Madison Medical Center

All Charges

Charge

Type

Setting

Price

RAMIPRIL (ALTACE) 10MG CAP

Facility

$11.00

Service Code	NDC 6.8084E+10
Hospital Charge Code	260654
Hospital Revenue Code	250
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$7.85
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$6.51
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.85
Rate for Payer: Cash Price	$9.90
Rate for Payer: UnitedHealthcare Commercial	$7.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.96

RAMIPRIL (ALTACE) 10MG CAP EMP

Facility

$21.00

Service Code	NDC 5.7237E+10
Hospital Charge Code	2627263
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

RAMIPRIL (ALTACE) 10MG CAP EMP

Facility

$21.00

Service Code	NDC 5.7237E+10
Hospital Charge Code	2627263
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.90

RAMIPRIL (ALTACE) 5MG CAP

Facility

$24.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2626327
Hospital Revenue Code	250
Min. Negotiated Rate	$8.64
Max. Negotiated Rate	$17.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$14.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$17.14
Rate for Payer: Cash Price	$21.60
Rate for Payer: UnitedHealthcare Commercial	$16.01
Rate for Payer: UnitedHealthcare Medicare Advantage	$8.64

RAMIPRIL (ALTACE) 5MG CAP

Facility

$10.00

Service Code	NDC 54010825
Hospital Charge Code	260643
Hospital Revenue Code	250
Rate for Payer: Cash Price	$9.00

RAMIPRIL (ALTACE) 5MG CAP

Facility

$24.00

Service Code	NDC 6.8382E+10
Hospital Charge Code	2626327
Hospital Revenue Code	250
Rate for Payer: Cash Price	$21.60

RAMIPRIL (ALTACE) 5MG CAP

Facility

$10.00

Service Code	NDC 54010825
Hospital Charge Code	260643
Hospital Revenue Code	250
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$7.14
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$5.92
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$7.14
Rate for Payer: Cash Price	$9.00
Rate for Payer: UnitedHealthcare Commercial	$6.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$3.60

RAM, NC INFANT

Facility

$21.00

Hospital Charge Code	4500332
Hospital Revenue Code	271
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

RAM, NC INFANT

Facility

$21.00

Hospital Charge Code	4500332
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

RAM, NC NEWBORN

Facility

$21.00

Hospital Charge Code	4500423
Hospital Revenue Code	271
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

RAM, NC NEWBORN

Facility

$21.00

Hospital Charge Code	4500423
Hospital Revenue Code	271
Rate for Payer: Cash Price	$18.90

RANITIDINE 25MG/ML MDV 6ML (150MG/6ML)

Facility

$43.00

Service Code	HCPCS J2780
Hospital Charge Code	2656146
Hospital Revenue Code	250
Rate for Payer: Cash Price	$38.70

RANITIDINE 25MG/ML MDV 6ML (150MG/6ML)

Facility

$43.00

Service Code	HCPCS J2780
Hospital Charge Code	2656146
Hospital Revenue Code	250
Min. Negotiated Rate	$15.48
Max. Negotiated Rate	$30.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$25.46
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$30.70
Rate for Payer: Cash Price	$38.70
Rate for Payer: UnitedHealthcare Commercial	$28.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$15.48

RANITIDINE SYRUP 15MG/ML EMP (75MG/5ML)

Facility

$20.00

Service Code	NDC 121072716
Hospital Charge Code	2620395
Hospital Revenue Code	250
Rate for Payer: Cash Price	$18.00

RANITIDINE SYRUP 15MG/ML EMP (75MG/5ML)

Facility

$20.00

Service Code	NDC 121072716
Hospital Charge Code	2620395
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

RANITIDINE (ZANTAC) 150MG TAB

Facility

$35.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2656147
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

RANITIDINE (ZANTAC) 150MG TAB

Facility

$35.00

Service Code	NDC 6.5162E+10
Hospital Charge Code	2656147
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

RANITIDINE (ZANTAC) 150MG TAB EMP

Facility

$35.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2697516
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

RANITIDINE (ZANTAC) 150MG TAB EMP

Facility

$35.00

Service Code	NDC 5.1079E+10
Hospital Charge Code	2697516
Hospital Revenue Code	250
Rate for Payer: Cash Price	$31.50

RANITIDINE (ZANTAC) 300MG TAB EMP

Facility

$51.00

Service Code	NDC 173039340
Hospital Charge Code	2656149
Hospital Revenue Code	250
Rate for Payer: Cash Price	$45.90

RANITIDINE (ZANTAC) 300MG TAB EMP

Facility

$51.00

Service Code	NDC 173039340
Hospital Charge Code	2656149
Hospital Revenue Code	250
Min. Negotiated Rate	$18.36
Max. Negotiated Rate	$36.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.19
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$36.41
Rate for Payer: Cash Price	$45.90
Rate for Payer: UnitedHealthcare Commercial	$34.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.36

RANOLAZINE ER 500MG TAB EMP

Facility

$28.00

Service Code	NDC 3089321
Hospital Charge Code	2625579
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

RANOLAZINE ER 500MG TAB EMP

Facility

$28.00

Service Code	NDC 3089321
Hospital Charge Code	2625579
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

RAPAMUNE (SIROLIMUS)

Facility

$408.00

Service Code	CPT 80195
Hospital Charge Code	2280290
Hospital Revenue Code	301
Min. Negotiated Rate	$12.36
Max. Negotiated Rate	$291.31
Rate for Payer: Aetna Better Health Medicaid/QHP	$12.36
Rate for Payer: Aetna Medicare Advantage	$13.73
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$241.54
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$291.31
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cigna Commercial HMO & PPO	$13.73
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$12.36
Rate for Payer: Home State Health Plan Medicaid Managed Care	$13.23
Rate for Payer: Home State Health Plan Medicare Advantage	$13.73
Rate for Payer: Humana Commercial	$27.46
Rate for Payer: Humana Medicare Advantage	$13.73
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$12.36
Rate for Payer: UnitedHealthcare Medicare Advantage	$146.88

RAPAMUNE (SIROLIMUS)

Facility

$408.00

Service Code	CPT 80195
Hospital Charge Code	2280290
Hospital Revenue Code	301
Rate for Payer: Cash Price	$367.20

Know your out-of-pocket cost for care.

All Charges