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NDC 0085461005

MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL INHALER

Reported by 20 hospitals in the network.

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.

National pricing summary

Low

$97

Average

$128

Median

$128

High

$169

Hospitals reporting this code

#HospitalLocation
1Catholic Health Initiatives ColoradoColorado Springs, CO$50$101$109$185$43
2Catholic Health Initiatives ColoradoSalt Lake City, UT$75$114$130$211$38
3Catholic Health Initiatives ColoradoColorado Springs, CO$57$105$122$185$42
4Catholic Health Initiatives ColoradoLehi, UT$75$114$129$211$38
5St Francis HospitalColorado Springs, CO$50$96$103$179$38
6Longmont United HospitalLongmont, CO$50$84$103$190$45
7Catholic Health Initiatives ColoradoFrisco, CO$57$126$139$194$45
8Commonspirit Kansas, Inc.Ulysses, KS$67$176$147$200$56
9Commonspirit Kansas, Inc.Dodge City, KS$74$169$162$190$29
10Catholic Health Initiatives ColoradoPueblo, CO$58$122$124$185$43
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