Madison Medical Center

All Charges

Charge

Type

Setting

Price

CHLORHEX (PERIDEX) ORAL RINSE 0.12%15ML

Facility

$16.00

Service Code	NDC 5.0383E+10
Hospital Charge Code	2626572
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

CHLORHEX (PERIDEX) ORAL RINSE 0.12%15ML

Facility

$16.00

Service Code	NDC 5.0383E+10
Hospital Charge Code	2626572
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

CHLORIDE

Facility

$112.00

Service Code	CPT 82435
Hospital Charge Code	223124
Hospital Revenue Code	301
Min. Negotiated Rate	$4.14
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.14
Rate for Payer: Aetna Medicare Advantage	$4.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$66.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$79.97
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cigna Commercial HMO & PPO	$4.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.43
Rate for Payer: Home State Health Plan Medicare Advantage	$4.60
Rate for Payer: Humana Commercial	$9.20
Rate for Payer: Humana Medicare Advantage	$4.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

CHLORIDE

Facility

$112.00

Service Code	CPT 82435
Hospital Charge Code	223124
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

CHLORIDE STOOL

Facility

$101.00

Service Code	CPT 82438
Hospital Charge Code	2282436
Hospital Revenue Code	301
Rate for Payer: Cash Price	$90.90

CHLORIDE STOOL

Facility

$101.00

Service Code	CPT 82438
Hospital Charge Code	2282436
Hospital Revenue Code	301
Min. Negotiated Rate	$4.50
Max. Negotiated Rate	$72.11
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.50
Rate for Payer: Aetna Medicare Advantage	$5.00
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	$5.00
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.50
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.82
Rate for Payer: Home State Health Plan Medicare Advantage	$5.00
Rate for Payer: Humana Commercial	$10.00
Rate for Payer: Humana Medicare Advantage	$5.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.50
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

CHLORIDE URINE RANDOM

Facility

$52.00

Service Code	CPT 82436
Hospital Charge Code	2282438
Hospital Revenue Code	305
Min. Negotiated Rate	$5.18
Max. Negotiated Rate	$37.13
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.18
Rate for Payer: Aetna Medicare Advantage	$5.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.13
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cash Price	$46.80
Rate for Payer: Cigna Commercial HMO & PPO	$5.75
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.54
Rate for Payer: Home State Health Plan Medicare Advantage	$5.75
Rate for Payer: Humana Commercial	$11.50
Rate for Payer: Humana Medicare Advantage	$5.75
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.18
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.72

CHLORIDE URINE RANDOM

Facility

$52.00

Service Code	CPT 82436
Hospital Charge Code	2282438
Hospital Revenue Code	305
Rate for Payer: Cash Price	$46.80

CHLOROPROCAINE INJ PF

Facility

$166.00

Hospital Charge Code	2058082
Hospital Revenue Code	370
Min. Negotiated Rate	$59.76
Max. Negotiated Rate	$118.52
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$98.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$118.52
Rate for Payer: Cash Price	$149.40
Rate for Payer: UnitedHealthcare Commercial	$110.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$59.76

CHLOROPROCAINE INJ PF

Facility

$166.00

Hospital Charge Code	2058082
Hospital Revenue Code	370
Rate for Payer: Cash Price	$149.40

CHLORPROMAZINE (THORAZINE) 100MG TAB

Facility

$45.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2697902
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

CHLORPROMAZINE (THORAZINE) 100MG TAB

Facility

$45.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2697902
Hospital Revenue Code	250
Rate for Payer: Cash Price	$40.50

CHLORPROMAZINE (THORAZINE) 25MG TAB

Facility

$40.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2654540
Hospital Revenue Code	250
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$28.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$28.56
Rate for Payer: Cash Price	$36.00
Rate for Payer: UnitedHealthcare Commercial	$26.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.40

CHLORPROMAZINE (THORAZINE) 25MG TAB

Facility

$40.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2654540
Hospital Revenue Code	250
Rate for Payer: Cash Price	$36.00

CHLORTHALIDONE 25MG TAB

Facility

$96.00

Service Code	NDC 378022201
Hospital Charge Code	2698498
Hospital Revenue Code	250
Min. Negotiated Rate	$34.56
Max. Negotiated Rate	$68.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$68.54
Rate for Payer: Cash Price	$86.40
Rate for Payer: UnitedHealthcare Commercial	$64.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.56

CHLORTHALIDONE 25MG TAB

Facility

$96.00

Service Code	NDC 378022201
Hospital Charge Code	2698498
Hospital Revenue Code	250
Rate for Payer: Cash Price	$86.40

CHLORTHALIDONE 25MG TAB EMP

Facility

$96.00

Service Code	NDC 378022201
Hospital Charge Code	2697257
Hospital Revenue Code	250
Rate for Payer: Cash Price	$86.40

CHLORTHALIDONE 25MG TAB EMP

Facility

$96.00

Service Code	NDC 378022201
Hospital Charge Code	2697257
Hospital Revenue Code	250
Min. Negotiated Rate	$34.56
Max. Negotiated Rate	$68.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$56.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$68.54
Rate for Payer: Cash Price	$86.40
Rate for Payer: UnitedHealthcare Commercial	$64.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.56

CHOLECALCIFEROL (VIT D3) 1000IU TAB

Facility

$20.00

Service Code	NDC 2.0555E+10
Hospital Charge Code	2626425
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

CHOLECALCIFEROL (VIT D3) 1000IU TAB

Facility

$20.00

Service Code	NDC 2.0555E+10
Hospital Charge Code	2626425
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

CHOLECALCIFEROL (VIT D3) 400IU TAB

Facility

$20.00

Service Code	NDC 4.3292E+10
Hospital Charge Code	2697075
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

CHOLECALCIFEROL (VIT D3) 400IU TAB

Facility

$20.00

Service Code	NDC 4.3292E+10
Hospital Charge Code	2697075
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

CHOLECALCIF (VIT D3) 2000IU (50MCG)TB/CP

Facility

$20.00

Service Code	NDC 536135301
Hospital Charge Code	2626608
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

CHOLECALCIF (VIT D3) 2000IU (50MCG)TB/CP

Facility

$20.00

Service Code	NDC 536135301
Hospital Charge Code	2626608
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

CHOLECYSTECOMY

Professional

Both

$2,969.00

Service Code	CPT 47562
Hospital Charge Code	4156340
Hospital Revenue Code	975
Min. Negotiated Rate	$501.18
Max. Negotiated Rate	$1,039.15
Rate for Payer: Aetna Commercial/Medicare Advantage	$601.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$501.18
Rate for Payer: Cash Price	$2,672.10
Rate for Payer: Cash Price	$2,672.10
Rate for Payer: Cigna Commercial HMO & PPO	$601.79
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$501.18
Rate for Payer: Home State Health Plan Medicaid Managed Care	$551.30
Rate for Payer: Home State Health Plan Medicare Advantage	$601.79
Rate for Payer: Optum Medicare Advantage	$1,039.15
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$501.18

Know your out-of-pocket cost for care.

All Charges