Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
MVI,ADULT NO.4 WITH VIT K 3300 UNIT-150 MCG/10 ML INTRAVENOUS SOLUTION
Belleville, IL
See all hospitals reporting HCPCS J3490 →Price type
Memorial Hospital’s median price of $44 is 9% below the median hospital's median price ($48), higher than 46% of the 1,749 hospitals reporting HCPCS J3490. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 18 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | Aetna bjc hb aetna commercial community percent of total billed charges · bothfrom % of charges | $33.08 | $41.77 | $4.48 – $96.43 |
| 2 | UnitedHealthcare bjc hb united health care community percent of total billed charges · bothfrom % of charges | $42.53 | $53.70 | $5.76 – $123.98 |
| 3 | Humana bjc hb humana choicecare community percent of total billed charges · bothfrom % of charges | $52.54 | $66.35 | $7.12 – $153.18 |
| 4 | Blue Cross Blue Shield bjc hb anthem choice community percent of total billed charges · bothfrom % of charges | $61.71 | $77.92 | $8.36 – $179.90 |
| 5 | Blue Cross Blue Shield bjc hb anthem access community percent of total billed charges · bothfrom % of charges | $62.47 | $78.88 | $8.46 – $182.11 |
| 6 | Aetna bjc hb aetna national percent of total billed charges · bothfrom % of charges | $70.22 | $88.66 | $9.51 – $204.70 |
| 7 | Aetna bjc hb first health percent of total billed charges · bothfrom % of charges | $70.22 | $88.66 | $9.51 – $204.70 |
| 8 | First Health bjc hb first health percent of total billed charges · bothfrom % of charges | $70.22 | $88.66 | $9.51 – $204.70 |
| 9 | UnitedHealthcare bjc hb first health percent of total billed charges · bothfrom % of charges | $70.22 | $88.66 | $9.51 – $204.70 |
| 10 | Aetna bjc hb group health plan ppo select percent of total billed charges · bothfrom % of charges | $70.88 | $89.50 | $9.60 – $206.63 |
| 11 | Beechstreet bjc hb multiplan percent of total billed charges · bothfrom % of charges | $70.88 | $89.50 | $9.60 – $206.63 |
| 12 | MultiPlan bjc hb multiplan percent of total billed charges · bothfrom % of charges | $70.88 | $89.50 | $9.60 – $206.63 |
| 13 | Phcs bjc hb phcs community percent of total billed charges · bothfrom % of charges | $70.88 | $89.50 | $9.60 – $206.63 |
| 14 | Medica bjc hb wellfirst first health community percent of total billed charges · bothfrom % of charges | $75.60 | $95.46 | $10.24 – $220.40 |
| 15 | Phcs bjc hb wellfirst first health community percent of total billed charges · bothfrom % of charges | $75.60 | $95.46 | $10.24 – $220.40 |
| 16 | Blue Cross Blue Shield bjc hb anthem alliance epo percent of total billed charges · bothfrom % of charges | $80.33 | $101.43 | $10.88 – $234.18 |
| 17 | Blue Cross Blue Shield bjc hb anthem blue preferred percent of total billed charges · bothfrom % of charges | $80.33 | $101.43 | $10.88 – $234.18 |
| 18 | Blue Cross Blue Shield bjc hb anthem traditional percent of total billed charges · bothfrom % of charges | $82.22 | $103.82 | $11.14 – $239.69 |
Last updated: Dec 15, 2025
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