Madison Medical Center

All Charges

Charge

Type

Setting

Price

POTASSIUM 10MEQ (750MG) BOLUS 100ML IVPB

Facility

$126.00

Service Code	HCPCS J3480
Hospital Charge Code	2626415
Hospital Revenue Code	250
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$89.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: UnitedHealthcare Commercial	$84.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

POTASSIUM 10MEQ BOLUS 50ML BAG

Facility

$126.00

Service Code	HCPCS J3480
Hospital Charge Code	2621260
Hospital Revenue Code	250
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$89.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: UnitedHealthcare Commercial	$84.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

POTASSIUM 10MEQ BOLUS 50ML BAG

Facility

$126.00

Service Code	HCPCS J3480
Hospital Charge Code	2621260
Hospital Revenue Code	250
Rate for Payer: Cash Price	$113.40

POTASSIUM 24HR URINE

Facility

$16.00

Service Code	CPT 84133
Hospital Charge Code	2284312
Hospital Revenue Code	307
Rate for Payer: Cash Price	$14.40

POTASSIUM 24HR URINE

Facility

$16.00

Service Code	CPT 84133
Hospital Charge Code	2284312
Hospital Revenue Code	307
Min. Negotiated Rate	$4.26
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.26
Rate for Payer: Aetna Medicare Advantage	$4.73
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: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cigna Commercial HMO & PPO	$4.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.26
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.56
Rate for Payer: Home State Health Plan Medicare Advantage	$4.73
Rate for Payer: Humana Commercial	$9.46
Rate for Payer: Humana Medicare Advantage	$4.73
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.26
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

POTASSIUM CHLOR 10MEQ ER CAP EMP

Facility

$18.00

Service Code	NDC 6.2037E+10
Hospital Charge Code	2621702
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

POTASSIUM CHLOR 10MEQ ER CAP EMP

Facility

$18.00

Service Code	NDC 6.2037E+10
Hospital Charge Code	2621702
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

POTASSIUM CHLORIDE 10MEQ/5ML INJ

Facility

$58.00

Service Code	HCPCS J3480
Hospital Charge Code	2626519
Hospital Revenue Code	250
Rate for Payer: Cash Price	$52.20

POTASSIUM CHLORIDE 10MEQ/5ML INJ

Facility

$58.00

Service Code	HCPCS J3480
Hospital Charge Code	2626519
Hospital Revenue Code	250
Min. Negotiated Rate	$20.88
Max. Negotiated Rate	$41.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$34.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$41.41
Rate for Payer: Cash Price	$52.20
Rate for Payer: UnitedHealthcare Commercial	$38.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.88

POTASSIUM CHLORIDE 10MEQ (750MG) ER TAB

Facility

$18.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2655965
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

POTASSIUM CHLORIDE 10MEQ (750MG) ER TAB

Facility

$18.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2655965
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

POTASSIUM CHLORIDE 10MEQ ER TAB EMP

Facility

$18.00

Service Code	NDC 74327813
Hospital Charge Code	2623737
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

POTASSIUM CHLORIDE 10MEQ ER TAB EMP

Facility

$18.00

Service Code	NDC 74327813
Hospital Charge Code	2623737
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

POTASSIUM CHLORIDE 20MEQ/10ML INJ

Facility

$46.00

Service Code	HCPCS J3480
Hospital Charge Code	2655960
Hospital Revenue Code	250
Min. Negotiated Rate	$16.56
Max. Negotiated Rate	$32.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$27.23
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.84
Rate for Payer: Cash Price	$41.40
Rate for Payer: UnitedHealthcare Commercial	$30.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.56

POTASSIUM CHLORIDE 20MEQ/10ML INJ

Facility

$46.00

Service Code	HCPCS J3480
Hospital Charge Code	2655960
Hospital Revenue Code	250
Rate for Payer: Cash Price	$41.40

POTASSIUM CHLORIDE 20MEQ (1500MG) ER TAB

Facility

$20.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2684641
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

POTASSIUM CHLORIDE 20MEQ (1500MG) ER TAB

Facility

$20.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2684641
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

POTASSIUM CHLORIDE 20MEQ ER TAB EMP

Facility

$20.00

Service Code	NDC 7.001E+10
Hospital Charge Code	2697491
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

POTASSIUM CHLORIDE 20MEQ ER TAB EMP

Facility

$20.00

Service Code	NDC 7.001E+10
Hospital Charge Code	2697491
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

POTASSIUM CHLORIDE 20MEQ TAB HE

Facility

$20.00

Service Code	NDC 245531911
Hospital Charge Code	2625493
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

POTASSIUM CHLORIDE 20MEQ TAB HE

Facility

$20.00

Service Code	NDC 245531911
Hospital Charge Code	2625493
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

POTASSIUM CHLORIDE 40MEQ/20ML INJ

Facility

$56.00

Service Code	HCPCS J3480
Hospital Charge Code	2655961
Hospital Revenue Code	250
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$39.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$33.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.98
Rate for Payer: Cash Price	$50.40
Rate for Payer: UnitedHealthcare Commercial	$37.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.16

POTASSIUM CHLORIDE 40MEQ/20ML INJ

Facility

$56.00

Service Code	HCPCS J3480
Hospital Charge Code	2655961
Hospital Revenue Code	250
Rate for Payer: Cash Price	$50.40

POTASSIUM CL 10% 20MEQ/15ML ORAL SOLN

Facility

$65.00

Service Code	NDC 121168016
Hospital Charge Code	2655970
Hospital Revenue Code	250
Rate for Payer: Cash Price	$58.50

POTASSIUM CL 10% 20MEQ/15ML ORAL SOLN

Facility

$65.00

Service Code	NDC 121168016
Hospital Charge Code	2655970
Hospital Revenue Code	250
Min. Negotiated Rate	$23.40
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$43.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

Know your out-of-pocket cost for care.

All Charges