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NDC 53276105003

ULTRAFOAM 8 CM X 6.25 CM X 1 CM SPONGE

Reported by 14 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

$63

Average

$72

Median

$73

High

$77

Hospitals reporting this code

#HospitalLocation
1Cleveland Clinic Weston Hospital Nonprofit CorporationWeston, FL$22$62$67$132$32
2The Union Hospital AssociationDover, OH$29$69$76$132$27
3Akron General Medical CenterAkron, OH$20$70$71$132$29
4Cleveland Clinic Mercy HospitalCanton, OH$29$66$72$132$27
5Martin Memorial Medical Center IncStuart, FL$27$50$63$132$30
6Lutheran HospitalCleveland, OH$22$73$74$132$28
7Marymount Hospital IncGarfield Heights, OH$22$73$74$132$28
8Fairview HospitalCleveland, OH$21$73$73$132$29
9Cleveland Clinic Health System - East RegionEuclid, OH$22$73$75$132$27
10Medina HospitalMedina, OH$19$69$70$132$29
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