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NDC 55390025101

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

Reported by 13 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

$39

Average

$315

Median

$223

High

$1.4k

Hospitals reporting this code

#HospitalLocation
1Bluffton Health System LLCBluffton, IN$160$174$174$602—
2Dukes Health System LLCPeru, IN$178$308$302$962$54
3St. Joseph Health System, LLCIN 46802, IN$328$1.4k$1.4k$1.4k—
4Northwest Sahurita Hospital LLCAZ 85748, AZ$16$17$42$236$43
5Northwest Sahurita Hospital LLCAZ 85629, AZ$16$17$42$236$43
6Oro Valley Hospital LLCTucson, AZ$16$17$40$353$40
7Northwest Hospital LLCAZ 85741, AZ$16$17$39$353$38
8Metro Knoxville HMA LLCKnoxville, TN$22$223$223$361—
9Metro Knoxville HMA LLCPowell, TN$22$223$223$509—
10Triad of Alabama LLCAL 36305, AL$20$273$273$1.3k$253
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