Madison Medical Center

All Charges

Charge

Type

Setting

Price

INSULIN, FIVE SPECIMENS

Facility

$86.00

Service Code	CPT 83525
Hospital Charge Code	222165
Hospital Revenue Code	301
Rate for Payer: Cash Price	$77.40

INSULIN, FIVE SPECIMENS

Facility

$86.00

Service Code	CPT 83525
Hospital Charge Code	222165
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 FREE

Facility

$35.00

Service Code	CPT 83527
Hospital Charge Code	2283527
Hospital Revenue Code	301
Rate for Payer: Cash Price	$31.50

INSULIN FREE

Facility

$35.00

Service Code	CPT 83527
Hospital Charge Code	2283527
Hospital Revenue Code	301
Min. Negotiated Rate	$11.66
Max. Negotiated Rate	$25.90
Rate for Payer: Aetna Better Health Medicaid/QHP	$11.66
Rate for Payer: Aetna Medicare Advantage	$12.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cash Price	$31.50
Rate for Payer: Cigna Commercial HMO & PPO	$12.95
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$11.66
Rate for Payer: Home State Health Plan Medicaid Managed Care	$12.48
Rate for Payer: Home State Health Plan Medicare Advantage	$12.95
Rate for Payer: Humana Commercial	$25.90
Rate for Payer: Humana Medicare Advantage	$12.95
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$11.66
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

INSULIN GLARGINE 1 PEN 300U LANTUS

Facility

$107.00

Service Code	HCPCS J1817
Hospital Charge Code	2627040
Hospital Revenue Code	250
Rate for Payer: Cash Price	$96.30

INSULIN GLARGINE 1 PEN 300U LANTUS

Facility

$107.00

Service Code	HCPCS J1817
Hospital Charge Code	2627040
Hospital Revenue Code	250
Min. Negotiated Rate	$38.52
Max. Negotiated Rate	$76.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$63.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$76.40
Rate for Payer: Cash Price	$96.30
Rate for Payer: UnitedHealthcare Commercial	$71.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.52

INSULIN GLARGINE 1 UN INJ LANTUS

Facility

$19.00

Service Code	HCPCS J1817
Hospital Charge Code	2626407
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

INSULIN GLARGINE 1 UN INJ LANTUS

Facility

$19.00

Service Code	HCPCS J1817
Hospital Charge Code	2626407
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 GLARG INJ (LANTUS) 1 UNIT

Facility

$19.00

Service Code	HCPCS J1817
Hospital Charge Code	2626348
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 GLARG INJ (LANTUS) 1 UNIT

Facility

$19.00

Service Code	HCPCS J1817
Hospital Charge Code	2626348
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

INSULIN (LABCORP)

Facility

$86.00

Service Code	CPT 83525
Hospital Charge Code	229401
Hospital Revenue Code	301
Rate for Payer: Cash Price	$77.40

INSULIN (LABCORP)

Facility

$86.00

Service Code	CPT 83525
Hospital Charge Code	229401
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 LIKE GROWTH FAC PROTEIN 3

Facility

$101.00

Service Code	CPT 83520
Hospital Charge Code	2284400
Hospital Revenue Code	301
Rate for Payer: Cash Price	$90.90

INSULIN LIKE GROWTH FAC PROTEIN 3

Facility

$101.00

Service Code	CPT 83520
Hospital Charge Code	2284400
Hospital Revenue Code	301
Min. Negotiated Rate	$15.54
Max. Negotiated Rate	$72.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$15.54
Rate for Payer: Aetna Medicare Advantage	$17.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cash Price	$90.90
Rate for Payer: Cigna Commercial HMO & PPO	$17.27
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$15.54
Rate for Payer: Home State Health Plan Medicaid Managed Care	$16.63
Rate for Payer: Home State Health Plan Medicare Advantage	$17.27
Rate for Payer: Humana Commercial	$34.54
Rate for Payer: Humana Medicare Advantage	$17.27
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$15.54
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

INSULIN LISPRO 1 UN INJ (HUMALOG)

Facility

$22.00

Service Code	HCPCS J1817
Hospital Charge Code	2697423
Hospital Revenue Code	250
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$15.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.92

INSULIN LISPRO 1 UN INJ (HUMALOG)

Facility

$22.00

Service Code	HCPCS J1817
Hospital Charge Code	2697423
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

INSULIN LISPRO INJ (HUMALOG) 1 UNIT

Facility

$19.00

Service Code	HCPCS J1817
Hospital Charge Code	2697041
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 LISPRO INJ (HUMALOG) 1 UNIT

Facility

$19.00

Service Code	HCPCS J1817
Hospital Charge Code	2697041
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

INSULIN LISPRO PEN 5X3ML EMP

Facility

$94.00

Service Code	NDC 2879959
Hospital Charge Code	2697344
Hospital Revenue Code	250
Min. Negotiated Rate	$33.84
Max. Negotiated Rate	$67.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$67.12
Rate for Payer: Cash Price	$84.60
Rate for Payer: UnitedHealthcare Commercial	$62.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.84

INSULIN LISPRO PEN 5X3ML EMP

Facility

$94.00

Service Code	NDC 2879959
Hospital Charge Code	2697344
Hospital Revenue Code	250
Rate for Payer: Cash Price	$84.60

INSULIN NPH 1UN INJ (NOVOLIN-N)

Facility

$19.00

Service Code	HCPCS J1815
Hospital Charge Code	2626404
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 NPH 1UN INJ (NOVOLIN-N)

Facility

$19.00

Service Code	HCPCS J1815
Hospital Charge Code	2626404
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

INSULIN NPH INJ (NOVOLIN-N) 1 UNIT

Facility

$18.00

Service Code	HCPCS J1815
Hospital Charge Code	2697633
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

INSULIN NPH INJ (NOVOLIN-N) 1 UNIT

Facility

$18.00

Service Code	HCPCS J1815
Hospital Charge Code	2697633
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

INSULIN PEN NEEDLES #100

Facility

$12.00

Service Code	NDC 8214030726
Hospital Charge Code	2620513
Hospital Revenue Code	250
Min. Negotiated Rate	$4.32
Max. Negotiated Rate	$8.57
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: UnitedHealthcare Commercial	$8.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.32

Know your out-of-pocket cost for care.

All Charges