Madison Medical Center

All Charges

Charge

Type

Setting

Price

JAK2 MUTATION

Facility

$846.00

Service Code	CPT 81270
Hospital Charge Code	2281270
Hospital Revenue Code	301
Rate for Payer: Cash Price	$761.40

JAK2V617F W/ RFX TO EXON12, CALR, & MPL

Facility

$388.00

Service Code	CPT 81270
Hospital Charge Code	22281270
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$277.03
Rate for Payer: Aetna Better Health Medicaid/QHP	$82.49
Rate for Payer: Aetna Medicare Advantage	$91.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$229.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$277.03
Rate for Payer: Cash Price	$349.20
Rate for Payer: Cash Price	$349.20
Rate for Payer: Cash Price	$349.20
Rate for Payer: Cigna Commercial HMO & PPO	$91.66
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$82.49
Rate for Payer: Home State Health Plan Medicaid Managed Care	$88.26
Rate for Payer: Home State Health Plan Medicare Advantage	$91.66
Rate for Payer: Humana Commercial	$183.32
Rate for Payer: Humana Medicare Advantage	$91.66
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$82.49
Rate for Payer: UnitedHealthcare Medicare Advantage	$139.68

JAK2V617F W/ RFX TO EXON12, CALR, & MPL

Facility

$388.00

Service Code	CPT 81270
Hospital Charge Code	22281270
Hospital Revenue Code	301
Rate for Payer: Cash Price	$349.20

JANUMET 50/500 TAB EMP

Facility

$39.00

Service Code	NDC 6057562
Hospital Charge Code	2623461
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

JANUMET 50/500 TAB EMP

Facility

$39.00

Service Code	NDC 6057562
Hospital Charge Code	2623461
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

JANUMET XR 50/1000 TAB EMP

Facility

$39.00

Service Code	NDC 6008062
Hospital Charge Code	2622240
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

JANUMET XR 50/1000 TAB EMP

Facility

$39.00

Service Code	NDC 6008062
Hospital Charge Code	2622240
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

JEGUNO T-FASTENER

Facility

$511.00

Hospital Charge Code	1211901
Hospital Revenue Code	271
Rate for Payer: Cash Price	$459.90

JEGUNO T-FASTENER

Facility

$511.00

Hospital Charge Code	1211901
Hospital Revenue Code	271
Min. Negotiated Rate	$183.96
Max. Negotiated Rate	$364.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$302.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$364.85
Rate for Payer: Cash Price	$459.90
Rate for Payer: UnitedHealthcare Commercial	$340.84
Rate for Payer: UnitedHealthcare Medicare Advantage	$183.96

JELCO 14GA

Facility

$45.00

Hospital Charge Code	2810864
Hospital Revenue Code	272
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

JELCO 14GA

Facility

$45.00

Hospital Charge Code	2810864
Hospital Revenue Code	272
Rate for Payer: Cash Price	$40.50

JELCO 16GA

Facility

$45.00

Hospital Charge Code	2810862
Hospital Revenue Code	272
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

JELCO 16GA

Facility

$45.00

Hospital Charge Code	2810862
Hospital Revenue Code	272
Rate for Payer: Cash Price	$40.50

JELCO 18GA

Facility

$45.00

Hospital Charge Code	2810863
Hospital Revenue Code	272
Rate for Payer: Cash Price	$40.50

JELCO 18GA

Facility

$45.00

Hospital Charge Code	2810863
Hospital Revenue Code	272
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

JELCO 20GA

Facility

$45.00

Hospital Charge Code	2810858
Hospital Revenue Code	272
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

JELCO 20GA

Facility

$45.00

Hospital Charge Code	2810858
Hospital Revenue Code	272
Rate for Payer: Cash Price	$40.50

JELCO 22GA

Facility

$45.00

Hospital Charge Code	2810860
Hospital Revenue Code	272
Rate for Payer: Cash Price	$40.50

JELCO 22GA

Facility

$45.00

Hospital Charge Code	2810860
Hospital Revenue Code	272
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

JELCO 24GA

Facility

$45.00

Hospital Charge Code	2810861
Hospital Revenue Code	272
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

JELCO 24GA

Facility

$45.00

Hospital Charge Code	2810861
Hospital Revenue Code	272
Rate for Payer: Cash Price	$40.50

JELLY, PETROLEUM

Facility

$21.00

Hospital Charge Code	2810854
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

JELLY, PETROLEUM

Facility

$21.00

Hospital Charge Code	2810854
Hospital Revenue Code	271
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

J HOOK

Facility

$319.00

Service Code	CPT Y7506
Hospital Charge Code	125000
Hospital Revenue Code	272
Min. Negotiated Rate	$114.84
Max. Negotiated Rate	$227.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$188.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$227.77
Rate for Payer: Cash Price	$287.10
Rate for Payer: UnitedHealthcare Commercial	$212.77
Rate for Payer: UnitedHealthcare Medicare Advantage	$114.84

J HOOK

Facility

$319.00

Service Code	CPT Y7506
Hospital Charge Code	125000
Hospital Revenue Code	272
Rate for Payer: Cash Price	$287.10

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All Charges