Madison Medical Center

All Charges

Charge

Type

Setting

Price

SODIUM BICARB 8.4% INJ ADLT 50ML SDV EMP

Facility

$169.00

Service Code	NDC 5.1755E+10
Hospital Charge Code	2624246
Hospital Revenue Code	250
Rate for Payer: Cash Price	$152.10

SODIUM BICARB 8.4% INJ ADLT 50ML SDV EMP

Facility

$169.00

Service Code	NDC 5.1755E+10
Hospital Charge Code	2624246
Hospital Revenue Code	250
Min. Negotiated Rate	$60.84
Max. Negotiated Rate	$120.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$120.67
Rate for Payer: Cash Price	$152.10
Rate for Payer: UnitedHealthcare Commercial	$112.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.84

SODIUM BICARB 8.4% INJ ADULT 50ML

Facility

$169.00

Service Code	NDC 409662502
Hospital Charge Code	2656190
Hospital Revenue Code	250
Rate for Payer: Cash Price	$152.10

SODIUM BICARB 8.4% INJ ADULT 50ML

Facility

$169.00

Service Code	NDC 409662502
Hospital Charge Code	2656190
Hospital Revenue Code	250
Min. Negotiated Rate	$60.84
Max. Negotiated Rate	$120.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$100.05
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$120.67
Rate for Payer: Cash Price	$152.10
Rate for Payer: UnitedHealthcare Commercial	$112.72
Rate for Payer: UnitedHealthcare Medicare Advantage	$60.84

SODIUM BICARB 8.4% PEDIATRIC INJ 10ML

Facility

$127.00

Service Code	NDC 409490034
Hospital Charge Code	2656193
Hospital Revenue Code	250
Rate for Payer: Cash Price	$114.30

SODIUM BICARB 8.4% PEDIATRIC INJ 10ML

Facility

$127.00

Service Code	NDC 409490034
Hospital Charge Code	2656193
Hospital Revenue Code	250
Min. Negotiated Rate	$45.72
Max. Negotiated Rate	$90.68
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: UnitedHealthcare Commercial	$84.71
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.72

SODIUM BICARBONATE 650MG TAB (10GR)

Facility

$16.00

Service Code	NDC 223172101
Hospital Charge Code	2626523
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

SODIUM BICARBONATE 650MG TAB (10GR)

Facility

$16.00

Service Code	NDC 223172101
Hospital Charge Code	2626523
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

SODIUM CHL INH SOL 3% NEB TX 4ML (RT)

Facility

$32.00

Service Code	HCPCS J7608
Hospital Charge Code	2626991
Hospital Revenue Code	250
Min. Negotiated Rate	$11.52
Max. Negotiated Rate	$22.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$18.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$22.85
Rate for Payer: Cash Price	$28.80
Rate for Payer: UnitedHealthcare Commercial	$21.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$11.52

SODIUM CHL INH SOL 3% NEB TX 4ML (RT)

Facility

$32.00

Service Code	HCPCS J7608
Hospital Charge Code	2626991
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

SODIUM CHLORIDE 0.9% 1000ML BAG EMP

Facility

$129.00

Service Code	NDC 338004904
Hospital Charge Code	2624245
Hospital Revenue Code	258
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

SODIUM CHLORIDE 0.9% 1000ML BAG EMP

Facility

$129.00

Service Code	NDC 338004904
Hospital Charge Code	2624245
Hospital Revenue Code	258
Min. Negotiated Rate	$86.04
Max. Negotiated Rate	$86.04
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04

SODIUM CHLORIDE 0.9% 1000ML HSP IVF

Facility

$129.00

Service Code	NDC 409798309
Hospital Charge Code	2697090
Hospital Revenue Code	258
Min. Negotiated Rate	$86.04
Max. Negotiated Rate	$86.04
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04

SODIUM CHLORIDE 0.9% 1000ML HSP IVF

Facility

$129.00

Service Code	NDC 409798309
Hospital Charge Code	2697090
Hospital Revenue Code	258
Min. Negotiated Rate	$46.44
Max. Negotiated Rate	$92.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$76.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$92.11
Rate for Payer: Cash Price	$116.10
Rate for Payer: UnitedHealthcare Commercial	$86.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$46.44

SODIUM CHLORIDE 3% 500ML IV

Facility

$126.00

Service Code	HCPCS J7040
Hospital Charge Code	2626422
Hospital Revenue Code	258
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

SODIUM CHLORIDE 3% 500ML IV

Facility

$126.00

Service Code	HCPCS J7040
Hospital Charge Code	2626422
Hospital Revenue Code	258
Min. Negotiated Rate	$84.04
Max. Negotiated Rate	$84.04
Rate for Payer: Cash Price	$113.40
Rate for Payer: UnitedHealthcare Commercial	$84.04

SODIUM CHLORIDE 50MEQ INJ

Facility

$36.00

Service Code	HCPCS J7051
Hospital Charge Code	2656195
Hospital Revenue Code	250
Rate for Payer: Cash Price	$32.40

SODIUM CHLORIDE 50MEQ INJ

Facility

$36.00

Service Code	HCPCS J7051
Hospital Charge Code	2656195
Hospital Revenue Code	250
Min. Negotiated Rate	$12.96
Max. Negotiated Rate	$25.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$25.70
Rate for Payer: Cash Price	$32.40
Rate for Payer: UnitedHealthcare Commercial	$24.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.96

SODIUM CHLORIDE (OCEAN) 0.65% NASAL SPRA

Facility

$67.00

Service Code	NDC 256015201
Hospital Charge Code	2656200
Hospital Revenue Code	250
Rate for Payer: Cash Price	$60.30

SODIUM CHLORIDE (OCEAN) 0.65% NASAL SPRA

Facility

$67.00

Service Code	NDC 256015201
Hospital Charge Code	2656200
Hospital Revenue Code	250
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

SODIUM CHLORIDE PF INJ 10ML VIAL

Facility

$55.00

Service Code	HCPCS A4216
Hospital Charge Code	2697281
Hospital Revenue Code	250
Min. Negotiated Rate	$19.80
Max. Negotiated Rate	$39.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$32.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.27
Rate for Payer: Cash Price	$49.50
Rate for Payer: UnitedHealthcare Commercial	$36.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.80

SODIUM CHLORIDE PF INJ 10ML VIAL

Facility

$55.00

Service Code	HCPCS A4216
Hospital Charge Code	2697281
Hospital Revenue Code	250
Rate for Payer: Cash Price	$49.50

SODIUM CHLORIDE (SALT) 1GM TAB

Facility

$20.00

Service Code	NDC 223176001
Hospital Charge Code	2626369
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

SODIUM CHLORIDE (SALT) 1GM TAB

Facility

$20.00

Service Code	NDC 223176001
Hospital Charge Code	2626369
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

SODIUM CHLOR INH SOL 0.9% 3ML NEB TX

Facility

$32.00

Service Code	HCPCS J7608
Hospital Charge Code	2626445
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

Know your out-of-pocket cost for care.

All Charges