Madison Medical Center

All Charges

Charge

Type

Setting

Price

JO-1 ANTIBODY

Facility

$186.00

Service Code	CPT 86235
Hospital Charge Code	2286234
Hospital Revenue Code	302
Rate for Payer: Cash Price	$167.40

JO-1 ANTIBODY

Facility

$186.00

Service Code	CPT 86235
Hospital Charge Code	2286234
Hospital Revenue Code	302
Min. Negotiated Rate	$16.14
Max. Negotiated Rate	$132.80
Rate for Payer: Aetna Better Health Medicaid/QHP	$16.14
Rate for Payer: Aetna Medicare Advantage	$17.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$110.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$132.80
Rate for Payer: Cash Price	$167.40
Rate for Payer: Cash Price	$167.40
Rate for Payer: Cash Price	$167.40
Rate for Payer: Cigna Commercial HMO & PPO	$17.93
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$16.14
Rate for Payer: Home State Health Plan Medicaid Managed Care	$17.27
Rate for Payer: Home State Health Plan Medicare Advantage	$17.93
Rate for Payer: Humana Commercial	$35.86
Rate for Payer: Humana Medicare Advantage	$17.93
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$16.14
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.96

JOINT DISLOCATION S/P REDUCT OF FINGER

Professional

Both

$1,341.00

Service Code	CPT 26700
Hospital Charge Code	1826700
Hospital Revenue Code	981
Min. Negotiated Rate	$258.80
Max. Negotiated Rate	$469.35
Rate for Payer: Aetna Commercial/Medicare Advantage	$320.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Medicaid Managed Care	$258.80
Rate for Payer: Cash Price	$1,206.90
Rate for Payer: Cash Price	$1,206.90
Rate for Payer: Cigna Commercial HMO & PPO	$320.59
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$258.80
Rate for Payer: Home State Health Plan Medicaid Managed Care	$284.68
Rate for Payer: Home State Health Plan Medicare Advantage	$320.59
Rate for Payer: Optum Medicare Advantage	$469.35
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$258.80

J P DRAIN

Facility

$189.00

Hospital Charge Code	124718
Hospital Revenue Code	271
Min. Negotiated Rate	$68.04
Max. Negotiated Rate	$134.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$111.89
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$134.95
Rate for Payer: Cash Price	$170.10
Rate for Payer: UnitedHealthcare Commercial	$126.06
Rate for Payer: UnitedHealthcare Medicare Advantage	$68.04

J P DRAIN

Facility

$189.00

Hospital Charge Code	124718
Hospital Revenue Code	271
Rate for Payer: Cash Price	$170.10

J/P RESERVOIR

Facility

$125.00

Hospital Charge Code	127858
Hospital Revenue Code	271
Rate for Payer: Cash Price	$112.50

J/P RESERVOIR

Facility

$125.00

Hospital Charge Code	127858
Hospital Revenue Code	271
Min. Negotiated Rate	$45.00
Max. Negotiated Rate	$89.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.25
Rate for Payer: Cash Price	$112.50
Rate for Payer: UnitedHealthcare Commercial	$83.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.00

JUBBONTI 60MG/ML SC INJ

Facility

$6,454.00

Service Code	HCPCS J0897
Hospital Charge Code	2627122
Hospital Revenue Code	250
Min. Negotiated Rate	$30.10
Max. Negotiated Rate	$4,608.16
Rate for Payer: Aetna Medicare Advantage	$30.10
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$3,820.77
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$4,608.16
Rate for Payer: Cash Price	$5,808.60
Rate for Payer: Cash Price	$5,808.60
Rate for Payer: Cigna Commercial HMO & PPO	$30.10
Rate for Payer: Home State Health Plan Medicare Advantage	$30.10
Rate for Payer: Humana Commercial	$60.20
Rate for Payer: Humana Medicare Advantage	$30.10
Rate for Payer: UnitedHealthcare Commercial	$4,304.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$2,323.44

JUBBONTI 60MG/ML SC INJ

Facility

$6,454.00

Service Code	HCPCS J0897
Hospital Charge Code	2627122
Hospital Revenue Code	250
Rate for Payer: Cash Price	$5,808.60

JUVEN 23GM PKT

Facility

$21.00

Service Code	NDC 5.9781E+10
Hospital Charge Code	2619204
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

JUVEN 23GM PKT

Facility

$21.00

Service Code	NDC 5.9781E+10
Hospital Charge Code	2619204
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

KALTOSTAT (LARGE) #168117

Facility

$101.00

Hospital Charge Code	2811399
Hospital Revenue Code	271
Rate for Payer: Cash Price	$90.90

KALTOSTAT (LARGE) #168117

Facility

$101.00

Hospital Charge Code	2811399
Hospital Revenue Code	271
Min. Negotiated Rate	$36.36
Max. Negotiated Rate	$72.11
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$59.79
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$72.11
Rate for Payer: Cash Price	$90.90
Rate for Payer: UnitedHealthcare Commercial	$67.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$36.36

KANGAROO SET, 1000ML PUMP SET (BAG)

Facility

$54.00

Hospital Charge Code	280015
Hospital Revenue Code	271
Rate for Payer: Cash Price	$48.60

KANGAROO SET, 1000ML PUMP SET (BAG)

Facility

$54.00

Hospital Charge Code	280015
Hospital Revenue Code	271
Min. Negotiated Rate	$19.44
Max. Negotiated Rate	$38.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$31.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$38.56
Rate for Payer: Cash Price	$48.60
Rate for Payer: UnitedHealthcare Commercial	$36.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$19.44

KAPPA/LAMBDA LT CHAIN SERUM

Facility

$161.00

Service Code	CPT 83883
Hospital Charge Code	2215121
Hospital Revenue Code	305
Min. Negotiated Rate	$12.24
Max. Negotiated Rate	$114.95
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.24
Rate for Payer: Aetna Medicare Advantage	$13.60
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$95.31
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$114.95
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cash Price	$144.90
Rate for Payer: Cigna Commercial HMO & PPO	$13.60
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.24
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.10
Rate for Payer: Home State Health Plan Medicare Advantage	$13.60
Rate for Payer: Humana Commercial	$27.20
Rate for Payer: Humana Medicare Advantage	$13.60
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.24
Rate for Payer: UnitedHealthcare Medicare Advantage	$57.96

KAPPA/LAMBDA LT CHAIN SERUM

Facility

$161.00

Service Code	CPT 83883
Hospital Charge Code	2215121
Hospital Revenue Code	305
Rate for Payer: Cash Price	$144.90

KAPPA/LAMBDA LT CHAIN URINE

Facility

$220.00

Hospital Charge Code	2215120
Hospital Revenue Code	305
Rate for Payer: Cash Price	$198.00

KAPPA/LAMBDA LT CHAIN URINE

Facility

$220.00

Hospital Charge Code	2215120
Hospital Revenue Code	305
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$157.08
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$130.24
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$157.08
Rate for Payer: Cash Price	$198.00
Rate for Payer: Cash Price	$198.00
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$79.20

KENALOG

Facility

$105.00

Service Code	HCPCS J3301
Hospital Charge Code	9603301
Hospital Revenue Code	636
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$74.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$74.97
Rate for Payer: Cash Price	$94.50
Rate for Payer: UnitedHealthcare Commercial	$70.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$37.80

KENALOG

Facility

$105.00

Service Code	HCPCS J3301
Hospital Charge Code	9603301
Hospital Revenue Code	636
Min. Negotiated Rate	$70.03
Max. Negotiated Rate	$70.03
Rate for Payer: Cash Price	$94.50
Rate for Payer: UnitedHealthcare Commercial	$70.03

KERLIX 2 1/4

Facility

$21.00

Hospital Charge Code	2811683
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

KERLIX 2 1/4

Facility

$21.00

Hospital Charge Code	2811683
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

KERLIX 4 1/2 IN

Facility

$52.00

Hospital Charge Code	2811681
Hospital Revenue Code	271
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

KERLIX 4 1/2 IN

Facility

$52.00

Hospital Charge Code	2811681
Hospital Revenue Code	271
Rate for Payer: Cash Price	$46.80

Know your out-of-pocket cost for care.

All Charges