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NDC 68094010120

phentolamine 5 mg Powder-Inj at Jefferson County HMA LLC

Jefferson City, TN

Pricing by billing methodology

Price type

All methodologies

$427

Aggregated across all available billing methodologies for this code.

Case rate

$159

Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.

Fee schedule

$427

Reflects negotiated fee schedule rates with commercial payers.

Per diem

$421

Reflects a negotiated per diem rate paid per day of care.

Percent of billed charges

$981

Reflects a negotiated percentage of total billed charges.

Other

Not reported

Reflects a payer-specific billing methodology not covered by the standard categories.

Last updated: Apr 1, 2026

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