Madison Medical Center

All Charges

Charge

Type

Setting

Price

PHENAZOPYRID (PYRIDIUM) 100MG TAB

Facility

$28.00

Service Code	NDC 4.2192E+10
Hospital Charge Code	2655850
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

PHENAZOPYRID (PYRIDIUM) 100MG TAB

Facility

$28.00

Service Code	NDC 4.2192E+10
Hospital Charge Code	2655850
Hospital Revenue Code	250
Rate for Payer: Cash Price	$25.20

PHENAZOPYRID (PYRIDIUM) 200MG TAB

Facility

$8.00

Service Code	NDC 603514221
Hospital Charge Code	2655855
Hospital Revenue Code	250
Min. Negotiated Rate	$2.88
Max. Negotiated Rate	$5.71
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: UnitedHealthcare Commercial	$5.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$2.88

PHENAZOPYRID (PYRIDIUM) 200MG TAB

Facility

$8.00

Service Code	NDC 603514221
Hospital Charge Code	2655855
Hospital Revenue Code	250
Rate for Payer: Cash Price	$7.20

PHENDIMETRAZINE TART 35MG TAB C3 EMP

Facility

$18.00

Service Code	NDC 6.9543E+10
Hospital Charge Code	2625047
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

PHENDIMETRAZINE TART 35MG TAB C3 EMP

Facility

$18.00

Service Code	NDC 6.9543E+10
Hospital Charge Code	2625047
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PHENERGAN 50MG

Facility

$45.00

Service Code	HCPCS J2550
Hospital Charge Code	9602550
Hospital Revenue Code	636
Min. Negotiated Rate	$30.02
Max. Negotiated Rate	$30.02
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02

PHENERGAN 50MG

Facility

$45.00

Service Code	HCPCS J2550
Hospital Charge Code	9602550
Hospital Revenue Code	636
Min. Negotiated Rate	$16.20
Max. Negotiated Rate	$32.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$26.64
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$32.13
Rate for Payer: Cash Price	$40.50
Rate for Payer: UnitedHealthcare Commercial	$30.02
Rate for Payer: UnitedHealthcare Medicare Advantage	$16.20

PHENERGAN 50 MG

Facility

$22.00

Hospital Charge Code	5206060
Hospital Revenue Code	521
Min. Negotiated Rate	$13.02
Max. Negotiated Rate	$173.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$13.02
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$15.71
Rate for Payer: Cash Price	$19.80
Rate for Payer: Cash Price	$19.80
Rate for Payer: UnitedHealthcare Commercial	$14.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$173.53

PHENERGAN 50 MG

Facility

$26.00

Service Code	CPT J6060
Hospital Charge Code	4106060
Hospital Revenue Code	636
Min. Negotiated Rate	$9.36
Max. Negotiated Rate	$18.56
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$15.39
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$18.56
Rate for Payer: Cash Price	$23.40
Rate for Payer: UnitedHealthcare Commercial	$17.34
Rate for Payer: UnitedHealthcare Medicare Advantage	$9.36

PHENERGAN 50 MG

Facility

$22.00

Hospital Charge Code	5206060
Hospital Revenue Code	521
Rate for Payer: Cash Price	$19.80

PHENERGAN 50 MG

Facility

$28.00

Service Code	HCPCS J6060
Hospital Charge Code	9606060
Hospital Revenue Code	636
Min. Negotiated Rate	$18.68
Max. Negotiated Rate	$18.68
Rate for Payer: Cash Price	$25.20
Rate for Payer: UnitedHealthcare Commercial	$18.68

PHENERGAN 50 MG

Facility

$28.00

Service Code	HCPCS J6060
Hospital Charge Code	9606060
Hospital Revenue Code	636
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

PHENERGAN 50 MG

Facility

$26.00

Service Code	CPT J6060
Hospital Charge Code	4106060
Hospital Revenue Code	636
Min. Negotiated Rate	$17.34
Max. Negotiated Rate	$17.34
Rate for Payer: Cash Price	$23.40
Rate for Payer: UnitedHealthcare Commercial	$17.34

PHENOBARB/BELLADON ALKA ELIXIR 10ML

Facility

$159.00

Service Code	NDC 4.2291E+10
Hospital Charge Code	2697121
Hospital Revenue Code	250
Min. Negotiated Rate	$57.24
Max. Negotiated Rate	$113.53
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$94.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$113.53
Rate for Payer: Cash Price	$143.10
Rate for Payer: UnitedHealthcare Commercial	$106.05
Rate for Payer: UnitedHealthcare Medicare Advantage	$57.24

PHENOBARB/BELLADON ALKA ELIXIR 10ML

Facility

$159.00

Service Code	NDC 4.2291E+10
Hospital Charge Code	2697121
Hospital Revenue Code	250
Rate for Payer: Cash Price	$143.10

PHENOBARBITAL

Facility

$65.00

Service Code	CPT 80345
Hospital Charge Code	2216700
Hospital Revenue Code	301
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$46.41
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$38.48
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$46.41
Rate for Payer: Cash Price	$58.50
Rate for Payer: Cash Price	$58.50
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicare Advantage	$23.40

PHENOBARBITAL

Facility

$65.00

Service Code	CPT 80345
Hospital Charge Code	2216700
Hospital Revenue Code	301
Rate for Payer: Cash Price	$58.50

PHENOBARBITAL 130MG/ML INJ C4

Facility

$52.00

Service Code	HCPCS J2560
Hospital Charge Code	2655865
Hospital Revenue Code	250
Rate for Payer: Cash Price	$46.80

PHENOBARBITAL 130MG/ML INJ C4

Facility

$52.00

Service Code	HCPCS J2560
Hospital Charge Code	2655865
Hospital Revenue Code	250
Min. Negotiated Rate	$18.72
Max. Negotiated Rate	$37.13
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$30.78
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$37.13
Rate for Payer: Cash Price	$46.80
Rate for Payer: UnitedHealthcare Commercial	$34.68
Rate for Payer: UnitedHealthcare Medicare Advantage	$18.72

PHENOBARBITAL 20MG/5ML ELIXIR C4

Facility

$18.00

Service Code	NDC 182031440
Hospital Charge Code	2655860
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

PHENOBARBITAL 20MG/5ML ELIXIR C4

Facility

$18.00

Service Code	NDC 182031440
Hospital Charge Code	2655860
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PHENOBARBITAL 30MG TAB C4

Facility

$18.00

Service Code	NDC 54870525
Hospital Charge Code	2655870
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

PHENOBARBITAL 30MG TAB C4

Facility

$18.00

Service Code	NDC 54870525
Hospital Charge Code	2655870
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

PHENOBARBITAL 32.4MG TAB C4

Facility

$18.00

Hospital Charge Code	2697061
Hospital Revenue Code	250
Rate for Payer: Cash Price	$16.20

Know your out-of-pocket cost for care.

All Charges