Madison Medical Center

All Charges

Charge

Type

Setting

Price

AMIODARONE (PACERONE) 200MG TAB UD

Facility

$24.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2626598
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

AMITIZA 24MCG CAP EMP

Facility

$56.00

Service Code	NDC 456120130
Hospital Charge Code	2623910
Hospital Revenue Code	250
Rate for Payer: Cash Price	$50.40

AMITIZA 24MCG CAP EMP

Facility

$56.00

Service Code	NDC 456120130
Hospital Charge Code	2623910
Hospital Revenue Code	250
Min. Negotiated Rate	$20.16
Max. Negotiated Rate	$39.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$33.15
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$39.98
Rate for Payer: Cash Price	$50.40
Rate for Payer: UnitedHealthcare Commercial	$37.35
Rate for Payer: UnitedHealthcare Medicare Advantage	$20.16

AMITRIPTYLINE

Facility

$142.00

Service Code	CPT 80335
Hospital Charge Code	2280152
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$101.39
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$51.12
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$84.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$101.39
Rate for Payer: Cash Price	$127.80
Rate for Payer: Cash Price	$127.80

AMITRIPTYLINE

Facility

$142.00

Service Code	CPT 80335
Hospital Charge Code	2280152
Hospital Revenue Code	301
Rate for Payer: Cash Price	$127.80

AMITRIPTYLINE 100MG TAB EMP

Facility

$15.00

Service Code	NDC 7.071E+10
Hospital Charge Code	2624559
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

AMITRIPTYLINE 100MG TAB EMP

Facility

$15.00

Service Code	NDC 7.071E+10
Hospital Charge Code	2624559
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

AMITRIPTYLINE 10MG TAB EMP

Facility

$20.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2619173
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

AMITRIPTYLINE 10MG TAB EMP

Facility

$20.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2619173
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

AMITRIPTYLINE 25MG TAB EMP

Facility

$15.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2622117
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

AMITRIPTYLINE 25MG TAB EMP

Facility

$15.00

Service Code	NDC 1.6729E+10
Hospital Charge Code	2622117
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

AMITRIPTYLINE 50MG TAB EMP

Facility

$18.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2619096
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

AMITRIPTYLINE 50MG TAB EMP

Facility

$18.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2619096
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
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: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

AMITRIPTYLINE 75MG TAB EMP

Facility

$15.00

Service Code	NDC 781148901
Hospital Charge Code	2697254
Hospital Revenue Code	250
Min. Negotiated Rate	$5.40
Max. Negotiated Rate	$10.71
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$8.88
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$10.71
Rate for Payer: Cash Price	$13.50
Rate for Payer: UnitedHealthcare Commercial	$10.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.40

AMITRIPTYLINE 75MG TAB EMP

Facility

$15.00

Service Code	NDC 781148901
Hospital Charge Code	2697254
Hospital Revenue Code	250
Rate for Payer: Cash Price	$13.50

AMITRIPTYLINE (ELAVIL) 25MG TAB

Facility

$20.00

Service Code	NDC 904020161
Hospital Charge Code	2654155
Hospital Revenue Code	250
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$14.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$14.28
Rate for Payer: Cash Price	$18.00
Rate for Payer: UnitedHealthcare Commercial	$13.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$7.20

AMITRIPTYLINE (ELAVIL) 25MG TAB

Facility

$20.00

Service Code	NDC 904020161
Hospital Charge Code	2654155
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

AMLODIPINE 10MG TAB EMP

Facility

$18.00

Service Code	NDC 3.1722E+10
Hospital Charge Code	2697205
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

AMLODIPINE 10MG TAB EMP

Facility

$18.00

Service Code	NDC 3.1722E+10
Hospital Charge Code	2697205
Hospital Revenue Code	250
Min. Negotiated Rate	$6.48
Max. Negotiated Rate	$12.85
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: UnitedHealthcare Commercial	$12.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.48

AMLODIPINE 2.5MG TAB EMP

Facility

$16.00

Service Code	NDC 6.9097E+10
Hospital Charge Code	2621733
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

AMLODIPINE 2.5MG TAB EMP

Facility

$16.00

Service Code	NDC 6.9097E+10
Hospital Charge Code	2621733
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

AMLODIPINE (NORVASC) 10MG TAB

Facility

$39.00

Service Code	NDC 904599361
Hospital Charge Code	2626339
Hospital Revenue Code	250
Min. Negotiated Rate	$14.04
Max. Negotiated Rate	$27.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$23.09
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$27.85
Rate for Payer: Cash Price	$35.10
Rate for Payer: UnitedHealthcare Commercial	$26.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$14.04

AMLODIPINE (NORVASC) 10MG TAB

Facility

$39.00

Service Code	NDC 904599361
Hospital Charge Code	2626339
Hospital Revenue Code	250
Rate for Payer: Cash Price	$35.10

AMLODIPINE (NORVASC) 5MG TAB EMP

Facility

$16.00

Service Code	NDC 69153068
Hospital Charge Code	2697232
Hospital Revenue Code	250
Min. Negotiated Rate	$5.76
Max. Negotiated Rate	$11.42
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$9.47
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$11.42
Rate for Payer: Cash Price	$14.40
Rate for Payer: UnitedHealthcare Commercial	$10.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$5.76

AMLODIPINE (NORVASC) 5MG TAB EMP

Facility

$16.00

Service Code	NDC 69153068
Hospital Charge Code	2697232
Hospital Revenue Code	250
Rate for Payer: Cash Price	$14.40

Know your out-of-pocket cost for care.

All Charges