Madison Medical Center

All Charges

Charge

Type

Setting

Price

INSULIN 70/30 10ML VIAL (HUMULIN)

Facility

$822.00

Service Code	HCPCS J1815
Hospital Charge Code	2626402
Hospital Revenue Code	250
Rate for Payer: Cash Price	$739.80

INSULIN 70/30 1UNIT INJ (HUMULIN 70/30)

Facility

$20.00

Service Code	HCPCS J1815
Hospital Charge Code	2626403
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

INSULIN 70/30 1UNIT INJ (HUMULIN 70/30)

Facility

$20.00

Service Code	HCPCS J1815
Hospital Charge Code	2626403
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

INSULIN 70/30 INJ 1 UNIT

Facility

$19.00

Service Code	HCPCS J1815
Hospital Charge Code	2697040
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
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: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

INSULIN 70/30 INJ 1 UNIT

Facility

$19.00

Service Code	HCPCS J1815
Hospital Charge Code	2697040
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

INSULIN 70/30 PEN 5X3ML 15ML EMP

Facility

$256.00

Service Code	NDC 169300715
Hospital Charge Code	2697345
Hospital Revenue Code	250
Rate for Payer: Cash Price	$230.40

INSULIN 70/30 PEN 5X3ML 15ML EMP

Facility

$256.00

Service Code	NDC 169300715
Hospital Charge Code	2697345
Hospital Revenue Code	250
Min. Negotiated Rate	$92.16
Max. Negotiated Rate	$182.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$151.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$182.78
Rate for Payer: Cash Price	$230.40
Rate for Payer: UnitedHealthcare Commercial	$170.75
Rate for Payer: UnitedHealthcare Medicare Advantage	$92.16

..INSULIN AEL

Facility

$86.00

Service Code	CPT 83525
Hospital Charge Code	229402
Hospital Revenue Code	301
Min. Negotiated Rate	$10.29
Max. Negotiated Rate	$61.40
Rate for Payer: Aetna Better Health Medicaid/QHP	$10.29
Rate for Payer: Aetna Medicare Advantage	$11.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$50.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$61.40
Rate for Payer: Cash Price	$77.40
Rate for Payer: Cash Price	$77.40
Rate for Payer: Cash Price	$77.40
Rate for Payer: Cigna Commercial HMO & PPO	$11.43
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$10.29
Rate for Payer: Home State Health Plan Medicaid Managed Care	$11.01
Rate for Payer: Home State Health Plan Medicare Advantage	$11.43
Rate for Payer: Humana Commercial	$22.86
Rate for Payer: Humana Medicare Advantage	$11.43
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$10.29
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.96

..INSULIN AEL

Facility

$86.00

Service Code	CPT 83525
Hospital Charge Code	229402
Hospital Revenue Code	301
Rate for Payer: Cash Price	$77.40

.INSULIN ANTIBODIES (LC141598)

Facility

$239.00

Service Code	CPT 86337
Hospital Charge Code	2286338
Hospital Revenue Code	301
Min. Negotiated Rate	$19.27
Max. Negotiated Rate	$170.65
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.27
Rate for Payer: Aetna Medicare Advantage	$21.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$141.49
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$170.65
Rate for Payer: Cash Price	$215.10
Rate for Payer: Cash Price	$215.10
Rate for Payer: Cash Price	$215.10
Rate for Payer: Cigna Commercial HMO & PPO	$21.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.62
Rate for Payer: Home State Health Plan Medicare Advantage	$21.41
Rate for Payer: Humana Commercial	$42.82
Rate for Payer: Humana Medicare Advantage	$21.41
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$86.04

.INSULIN ANTIBODIES (LC141598)

Facility

$239.00

Service Code	CPT 86337
Hospital Charge Code	2286338
Hospital Revenue Code	301
Rate for Payer: Cash Price	$215.10

INSULIN ASPART 10ML VIAL (NOVOLOG) EMP

Facility

$1,027.00

Service Code	HCPCS J1817
Hospital Charge Code	2626408
Hospital Revenue Code	250
Min. Negotiated Rate	$369.72
Max. Negotiated Rate	$733.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$607.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$733.28
Rate for Payer: Cash Price	$924.30
Rate for Payer: UnitedHealthcare Commercial	$685.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$369.72

INSULIN ASPART 10ML VIAL (NOVOLOG) EMP

Facility

$1,027.00

Service Code	HCPCS J1817
Hospital Charge Code	2626408
Hospital Revenue Code	250
Rate for Payer: Cash Price	$924.30

INSULIN ASPART 1UNIT INJ (NOVOLOG)

Facility

$19.00

Service Code	HCPCS J1817
Hospital Charge Code	2626409
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
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: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

INSULIN ASPART 1UNIT INJ (NOVOLOG)

Facility

$19.00

Service Code	HCPCS J1817
Hospital Charge Code	2626409
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

INSULIN AUTOANTIBODY

Facility

$391.00

Service Code	CPT 86337
Hospital Charge Code	2286341
Hospital Revenue Code	301
Min. Negotiated Rate	$19.27
Max. Negotiated Rate	$279.17
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.27
Rate for Payer: Aetna Medicare Advantage	$21.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$231.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$279.17
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cash Price	$351.90
Rate for Payer: Cigna Commercial HMO & PPO	$21.41
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19.27
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.62
Rate for Payer: Home State Health Plan Medicare Advantage	$21.41
Rate for Payer: Humana Commercial	$42.82
Rate for Payer: Humana Medicare Advantage	$21.41
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.27
Rate for Payer: UnitedHealthcare Medicare Advantage	$140.76

INSULIN AUTOANTIBODY

Facility

$391.00

Service Code	CPT 86337
Hospital Charge Code	2286341
Hospital Revenue Code	301
Rate for Payer: Cash Price	$351.90

INSULIN DETEMIR 1UN INJ (LEVEMIR)

Facility

$19.00

Service Code	HCPCS J1817
Hospital Charge Code	2626578
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
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: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

INSULIN DETEMIR 1UN INJ (LEVEMIR)

Facility

$19.00

Service Code	HCPCS J1817
Hospital Charge Code	2626578
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

INSULIN DETEMIR FLEXPEN 100U/ML #5 EMP

Facility

$613.00

Service Code	HCPCS J1817
Hospital Charge Code	2625997
Hospital Revenue Code	250
Rate for Payer: Cash Price	$551.70

INSULIN DETEMIR FLEXPEN 100U/ML #5 EMP

Facility

$613.00

Service Code	HCPCS J1817
Hospital Charge Code	2625997
Hospital Revenue Code	250
Min. Negotiated Rate	$220.68
Max. Negotiated Rate	$437.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$362.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$437.68
Rate for Payer: Cash Price	$551.70
Rate for Payer: UnitedHealthcare Commercial	$408.87
Rate for Payer: UnitedHealthcare Medicare Advantage	$220.68

INSULIN DETEMIR INJ (LEVEMIR) 1 UNIT

Facility

$19.00

Service Code	HCPCS J1817
Hospital Charge Code	2697631
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
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: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

INSULIN DETEMIR INJ (LEVEMIR) 1 UNIT

Facility

$19.00

Service Code	HCPCS J1817
Hospital Charge Code	2697631
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

INSULIN DRIP 100U REG INS/100ML IVPB

Facility

$1,783.00

Service Code	HCPCS J1815
Hospital Charge Code	2626464
Hospital Revenue Code	250
Min. Negotiated Rate	$641.88
Max. Negotiated Rate	$1,273.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,055.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,273.06
Rate for Payer: Cash Price	$1,604.70
Rate for Payer: UnitedHealthcare Commercial	$1,189.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$641.88

INSULIN DRIP 100U REG INS/100ML IVPB

Facility

$1,783.00

Service Code	HCPCS J1815
Hospital Charge Code	2626464
Hospital Revenue Code	250
Rate for Payer: Cash Price	$1,604.70

Know your out-of-pocket cost for care.

All Charges