Madison Medical Center

All Charges

Charge

Type

Setting

Price

VENLAFAXINE XR 75MG CAP EMP

Facility

$28.00

Service Code	NDC 5.9762E+10
Hospital Charge Code	2698466
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

VENOGRAM KIT

Facility

$126.00

Hospital Charge Code	3200128
Hospital Revenue Code	271
Min. Negotiated Rate	$45.36
Max. Negotiated Rate	$89.96
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$74.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$89.96
Rate for Payer: Cash Price	$113.40
Rate for Payer: UnitedHealthcare Commercial	$84.04
Rate for Payer: UnitedHealthcare Medicare Advantage	$45.36

VENOGRAM KIT

Facility

$152.00

Hospital Charge Code	2800128
Hospital Revenue Code	271
Rate for Payer: Cash Price	$136.80

VENOGRAM KIT

Facility

$152.00

Hospital Charge Code	2800128
Hospital Revenue Code	271
Min. Negotiated Rate	$54.72
Max. Negotiated Rate	$108.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$89.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$108.53
Rate for Payer: Cash Price	$136.80
Rate for Payer: UnitedHealthcare Commercial	$101.38
Rate for Payer: UnitedHealthcare Medicare Advantage	$54.72

VENOGRAM KIT

Facility

$126.00

Hospital Charge Code	3200128
Hospital Revenue Code	271
Rate for Payer: Cash Price	$113.40

VENOGRAPHY-CONTRAST INJECTION PROCEDURE

Facility

$251.00

Service Code	CPT 36005
Hospital Charge Code	3236005
Hospital Revenue Code	320
Rate for Payer: Cash Price	$225.90

VENOGRAPHY-CONTRAST INJECTION PROCEDURE

Facility

$251.00

Service Code	CPT 36005
Hospital Charge Code	3236005
Hospital Revenue Code	320
Min. Negotiated Rate	$90.36
Max. Negotiated Rate	$179.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$148.59
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$179.21
Rate for Payer: Cash Price	$225.90
Rate for Payer: Cash Price	$225.90
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$90.36

VENOGRAPHY, SVC

Facility

$807.00

Service Code	CPT 75827
Hospital Charge Code	3275827
Hospital Revenue Code	320
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$3,216.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,419.02
Rate for Payer: Aetna Medicare Advantage	$1,608.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$477.74
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$576.20
Rate for Payer: Cash Price	$726.30
Rate for Payer: Cash Price	$726.30
Rate for Payer: Cash Price	$726.30
Rate for Payer: Cigna Commercial HMO & PPO	$1,608.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,419.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,518.35
Rate for Payer: Home State Health Plan Medicare Advantage	$1,608.25
Rate for Payer: Humana Commercial	$3,216.50
Rate for Payer: Humana Medicare Advantage	$1,608.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,419.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$290.52

VENOGRAPHY, SVC

Facility

$807.00

Service Code	CPT 75827
Hospital Charge Code	3275827
Hospital Revenue Code	320
Rate for Payer: Cash Price	$726.30

VENOGRAPHY TRAY

Facility

$156.00

Hospital Charge Code	2822040
Hospital Revenue Code	271
Min. Negotiated Rate	$56.16
Max. Negotiated Rate	$111.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$92.35
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$111.38
Rate for Payer: Cash Price	$140.40
Rate for Payer: UnitedHealthcare Commercial	$104.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$56.16

VENOGRAPHY TRAY

Facility

$156.00

Hospital Charge Code	2822040
Hospital Revenue Code	271
Rate for Payer: Cash Price	$140.40

VENOGRAPHY UNILATEXT

Facility

$798.00

Service Code	CPT 75820
Hospital Charge Code	3222200
Hospital Revenue Code	320
Rate for Payer: Cash Price	$718.20

VENOGRAPHY UNILATEXT

Facility

$798.00

Service Code	CPT 75820
Hospital Charge Code	3222200
Hospital Revenue Code	320
Min. Negotiated Rate	$175.00
Max. Negotiated Rate	$3,216.50
Rate for Payer: Aetna Better Health Medicaid/QHP	$1,419.02
Rate for Payer: Aetna Medicare Advantage	$1,608.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$472.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$569.77
Rate for Payer: Cash Price	$718.20
Rate for Payer: Cash Price	$718.20
Rate for Payer: Cash Price	$718.20
Rate for Payer: Cigna Commercial HMO & PPO	$1,608.25
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$1,419.02
Rate for Payer: Home State Health Plan Medicaid Managed Care	$1,518.35
Rate for Payer: Home State Health Plan Medicare Advantage	$1,608.25
Rate for Payer: Humana Commercial	$3,216.50
Rate for Payer: Humana Medicare Advantage	$1,608.25
Rate for Payer: UnitedHealthcare Commercial	$175.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$1,419.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$287.28

VENOUS PRESS SOL

Facility

$62.00

Hospital Charge Code	2822526
Hospital Revenue Code	271
Min. Negotiated Rate	$22.32
Max. Negotiated Rate	$44.27
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$36.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$44.27
Rate for Payer: Cash Price	$55.80
Rate for Payer: UnitedHealthcare Commercial	$41.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$22.32

VENOUS PRESS SOL

Facility

$62.00

Hospital Charge Code	2822526
Hospital Revenue Code	271
Rate for Payer: Cash Price	$55.80

VENTILATOR CIRCUIT

Facility

$91.00

Hospital Charge Code	4524488
Hospital Revenue Code	271
Min. Negotiated Rate	$32.76
Max. Negotiated Rate	$64.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$53.87
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$64.97
Rate for Payer: Cash Price	$81.90
Rate for Payer: UnitedHealthcare Commercial	$60.70
Rate for Payer: UnitedHealthcare Medicare Advantage	$32.76

VENTILATOR CIRCUIT

Facility

$91.00

Hospital Charge Code	4524488
Hospital Revenue Code	271
Rate for Payer: Cash Price	$81.90

VENTILATOR DAILY AFTER INITIAL

Facility

$504.00

Service Code	CPT 94003
Hospital Charge Code	4524401
Hospital Revenue Code	271
Min. Negotiated Rate	$181.44
Max. Negotiated Rate	$1,262.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$556.91
Rate for Payer: Aetna Medicare Advantage	$631.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$298.37
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$359.86
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cigna Commercial HMO & PPO	$631.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$556.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$595.89
Rate for Payer: Home State Health Plan Medicare Advantage	$631.17
Rate for Payer: Humana Commercial	$1,262.34
Rate for Payer: Humana Medicare Advantage	$631.17
Rate for Payer: UnitedHealthcare Commercial	$336.17
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$556.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$181.44

VENTILATOR DAILY AFTER INITIAL

Facility

$504.00

Service Code	CPT 94003
Hospital Charge Code	4524401
Hospital Revenue Code	271
Rate for Payer: Cash Price	$453.60

VENTILATOR INITIAL DAY

Facility

$860.00

Service Code	CPT 94002
Hospital Charge Code	4524400
Hospital Revenue Code	271
Min. Negotiated Rate	$309.60
Max. Negotiated Rate	$1,262.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$556.91
Rate for Payer: Aetna Medicare Advantage	$631.17
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$509.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$614.04
Rate for Payer: Cash Price	$774.00
Rate for Payer: Cash Price	$774.00
Rate for Payer: Cash Price	$774.00
Rate for Payer: Cigna Commercial HMO & PPO	$631.17
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$556.91
Rate for Payer: Home State Health Plan Medicaid Managed Care	$595.89
Rate for Payer: Home State Health Plan Medicare Advantage	$631.17
Rate for Payer: Humana Commercial	$1,262.34
Rate for Payer: Humana Medicare Advantage	$631.17
Rate for Payer: UnitedHealthcare Commercial	$573.62
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$556.91
Rate for Payer: UnitedHealthcare Medicare Advantage	$309.60

VENTILATOR INITIAL DAY

Facility

$860.00

Service Code	CPT 94002
Hospital Charge Code	4524400
Hospital Revenue Code	271
Rate for Payer: Cash Price	$774.00

VENTRALEX HERNIA PATCH LARGE

Facility

$3,119.00

Hospital Charge Code	1210303
Hospital Revenue Code	271
Min. Negotiated Rate	$1,122.84
Max. Negotiated Rate	$2,226.97
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,846.45
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,226.97
Rate for Payer: Cash Price	$2,807.10
Rate for Payer: UnitedHealthcare Commercial	$2,080.37
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,122.84

VENTRALEX HERNIA PATCH LARGE

Facility

$3,119.00

Hospital Charge Code	1210303
Hospital Revenue Code	271
Rate for Payer: Cash Price	$2,807.10

VENTRALEX ST HERNIA PATCH MEDIUM

Facility

$2,933.00

Hospital Charge Code	1210205
Hospital Revenue Code	271
Min. Negotiated Rate	$1,055.88
Max. Negotiated Rate	$2,094.16
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$1,736.34
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$2,094.16
Rate for Payer: Cash Price	$2,639.70
Rate for Payer: UnitedHealthcare Commercial	$1,956.31
Rate for Payer: UnitedHealthcare Medicare Advantage	$1,055.88

VENTRALEX ST HERNIA PATCH MEDIUM

Facility

$2,933.00

Hospital Charge Code	1210205
Hospital Revenue Code	271
Rate for Payer: Cash Price	$2,639.70

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