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NDC 39822016605

39822-0166-05 - polymyxin B sulfate 500000. unit(s

Reported by 15 hospitals in the network under the other 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 payer-specific billing methodology not covered by the standard categories.

National pricing summary

Low

$15

Average

$106

Median

$33

High

$440

Hospitals reporting this code

#HospitalLocation
1Bluffton Health System LLCBluffton, IN$19$20$20$71—
2Dukes Health System LLCPeru, IN$30$51$50$160$9
3St. Joseph Health System, LLCIN 46802, IN$43$178$178$178—
4Northwest Sahurita Hospital LLCAZ 85748, AZ$7$16$15$52$0
5Northwest Sahurita Hospital LLCAZ 85629, AZ$7$16$15$52$0
6Oro Valley Hospital LLCTucson, AZ$8$16$19$52$6
7Northwest Hospital LLCAZ 85741, AZ$8$16$19$52$6
8Metro Knoxville HMA LLCKnoxville, TN$14$33$33$53—
9Metro Knoxville HMA LLCPowell, TN$14$33$33$75—
10Triad of Alabama LLCAL 36305, AL$440$440$440$440—
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