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APC 9261

Ustekinumab sub cu inj, 1 mg

Reported by 4 hospitals in the network under the case rate methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

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

National pricing summary

Low

$163

Average

$213

Median

$225

High

$239

Hospitals reporting this code

#HospitalLocation
1Palmdale Regional Medical CenterPalmdale, CA—$160$163—$14
2Sanford Fargo Medical CenterFargo, ND$196$227$228$263$24
3Sanford Medical Center BismarckBismarck, ND$220$239$239$259$19
4Sanford USD Medical CenterSioux Falls, SD$191$221$222$256$23

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