00

Service Code	CPT 94665
Hospital Charge Code	4500076
Hospital Revenue Code	412
Rate for Payer: Cash Price	$39.60

HALOPERIDOL 1MG TAB (HALDOL)

Facility

$15.00

Service Code	NDC 781139213
Hospital Charge Code	2697334
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

Know your out-of-pocket cost for care.

All Charges