Madison Medical Center

All Charges

Charge

Type

Setting

Price

VENIPUNCTURE

Facility

$36.00

Service Code	CPT 36415
Hospital Charge Code	221111
Hospital Revenue Code	300
Rate for Payer: Cash Price	$32.40

VENIPUNCTURE

Facility

$5.00

Service Code	CPT 36415
Hospital Charge Code	9836415
Hospital Revenue Code	301
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Medicare Advantage	$9.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3.57
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cigna Commercial HMO & PPO	$9.34
Rate for Payer: Home State Health Plan Medicare Advantage	$9.34
Rate for Payer: Humana Commercial	$18.68
Rate for Payer: Humana Medicare Advantage	$9.34
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.80

VENIPUNCTURE/FINGERSTICK

Facility

$8.00

Service Code	CPT 36415
Hospital Charge Code	4236415
Hospital Revenue Code	301
Rate for Payer: Cash Price	$7.20

VENIPUNCTURE/FINGERSTICK

Facility

$8.00

Service Code	CPT 36415
Hospital Charge Code	4236415
Hospital Revenue Code	301
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Medicare Advantage	$9.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$4.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$5.71
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cash Price	$7.20
Rate for Payer: Cigna Commercial HMO & PPO	$9.34
Rate for Payer: Home State Health Plan Medicare Advantage	$9.34
Rate for Payer: Humana Commercial	$18.68
Rate for Payer: Humana Medicare Advantage	$9.34
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.88

VENIPUNCTURE, FOR SPECIMEN

Facility

$18.00

Service Code	CPT 36415
Hospital Charge Code	4436415
Hospital Revenue Code	301
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Medicare Advantage	$9.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$10.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$12.85
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cash Price	$16.20
Rate for Payer: Cigna Commercial HMO & PPO	$9.34
Rate for Payer: Home State Health Plan Medicare Advantage	$9.34
Rate for Payer: Humana Commercial	$18.68
Rate for Payer: Humana Medicare Advantage	$9.34
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

VENIPUNCTURE, FOR SPECIMEN

Facility

$18.00

Service Code	CPT 36415
Hospital Charge Code	4436415
Hospital Revenue Code	301
Rate for Payer: Cash Price	$16.20

VENIPUNCTURE IV

Facility

$5.00

Service Code	CPT 36410
Hospital Charge Code	9836410
Hospital Revenue Code	301
Rate for Payer: Cash Price	$4.50

VENIPUNCTURE IV

Facility

$5.00

Service Code	CPT 36410
Hospital Charge Code	9836410
Hospital Revenue Code	301
Min. Negotiated Rate	$1.80
Max. Negotiated Rate	$21.00
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$2.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$3.57
Rate for Payer: Cash Price	$4.50
Rate for Payer: Cash Price	$4.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$1.80

VENLAFAXINE (EFFEXOR) 75MG TAB

Facility

$21.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2626602
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

VENLAFAXINE (EFFEXOR) 75MG TAB

Facility

$21.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	2626602
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

VENLAFAXINE (EFFEXOR) 75MG TAB EMP

Facility

$21.00

Service Code	NDC 6.2332E+10
Hospital Charge Code	2624180
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

VENLAFAXINE (EFFEXOR) 75MG TAB EMP

Facility

$21.00

Service Code	NDC 6.2332E+10
Hospital Charge Code	2624180
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

VENLAFAXINE (EFFEXOR) ER 75MG CAP

Facility

$28.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2626294
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

VENLAFAXINE (EFFEXOR) ER 75MG CAP

Facility

$28.00

Service Code	NDC 6.5862E+10
Hospital Charge Code	2626294
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

VENLAFAXINE ER 37.5MG TAB EMP

Facility

$28.00

Service Code	NDC 6.498E+10
Hospital Charge Code	2627265
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

VENLAFAXINE ER 37.5MG TAB EMP

Facility

$28.00

Service Code	NDC 6.498E+10
Hospital Charge Code	2627265
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

VENLAFAXINE ER 75MG TAB EMP

Facility

$28.00

Service Code	NDC 6.498E+10
Hospital Charge Code	2627167
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

VENLAFAXINE ER 75MG TAB EMP

Facility

$28.00

Service Code	NDC 6.498E+10
Hospital Charge Code	2627167
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

VENLAFAXINE XR 150MG CAP EMP

Facility

$32.00

Service Code	NDC 1E+11
Hospital Charge Code	2698516
Hospital Revenue Code	250
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

VENLAFAXINE XR 150MG CAP EMP

Facility

$32.00

Service Code	NDC 1E+11
Hospital Charge Code	2698516
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

VENLAFAXINE XR 150MG TAB EMP

Facility

$32.00

Service Code	NDC 7.5834E+10
Hospital Charge Code	2625644
Hospital Revenue Code	250
Rate for Payer: Cash Price	$28.80

VENLAFAXINE XR 150MG TAB EMP

Facility

$32.00

Service Code	NDC 7.5834E+10
Hospital Charge Code	2625644
Hospital Revenue Code	250
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

VENLAFAXINE XR 37.5MG CAP EMP

Facility

$28.00

Service Code	NDC 8083721
Hospital Charge Code	2622032
Hospital Revenue Code	250
Min. Negotiated Rate	$10.08
Max. Negotiated Rate	$19.99
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$16.58
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$19.99
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$10.08

VENLAFAXINE XR 37.5MG CAP EMP

Facility

$28.00

Service Code	NDC 8083721
Hospital Charge Code	2622032
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

VENLAFAXINE XR 75MG CAP EMP

Facility

$28.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2698466
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

Know your out-of-pocket cost for care.

All Charges