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NDC 0085720607

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

Reported by 20 hospitals in the network under the percent of billed charges 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 percentage 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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