Madison Medical Center

All Charges

Charge

Type

Setting

Price

MA CO HEALTH CHEST

Facility

$51.00

Hospital Charge Code	323121
Hospital Revenue Code	320
Rate for Payer: Cash Price	$45.90

MA CO HEALTH CHEST

Facility

$51.00

Hospital Charge Code	323121
Hospital Revenue Code	320
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$175.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$36.41
Rate for Payer: Cash Price	$45.90
Rate for Payer: Cash Price	$45.90
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.36

MAG-AL PLUS 30ML

Facility

$22.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2624893
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

MAG-AL PLUS 30ML

Facility

$22.00

Service Code	NDC 6.3739E+10
Hospital Charge Code	2624893
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

MAG-AL PLUS XS 30ML UD

Facility

$22.00

Service Code	NDC 904000514
Hospital Charge Code	2697123
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

MAG-AL PLUS XS 30ML UD

Facility

$22.00

Service Code	NDC 904000514
Hospital Charge Code	2697123
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

MAG-AL-SIMETH MAX ORAL SUSP 10ML

Facility

$22.00

Service Code	NDC 536001583
Hospital Charge Code	2623454
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

MAG-AL-SIMETH MAX ORAL SUSP 10ML

Facility

$22.00

Service Code	NDC 536001583
Hospital Charge Code	2623454
Hospital Revenue Code	250
Rate for Payer: Cash Price	$19.80

MAG CITRATE (CITROMA) 296ML OR SOL

Facility

$24.00

Service Code	NDC 869069338
Hospital Charge Code	2654600
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

MAG CITRATE (CITROMA) 296ML OR SOL

Facility

$24.00

Service Code	NDC 869069338
Hospital Charge Code	2654600
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

MAGNESIUM

Facility

$127.00

Service Code	CPT 83735
Hospital Charge Code	2213301
Hospital Revenue Code	301
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$90.68
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.03
Rate for Payer: Aetna Medicare Advantage	$6.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$75.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$90.68
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cash Price	$114.30
Rate for Payer: Cigna Commercial HMO & PPO	$6.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.45
Rate for Payer: Home State Health Plan Medicare Advantage	$6.70
Rate for Payer: Humana Commercial	$13.40
Rate for Payer: Humana Medicare Advantage	$6.70
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

MAGNESIUM

Facility

$127.00

Service Code	CPT 83735
Hospital Charge Code	2213301
Hospital Revenue Code	301
Rate for Payer: Cash Price	$114.30

MAGNESIUM OX (MAG-OX) 400MG TAB

Facility

$20.00

Service Code	NDC 1.0006E+10
Hospital Charge Code	2626427
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

MAGNESIUM OX (MAG-OX) 400MG TAB

Facility

$20.00

Service Code	NDC 1.0006E+10
Hospital Charge Code	2626427
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

MAGNESIUM SULF 50% (1GM) 2ML VIAL IM

Facility

$39.00

Service Code	HCPCS J3475
Hospital Charge Code	2626527
Hospital Revenue Code	250
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

MAGNESIUM SULF 50% (1GM) 2ML VIAL IM

Facility

$39.00

Service Code	HCPCS J3475
Hospital Charge Code	2626527
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

MAGNESIUM SULF 5GM IV/IM 10ML VIAL

Facility

$63.00

Service Code	HCPCS J3475
Hospital Charge Code	2619845
Hospital Revenue Code	250
Min. Negotiated Rate	$22.68
Max. Negotiated Rate	$44.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$37.30
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.98
Rate for Payer: Cash Price	$56.70
Rate for Payer: UnitedHealthcare Commercial	$42.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.68

MAGNESIUM SULF 5GM IV/IM 10ML VIAL

Facility

$63.00

Service Code	HCPCS J3475
Hospital Charge Code	2619845
Hospital Revenue Code	250
Rate for Payer: Cash Price	$56.70

MAGNESIUM SULFATE 500MG/ML 20ML IV/IM

Facility

$205.00

Service Code	HCPCS J3475
Hospital Charge Code	2626470
Hospital Revenue Code	250
Min. Negotiated Rate	$73.80
Max. Negotiated Rate	$146.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$121.36
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$146.37
Rate for Payer: Cash Price	$184.50
Rate for Payer: UnitedHealthcare Commercial	$136.74
Rate for Payer: UnitedHealthcare Medicare Advantage	$73.80

MAGNESIUM SULFATE 500MG/ML 20ML IV/IM

Facility

$205.00

Service Code	HCPCS J3475
Hospital Charge Code	2626470
Hospital Revenue Code	250
Rate for Payer: Cash Price	$184.50

MAGNESIUM SULF + NS : 1GM + 100ML IVPB

Facility

$289.00

Service Code	HCPCS J3475
Hospital Charge Code	2627186
Hospital Revenue Code	250
Rate for Payer: Cash Price	$260.10

MAGNESIUM SULF + NS : 1GM + 100ML IVPB

Facility

$289.00

Service Code	HCPCS J3475
Hospital Charge Code	2627186
Hospital Revenue Code	250
Min. Negotiated Rate	$104.04
Max. Negotiated Rate	$206.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$171.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$206.35
Rate for Payer: Cash Price	$260.10
Rate for Payer: UnitedHealthcare Commercial	$192.76
Rate for Payer: UnitedHealthcare Medicare Advantage	$104.04

MAGNESIUM URINE

Facility

$44.00

Service Code	CPT 83735
Hospital Charge Code	2223735
Hospital Revenue Code	301
Min. Negotiated Rate	$6.03
Max. Negotiated Rate	$31.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$6.03
Rate for Payer: Aetna Medicare Advantage	$6.70
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: Cash Price	$39.60
Rate for Payer: Cash Price	$39.60
Rate for Payer: Cigna Commercial HMO & PPO	$6.70
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$6.03
Rate for Payer: Home State Health Plan Medicaid Managed Care	$6.45
Rate for Payer: Home State Health Plan Medicare Advantage	$6.70
Rate for Payer: Humana Commercial	$13.40
Rate for Payer: Humana Medicare Advantage	$6.70
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$6.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.84

MAGNESIUM URINE

Facility

$44.00

Service Code	CPT 83735
Hospital Charge Code	2223735
Hospital Revenue Code	301
Rate for Payer: Cash Price	$39.60

MAGNESIUM URINE 24 HOUR

Facility

$44.00

Service Code	CPT 83735
Hospital Charge Code	2203735
Hospital Revenue Code	307
Rate for Payer: Cash Price	$39.60

Know your out-of-pocket cost for care.

All Charges