Madison Medical Center

All Charges

Charge

Type

Setting

Price

CALCITRIOL (ROCALTROL) 0.25MCG CAP EMP

Facility

$20.00

Service Code	NDC 6.438E+10
Hospital Charge Code	2623040
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

CALCIUM

Facility

$112.00

Service Code	CPT 82310
Hospital Charge Code	223170
Hospital Revenue Code	301
Min. Negotiated Rate	$4.64
Max. Negotiated Rate	$79.97
Rate for Payer: Aetna Better Health Medicaid/QHP	$4.64
Rate for Payer: Aetna Medicare Advantage	$5.16
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	$5.16
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$4.64
Rate for Payer: Home State Health Plan Medicaid Managed Care	$4.96
Rate for Payer: Home State Health Plan Medicare Advantage	$5.16
Rate for Payer: Humana Commercial	$10.32
Rate for Payer: Humana Medicare Advantage	$5.16
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$4.64
Rate for Payer: UnitedHealthcare Medicare Advantage	$40.32

CALCIUM

Facility

$112.00

Service Code	CPT 82310
Hospital Charge Code	223170
Hospital Revenue Code	301
Rate for Payer: Cash Price	$100.80

CALCIUM 24HR URINE W/CREA

Facility

$37.00

Service Code	CPT 82340
Hospital Charge Code	2221202
Hospital Revenue Code	307
Rate for Payer: Cash Price	$33.30

CALCIUM 24HR URINE W/CREA

Facility

$37.00

Service Code	CPT 82340
Hospital Charge Code	2221202
Hospital Revenue Code	307
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$26.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.43
Rate for Payer: Aetna Medicare Advantage	$6.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$26.42
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cigna Commercial HMO & PPO	$6.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.81
Rate for Payer: Home State Health Plan Medicare Advantage	$6.03
Rate for Payer: Humana Commercial	$12.06
Rate for Payer: Humana Medicare Advantage	$6.03
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.32

CALCIUM 24HR URINE W/O CREA

Facility

$37.00

Service Code	CPT 82340
Hospital Charge Code	2221203
Hospital Revenue Code	307
Rate for Payer: Cash Price	$33.30

CALCIUM 24HR URINE W/O CREA

Facility

$37.00

Service Code	CPT 82340
Hospital Charge Code	2221203
Hospital Revenue Code	307
Min. Negotiated Rate	$5.43
Max. Negotiated Rate	$26.42
Rate for Payer: Aetna Better Health Medicaid/QHP	$5.43
Rate for Payer: Aetna Medicare Advantage	$6.03
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$21.90
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$26.42
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cash Price	$33.30
Rate for Payer: Cigna Commercial HMO & PPO	$6.03
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$5.43
Rate for Payer: Home State Health Plan Medicaid Managed Care	$5.81
Rate for Payer: Home State Health Plan Medicare Advantage	$6.03
Rate for Payer: Humana Commercial	$12.06
Rate for Payer: Humana Medicare Advantage	$6.03
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$5.43
Rate for Payer: UnitedHealthcare Medicare Advantage	$13.32

CALCIUM ACETATE (PHOS LO) 667MG CAP

Facility

$21.00

Service Code	NDC 54008826
Hospital Charge Code	2626507
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

CALCIUM ACETATE (PHOS LO) 667MG CAP

Facility

$21.00

Service Code	NDC 54008826
Hospital Charge Code	2626507
Hospital Revenue Code	250
Min. Negotiated Rate	$7.56
Max. Negotiated Rate	$14.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$12.43
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.99
Rate for Payer: Cash Price	$18.90
Rate for Payer: UnitedHealthcare Commercial	$14.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.56

CALCIUM ALGINATE DRESSING

Facility

$58.00

Hospital Charge Code	2811398
Hospital Revenue Code	271
Rate for Payer: Cash Price	$52.20

CALCIUM ALGINATE DRESSING

Facility

$58.00

Hospital Charge Code	2811398
Hospital Revenue Code	271
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

CALCIUM CARB (TUMS) EX 750MG 4 TABS

Facility

$20.00

Service Code	NDC 904769591
Hospital Charge Code	2654224
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

CALCIUM CARB (TUMS) EX 750MG 4 TABS

Facility

$20.00

Service Code	NDC 904769591
Hospital Charge Code	2654224
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

CALCIUM CHLORIDE 10%(1GM) 10ML SDV

Facility

$75.00

Service Code	NDC 517671010
Hospital Charge Code	2621892
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

CALCIUM CHLORIDE 10%(1GM) 10ML SDV

Facility

$75.00

Service Code	NDC 517671010
Hospital Charge Code	2621892
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

CALCIUM CHLORIDE 10%(1GM) PFS INJ 10ML

Facility

$75.00

Service Code	NDC 7.6329E+10
Hospital Charge Code	2654375
Hospital Revenue Code	250
Rate for Payer: Cash Price	$67.50

CALCIUM CHLORIDE 10%(1GM) PFS INJ 10ML

Facility

$75.00

Service Code	NDC 7.6329E+10
Hospital Charge Code	2654375
Hospital Revenue Code	250
Min. Negotiated Rate	$27.00
Max. Negotiated Rate	$53.55
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$44.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$53.55
Rate for Payer: Cash Price	$67.50
Rate for Payer: UnitedHealthcare Commercial	$50.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$27.00

CALCIUM CHLORIDE INJ

Facility

$79.00

Hospital Charge Code	2058010
Hospital Revenue Code	370
Min. Negotiated Rate	$28.44
Max. Negotiated Rate	$56.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$46.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$56.41
Rate for Payer: Cash Price	$71.10
Rate for Payer: UnitedHealthcare Commercial	$52.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$28.44

CALCIUM CHLORIDE INJ

Facility

$79.00

Hospital Charge Code	2058010
Hospital Revenue Code	370
Rate for Payer: Cash Price	$71.10

CALCIUM GLOCONATE INJ

Facility

$65.00

Hospital Charge Code	2058012
Hospital Revenue Code	370
Rate for Payer: Cash Price	$58.50

CALCIUM GLOCONATE INJ

Facility

$65.00

Hospital Charge Code	2058012
Hospital Revenue Code	370
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

CALCIUM GLUCONATE 10% 1000MG SDV 10ML

Facility

$63.00

Service Code	HCPCS J0612
Hospital Charge Code	2654376
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

CALCIUM GLUCONATE 10% 1000MG SDV 10ML

Facility

$63.00

Service Code	HCPCS J0612
Hospital Charge Code	2654376
Hospital Revenue Code	250
Rate for Payer: Cash Price	$56.70

CALCIUM IONIZED

Facility

$153.00

Service Code	CPT 82330
Hospital Charge Code	229600
Hospital Revenue Code	301
Min. Negotiated Rate	$12.31
Max. Negotiated Rate	$109.24
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.31
Rate for Payer: Aetna Medicare Advantage	$13.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$90.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$109.24
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cash Price	$137.70
Rate for Payer: Cigna Commercial HMO & PPO	$13.68
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.31
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.17
Rate for Payer: Home State Health Plan Medicare Advantage	$13.68
Rate for Payer: Humana Commercial	$27.36
Rate for Payer: Humana Medicare Advantage	$13.68
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$55.08

CALCIUM IONIZED

Facility

$153.00

Service Code	CPT 82330
Hospital Charge Code	229600
Hospital Revenue Code	301
Rate for Payer: Cash Price	$137.70

Know your out-of-pocket cost for care.

All Charges