Madison Medical Center

All Charges

Charge

Type

Setting

Price

EPIFIX, 4CM X 4CM

Facility

$594.00

Service Code	CPT Q4131
Hospital Charge Code	285440
Hospital Revenue Code	271
Rate for Payer: Cash Price	$534.60

EPIFIX,5CM X 6CM

Facility

$594.00

Service Code	CPT Q4131
Hospital Charge Code	285560
Hospital Revenue Code	271
Rate for Payer: Cash Price	$534.60

EPIFIX,5CM X 6CM

Facility

$594.00

Service Code	CPT Q4131
Hospital Charge Code	285560
Hospital Revenue Code	271
Min. Negotiated Rate	$213.84
Max. Negotiated Rate	$424.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$351.65
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$424.12
Rate for Payer: Cash Price	$534.60
Rate for Payer: UnitedHealthcare Commercial	$396.20
Rate for Payer: UnitedHealthcare Medicare Advantage	$213.84

EPIFIX FACILITY APPLICATION

Facility

$2,532.00

Service Code	CPT 15275
Hospital Charge Code	4015275
Hospital Revenue Code	510
Rate for Payer: Cash Price	$2,278.80

EPIFIX FACILITY APPLICATION

Facility

$2,532.00

Service Code	CPT 15275
Hospital Charge Code	4015275
Hospital Revenue Code	510
Min. Negotiated Rate	$666.23
Max. Negotiated Rate	$1,807.85
Rate for Payer: Aetna Better Health Medicaid/QHP	$666.23
Rate for Payer: Aetna Medicare Advantage	$755.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,498.94
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,807.85
Rate for Payer: Cash Price	$2,278.80
Rate for Payer: Cash Price	$2,278.80
Rate for Payer: Cash Price	$2,278.80
Rate for Payer: Cigna Commercial HMO & PPO	$755.08
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$666.23
Rate for Payer: Home State Health Plan Medicaid Managed Care	$712.87
Rate for Payer: Home State Health Plan Medicare Advantage	$755.08
Rate for Payer: Humana Commercial	$1,510.16
Rate for Payer: Humana Medicare Advantage	$755.08
Rate for Payer: UnitedHealthcare Commercial	$1,688.84
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$666.23
Rate for Payer: UnitedHealthcare Medicare Advantage	$911.52

EPI NEEDLE TUOHY 20GX3.5

Facility

$32.00

Hospital Charge Code	2824491
Hospital Revenue Code	270
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

EPI NEEDLE TUOHY 20GX3.5

Facility

$32.00

Hospital Charge Code	2824491
Hospital Revenue Code	270
Rate for Payer: Cash Price	$28.80

EPINEPHRINE

Facility

$96.00

Service Code	CPT 80324
Hospital Charge Code	2282492
Hospital Revenue Code	301
Rate for Payer: Cash Price	$86.40

EPINEPHRINE

Facility

$96.00

Service Code	CPT 80324
Hospital Charge Code	2282492
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
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: Cash Price	$86.40
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$34.56

EPINEPHRINE 1MG/10ML PFS

Facility

$52.00

Service Code	HCPCS J0169
Hospital Charge Code	2654940
Hospital Revenue Code	250
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$37.13
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: UnitedHealthcare Commercial	$34.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.72

EPINEPHRINE 1MG/10ML PFS

Facility

$52.00

Service Code	HCPCS J0169
Hospital Charge Code	2654940
Hospital Revenue Code	250
Rate for Payer: Cash Price	$46.80

EPINEPHRINE 1MG/ML AMP/VIAL 1ML

Facility

$96.00

Service Code	NDC 4.2023E+10
Hospital Charge Code	2654939
Hospital Revenue Code	250
Rate for Payer: Cash Price	$86.40

EPINEPHRINE 1MG/ML AMP/VIAL 1ML

Facility

$96.00

Service Code	NDC 4.2023E+10
Hospital Charge Code	2654939
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

EPINEPHRINE 1MG NEB SOL 1ML

Facility

$96.00

Service Code	NDC 5.4288E+10
Hospital Charge Code	2627119
Hospital Revenue Code	250
Rate for Payer: Cash Price	$86.40

EPINEPHRINE 1MG NEB SOL 1ML

Facility

$96.00

Service Code	NDC 5.4288E+10
Hospital Charge Code	2627119
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

EPINEPHRINE 1ML

Facility

$58.00

Service Code	HCPCS J0170
Hospital Charge Code	2059104
Hospital Revenue Code	370
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

EPINEPHRINE 1ML

Facility

$58.00

Service Code	HCPCS J0170
Hospital Charge Code	2059104
Hospital Revenue Code	370
Rate for Payer: Cash Price	$52.20

EPINEPHRINE (ADRENALIN) 30ML VIAL

Facility

$347.00

Service Code	HCPCS J0169
Hospital Charge Code	2654063
Hospital Revenue Code	250
Rate for Payer: Cash Price	$312.30

EPINEPHRINE (ADRENALIN) 30ML VIAL

Facility

$347.00

Service Code	HCPCS J0169
Hospital Charge Code	2654063
Hospital Revenue Code	250
Min. Negotiated Rate	$124.92
Max. Negotiated Rate	$247.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$205.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$247.76
Rate for Payer: Cash Price	$312.30
Rate for Payer: UnitedHealthcare Commercial	$231.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.92

EPINEPHRINE (ADRENALIN) 30ML VIAL EMP

Facility

$347.00

Service Code	NDC 4.2023E+10
Hospital Charge Code	2624247
Hospital Revenue Code	250
Min. Negotiated Rate	$124.92
Max. Negotiated Rate	$247.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$205.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$247.76
Rate for Payer: Cash Price	$312.30
Rate for Payer: UnitedHealthcare Commercial	$231.45
Rate for Payer: UnitedHealthcare Medicare Advantage	$124.92

EPINEPHRINE (ADRENALIN) 30ML VIAL EMP

Facility

$347.00

Service Code	NDC 4.2023E+10
Hospital Charge Code	2624247
Hospital Revenue Code	250
Rate for Payer: Cash Price	$312.30

EPIPEN 0.3MG AUTOINJECTOR 2-PAK EMP

Facility

$453.00

Service Code	NDC 4.9502E+10
Hospital Charge Code	2622824
Hospital Revenue Code	250
Rate for Payer: Cash Price	$407.70

EPIPEN 0.3MG AUTOINJECTOR 2-PAK EMP

Facility

$453.00

Service Code	NDC 4.9502E+10
Hospital Charge Code	2622824
Hospital Revenue Code	250
Min. Negotiated Rate	$163.08
Max. Negotiated Rate	$323.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$268.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$323.44
Rate for Payer: Cash Price	$407.70
Rate for Payer: UnitedHealthcare Commercial	$302.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$163.08

EPIPEN JR 0.15MG AUTOINJECTOR 2-PAK EMP

Facility

$453.00

Service Code	NDC 4.9502E+10
Hospital Charge Code	2623899
Hospital Revenue Code	250
Min. Negotiated Rate	$163.08
Max. Negotiated Rate	$323.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$268.18
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$323.44
Rate for Payer: Cash Price	$407.70
Rate for Payer: UnitedHealthcare Commercial	$302.15
Rate for Payer: UnitedHealthcare Medicare Advantage	$163.08

EPIPEN JR 0.15MG AUTOINJECTOR 2-PAK EMP

Facility

$453.00

Service Code	NDC 4.9502E+10
Hospital Charge Code	2623899
Hospital Revenue Code	250
Rate for Payer: Cash Price	$407.70

Know your out-of-pocket cost for care.

All Charges