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NDC 58657045401

58657-0454-01 - hyoscyamine/methenam/m-blue/sodium

Reported by 9 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

Based on 6–60 billing samples across every hospital reporting.

Low

$1

Average

$16

Median

$13

High

$68

Hospitals reporting this code

#HospitalLocationApproximate number of payer billing records behind this hospital’s price. CMS privacy rules cap small counts as a range (e.g. “1–10”) rather than an exact number — more samples means a more reliable price.
1The Charlotte Mecklenburg Hospital AuthorityConcord, NC$1$1—2–20$127$983
2Atrium Health Hospitals IncShelby, NC$2$2—2–20$145$983
3Carolinas Medical CenterCharlotte, NC$16$16—1–10$226$931
4The Charlotte Mecklenburg Hospital AuthorityCharlotte, NC$1$1—1–10$103$1.0k
5St. Joseph Health System, LLCWayne, IN$68$68——$16$68
6Natchez Hospital Company LLCNatchez, MS$19$17$7—$1$22
7Wesley Health System LLCHattiesburg, MS$19$19$3—$2$22
8Metro Knoxville HMA LLCPowell, TN$13$13——$6$29
9Triad of Alabama LLCDothan, AL$5$5——$5$5

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