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NDC 64980017750

64980-0177-50 - chloroquine 250 mg Tab

Reported by 38 hospitals in the network under the percent of billed charges 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 negotiated percentage of total billed charges.

National pricing summary

Low

$3

Average

$11

Median

$4

High

$59

Hospitals reporting this code

#HospitalLocation
1IOM Health System LPFort Wayne, IN$9$17$19$32$7
2Bluffton Health System LLCBluffton, IN$21$55$55$80$18
3Dukes Health System LLCPeru, IN$15$43$47$78$14
4Warsaw Health System LLCWarsaw, IN$21$59$59$95$20
5Lutheran Musculoskeletal Center LLCFort Wayne, IN$21$44$47$89$17
6St. Joseph Health System, LLCIN 46802, IN$10$23$26$42$10
7Dupont Hospital LLCIN 46825, IN$6$12$13$21$5
8Sanford Medical Center BismarckBismarck, ND$2$5$5$6$1
9Saint Joseph Hospital, Inc. Dba Intermountain Nhealth Saint Joseph HospitalDENVER, CO$8$26$26$46$11
10Baylor Scott & White Medical Center - TempleTemple, TX$1$4$4$6$1
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