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NDC 55390025101

55390-0251-01 - mitomycin 5. mg REC Injection

Reported by 38 hospitals in the network under the fee schedule 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 negotiated fee schedule rates with commercial payers.

National pricing summary

Low

$25

Average

$40

Median

$33

High

$259

Hospitals reporting this code

#HospitalLocation
1Dukes Health System LLCPeru, IN$178$193$259$962$103
2Northwest Sahurita Hospital LLCAZ 85748, AZ$26$26$29$50$7
3Northwest Sahurita Hospital LLCAZ 85629, AZ$26$26$30$50$7
4Oro Valley Hospital LLCTucson, AZ$26$26$31$60$10
5Northwest Hospital LLCAZ 85741, AZ$26$26$31$60$10
6Metro Knoxville HMA LLCKnoxville, TN$22$27$57$361$66
7Metro Knoxville HMA LLCPowell, TN$22$27$56$509$65
8Triad of Alabama LLCAL 36305, AL$20$26$29$1.3k$13
9Gadsden Regional Medical Center LLCGadsden, AL$20$26$25$905$2
10Laredo Texas Hospital Company LPLaredo, TX$26$44$44$826$20
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