Madison Medical Center

All Charges

Charge

Type

Setting

Price

PHENOBARBITAL 32.4MG TAB C4

Facility

$18.00

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

PHENOL 29MG 18 LOZENGE BOX

Facility

$67.00

Hospital Charge Code	2656370
Hospital Revenue Code	250
Rate for Payer: Cash Price	$60.30

PHENOL 29MG 18 LOZENGE BOX

Facility

$67.00

Hospital Charge Code	2656370
Hospital Revenue Code	250
Min. Negotiated Rate	$24.12
Max. Negotiated Rate	$47.84
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$39.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$47.84
Rate for Payer: Cash Price	$60.30
Rate for Payer: UnitedHealthcare Commercial	$44.69
Rate for Payer: UnitedHealthcare Medicare Advantage	$24.12

PHENOL 29MG LOZENGE 1 LOZ

Facility

$13.00

Hospital Charge Code	2698111
Hospital Revenue Code	250
Rate for Payer: Cash Price	$11.70

PHENOL 29MG LOZENGE 1 LOZ

Facility

$13.00

Hospital Charge Code	2698111
Hospital Revenue Code	250
Min. Negotiated Rate	$4.68
Max. Negotiated Rate	$9.28
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$7.70
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$9.28
Rate for Payer: Cash Price	$11.70
Rate for Payer: UnitedHealthcare Commercial	$8.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$4.68

PHENTERMINE 15MG CAP EMP C4

Facility

$19.00

Service Code	NDC 1.1534E+10
Hospital Charge Code	2624269
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

PHENTERMINE 15MG CAP EMP C4

Facility

$19.00

Service Code	NDC 1.1534E+10
Hospital Charge Code	2624269
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

PHENTERMINE 37.5MG TAB EMP C4

Facility

$19.00

Service Code	NDC 1.0702E+10
Hospital Charge Code	2620885
Hospital Revenue Code	250
Min. Negotiated Rate	$6.84
Max. Negotiated Rate	$13.57
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$11.25
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$13.57
Rate for Payer: Cash Price	$17.10
Rate for Payer: UnitedHealthcare Commercial	$12.67
Rate for Payer: UnitedHealthcare Medicare Advantage	$6.84

PHENTERMINE 37.5MG TAB EMP C4

Facility

$19.00

Service Code	NDC 1.0702E+10
Hospital Charge Code	2620885
Hospital Revenue Code	250
Rate for Payer: Cash Price	$17.10

PHENTOLAMINE INJ

Facility

$448.00

Service Code	HCPCS J2760
Hospital Charge Code	2058050
Hospital Revenue Code	370
Rate for Payer: Cash Price	$403.20

PHENTOLAMINE INJ

Facility

$448.00

Service Code	HCPCS J2760
Hospital Charge Code	2058050
Hospital Revenue Code	370
Min. Negotiated Rate	$161.28
Max. Negotiated Rate	$577.26
Rate for Payer: Aetna Medicare Advantage	$288.63
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$265.22
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$319.87
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cash Price	$403.20
Rate for Payer: Cigna Commercial HMO & PPO	$288.63
Rate for Payer: Home State Health Plan Medicare Advantage	$288.63
Rate for Payer: Humana Commercial	$577.26
Rate for Payer: Humana Medicare Advantage	$288.63
Rate for Payer: UnitedHealthcare Commercial	$298.82
Rate for Payer: UnitedHealthcare Medicare Advantage	$161.28

PHENTOLAMINE MESYLATE 5MG INJ

Facility

$1,570.00

Service Code	NDC 6.8094E+10
Hospital Charge Code	2625910
Hospital Revenue Code	250
Rate for Payer: Cash Price	$1,413.00

PHENTOLAMINE MESYLATE 5MG INJ

Facility

$1,570.00

Service Code	NDC 6.8094E+10
Hospital Charge Code	2625910
Hospital Revenue Code	250
Min. Negotiated Rate	$565.20
Max. Negotiated Rate	$1,120.98
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$929.44
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$1,120.98
Rate for Payer: Cash Price	$1,413.00
Rate for Payer: UnitedHealthcare Commercial	$1,047.19
Rate for Payer: UnitedHealthcare Medicare Advantage	$565.20

PHENYLALANINE

Facility

$317.00

Service Code	CPT 83921
Hospital Charge Code	2282132
Hospital Revenue Code	301
Min. Negotiated Rate	$19.09
Max. Negotiated Rate	$226.34
Rate for Payer: Aetna Better Health Medicaid/QHP	$19.09
Rate for Payer: Aetna Medicare Advantage	$21.21
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$187.66
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$226.34
Rate for Payer: Cash Price	$285.30
Rate for Payer: Cash Price	$285.30
Rate for Payer: Cash Price	$285.30
Rate for Payer: Cigna Commercial HMO & PPO	$21.21
Rate for Payer: Healthy Blue CHP/Medicaid Managed Care	$19.09
Rate for Payer: Home State Health Plan Medicaid Managed Care	$20.43
Rate for Payer: Home State Health Plan Medicare Advantage	$21.21
Rate for Payer: Humana Commercial	$42.42
Rate for Payer: Humana Medicare Advantage	$21.21
Rate for Payer: UnitedHealthcare Commercial	$21.00
Rate for Payer: UnitedHealthcare Medicaid Managed Care	$19.09
Rate for Payer: UnitedHealthcare Medicare Advantage	$114.12

PHENYLALANINE

Facility

$317.00

Service Code	CPT 83921
Hospital Charge Code	2282132
Hospital Revenue Code	301
Rate for Payer: Cash Price	$285.30

PHENYLEPHRINE 0.25% (MILD)15ML NASPRY

Facility

$91.00

Service Code	NDC 24134803
Hospital Charge Code	2658097
Hospital Revenue Code	250
Rate for Payer: Cash Price	$81.90

PHENYLEPHRINE 0.25% (MILD)15ML NASPRY

Facility

$91.00

Service Code	NDC 24134803
Hospital Charge Code	2658097
Hospital Revenue Code	250
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

PHENYLEPHRINE 0.5% (REG) 15ML NA SPRY

Facility

$91.00

Service Code	NDC 225080547
Hospital Charge Code	2697085
Hospital Revenue Code	250
Rate for Payer: Cash Price	$81.90

PHENYLEPHRINE 0.5% (REG) 15ML NA SPRY

Facility

$91.00

Service Code	NDC 225080547
Hospital Charge Code	2697085
Hospital Revenue Code	250
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

PHENYLEPHRINE 1% 10MG INJ 1ML

Facility

$93.00

Service Code	HCPCS J2370
Hospital Charge Code	2626542
Hospital Revenue Code	250
Rate for Payer: Cash Price	$83.70

PHENYLEPHRINE 1% 10MG INJ 1ML

Facility

$93.00

Service Code	HCPCS J2370
Hospital Charge Code	2626542
Hospital Revenue Code	250
Min. Negotiated Rate	$33.48
Max. Negotiated Rate	$66.40
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$55.06
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$66.40
Rate for Payer: Cash Price	$83.70
Rate for Payer: UnitedHealthcare Commercial	$62.03
Rate for Payer: UnitedHealthcare Medicare Advantage	$33.48

PHENYLEPHRINE INJ

Facility

$91.00

Service Code	HCPCS J2370
Hospital Charge Code	2058036
Hospital Revenue Code	370
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

PHENYLEPHRINE INJ

Facility

$91.00

Service Code	HCPCS J2370
Hospital Charge Code	2058036
Hospital Revenue Code	370
Rate for Payer: Cash Price	$81.90

PHENYTOIN 125MG/5ML SUSP 237ML

Facility

$184.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2655881
Hospital Revenue Code	250
Rate for Payer: Cash Price	$165.60

PHENYTOIN 125MG/5ML SUSP 237ML

Facility

$184.00

Service Code	NDC 5.1672E+10
Hospital Charge Code	2655881
Hospital Revenue Code	250
Min. Negotiated Rate	$66.24
Max. Negotiated Rate	$131.38
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Blue Access/Blue Preferred and Pathway/Pathway X	$108.93
Rate for Payer: Anthem Blue Cross Blue Shield Missouri Traditional	$131.38
Rate for Payer: Cash Price	$165.60
Rate for Payer: UnitedHealthcare Commercial	$122.73
Rate for Payer: UnitedHealthcare Medicare Advantage	$66.24

Know your out-of-pocket cost for care.

All Charges