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NDC 0085720601

MOMETASONE-FORMOTEROL HFA 100 MCG-5 MCG/ACTUATION AEROSOL BULK 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

$144

Average

$188

Median

$190

High

$250

Hospitals reporting this code

#HospitalLocation
1Catholic Health Initiatives ColoradoColorado Springs, CO$73$149$162$274$64
2Catholic Health Initiatives ColoradoSalt Lake City, UT$111$169$192$311$56
3Catholic Health Initiatives ColoradoColorado Springs, CO$84$156$180$274$62
4Catholic Health Initiatives ColoradoLehi, UT$111$168$190$311$56
5St Francis HospitalColorado Springs, CO$73$142$152$265$56
6Longmont United HospitalLongmont, CO$73$125$153$280$66
7Catholic Health Initiatives ColoradoFrisco, CO$84$187$205$286$66
8Commonspirit Kansas, Inc.Ulysses, KS$100$260$218$296$83
9Commonspirit Kansas, Inc.Dodge City, KS$109$249$239$280$43
10Catholic Health Initiatives ColoradoPueblo, CO$86$181$183$274$63
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