Madison Medical Center

All Charges

Charge

Type

Setting

Price

MORPHINE 20MG/ML CONC.OR SOL 30ML NH C2

Facility

$340.00

Service Code	NDC 406800330
Hospital Charge Code	2620049
Hospital Revenue Code	250
Rate for Payer: Cash Price	$306.00

MORPHINE 20MG/ML CONC.OR SOL 30ML NH C2

Facility

$340.00

Service Code	NDC 406800330
Hospital Charge Code	2620049
Hospital Revenue Code	250
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$242.76
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$201.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$242.76
Rate for Payer: Cash Price	$306.00
Rate for Payer: UnitedHealthcare Commercial	$226.78
Rate for Payer: UnitedHealthcare Medicare Advantage	$122.40

MORPHINE 2MG INJ 1ML C2

Facility

$81.00

Service Code	HCPCS J2270
Hospital Charge Code	2655608
Hospital Revenue Code	250
Rate for Payer: Cash Price	$72.90

MORPHINE 2MG INJ 1ML C2

Facility

$81.00

Service Code	HCPCS J2270
Hospital Charge Code	2655608
Hospital Revenue Code	250
Min. Negotiated Rate	$29.16
Max. Negotiated Rate	$57.83
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$47.95
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$57.83
Rate for Payer: Cash Price	$72.90
Rate for Payer: UnitedHealthcare Commercial	$54.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$29.16

MORPHINE 4MG INJ 1ML C2

Facility

$86.00

Service Code	HCPCS J2270
Hospital Charge Code	2626488
Hospital Revenue Code	250
Min. Negotiated Rate	$30.96
Max. Negotiated Rate	$61.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$50.91
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$61.40
Rate for Payer: Cash Price	$77.40
Rate for Payer: UnitedHealthcare Commercial	$57.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$30.96

MORPHINE 4MG INJ 1ML C2

Facility

$86.00

Service Code	HCPCS J2270
Hospital Charge Code	2626488
Hospital Revenue Code	250
Rate for Payer: Cash Price	$77.40

MORPHINE ER 15MG TAB C2

Facility

$35.00

Service Code	NDC 904655761
Hospital Charge Code	2655604
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

MORPHINE ER 15MG TAB C2

Facility

$35.00

Service Code	NDC 904655761
Hospital Charge Code	2655604
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

MORPHINE INJ

Facility

$106.00

Service Code	HCPCS J2270
Hospital Charge Code	2058015
Hospital Revenue Code	370
Rate for Payer: Cash Price	$95.40

MORPHINE INJ

Facility

$106.00

Service Code	HCPCS J2270
Hospital Charge Code	2058015
Hospital Revenue Code	370
Min. Negotiated Rate	$38.16
Max. Negotiated Rate	$75.68
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$62.75
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$75.68
Rate for Payer: Cash Price	$95.40
Rate for Payer: UnitedHealthcare Commercial	$70.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$38.16

MORPHINE PCA 1MG/ML 30ML PFS C2

Facility

$116.00

Service Code	HCPCS J2270
Hospital Charge Code	2626580
Hospital Revenue Code	250
Min. Negotiated Rate	$41.76
Max. Negotiated Rate	$82.82
Rate for Payer: UnitedHealthcare Commercial	$77.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$68.67
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$82.82
Rate for Payer: Cash Price	$104.40
Rate for Payer: UnitedHealthcare Medicare Advantage	$41.76

MORPHINE PCA 1MG/ML 30ML PFS C2

Facility

$116.00

Service Code	HCPCS J2270
Hospital Charge Code	2626580
Hospital Revenue Code	250
Rate for Payer: Cash Price	$104.40

MORPHINE SULF IR 15MG TAB C2

Facility

$35.00

Service Code	NDC 54023525
Hospital Charge Code	2626587
Hospital Revenue Code	250
Min. Negotiated Rate	$12.60
Max. Negotiated Rate	$24.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$20.72
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$24.99
Rate for Payer: Cash Price	$31.50
Rate for Payer: UnitedHealthcare Commercial	$23.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$12.60

MORPHINE SULF IR 15MG TAB C2

Facility

$35.00

Service Code	NDC 54023525
Hospital Charge Code	2626587
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

MOUNJARO 10MG/0.5ML INJ PEN

Facility

$3,978.00

Service Code	NDC 1E+11
Hospital Charge Code	2625919
Hospital Revenue Code	250
Rate for Payer: Cash Price	$3,580.20

MOUNJARO 10MG/0.5ML INJ PEN

Facility

$3,978.00

Service Code	NDC 1E+11
Hospital Charge Code	2625919
Hospital Revenue Code	250
Min. Negotiated Rate	$1,432.08
Max. Negotiated Rate	$2,840.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,354.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,840.29
Rate for Payer: Cash Price	$3,580.20
Rate for Payer: UnitedHealthcare Commercial	$2,653.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,432.08

MOUNJARO 12.5MG/0.5ML INJ PEN

Facility

$3,978.00

Service Code	NDC 1E+11
Hospital Charge Code	2625921
Hospital Revenue Code	250
Rate for Payer: Cash Price	$3,580.20

MOUNJARO 12.5MG/0.5ML INJ PEN

Facility

$3,978.00

Service Code	NDC 1E+11
Hospital Charge Code	2625921
Hospital Revenue Code	250
Min. Negotiated Rate	$1,432.08
Max. Negotiated Rate	$2,840.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,354.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,840.29
Rate for Payer: Cash Price	$3,580.20
Rate for Payer: UnitedHealthcare Commercial	$2,653.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,432.08

MOUNJARO 15MG/0.5ML INJ PEN

Facility

$3,978.00

Service Code	NDC 1E+11
Hospital Charge Code	2625922
Hospital Revenue Code	250
Min. Negotiated Rate	$1,432.08
Max. Negotiated Rate	$2,840.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,354.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,840.29
Rate for Payer: Cash Price	$3,580.20
Rate for Payer: UnitedHealthcare Commercial	$2,653.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,432.08

MOUNJARO 15MG/0.5ML INJ PEN

Facility

$3,978.00

Service Code	NDC 1E+11
Hospital Charge Code	2625922
Hospital Revenue Code	250
Rate for Payer: Cash Price	$3,580.20

MOUNJARO 2.5MG/0.5ML INJ PEN

Facility

$3,978.00

Service Code	NDC 1E+11
Hospital Charge Code	2625923
Hospital Revenue Code	250
Min. Negotiated Rate	$1,432.08
Max. Negotiated Rate	$2,840.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,354.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,840.29
Rate for Payer: Cash Price	$3,580.20
Rate for Payer: UnitedHealthcare Commercial	$2,653.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,432.08

MOUNJARO 2.5MG/0.5ML INJ PEN

Facility

$3,978.00

Service Code	NDC 1E+11
Hospital Charge Code	2625923
Hospital Revenue Code	250
Rate for Payer: Cash Price	$3,580.20

MOUNJARO 5MG/0.5ML INJ PEN

Facility

$3,978.00

Service Code	NDC 1E+11
Hospital Charge Code	2625924
Hospital Revenue Code	250
Min. Negotiated Rate	$1,432.08
Max. Negotiated Rate	$2,840.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,354.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,840.29
Rate for Payer: Cash Price	$3,580.20
Rate for Payer: UnitedHealthcare Commercial	$2,653.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,432.08

MOUNJARO 5MG/0.5ML INJ PEN

Facility

$3,978.00

Service Code	NDC 1E+11
Hospital Charge Code	2625924
Hospital Revenue Code	250
Rate for Payer: Cash Price	$3,580.20

MOUNJARO 7.5MG/0.5ML INJ PEN

Facility

$3,978.00

Service Code	NDC 1E+11
Hospital Charge Code	2625925
Hospital Revenue Code	250
Min. Negotiated Rate	$1,432.08
Max. Negotiated Rate	$2,840.29
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2,354.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,840.29
Rate for Payer: Cash Price	$3,580.20
Rate for Payer: UnitedHealthcare Commercial	$2,653.33
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,432.08

Know your out-of-pocket cost for care.

All Charges