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NDC 74300001067

74300-0010-67 - glycerin/hypromellose/peg 400 Soln

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

Low

$3

Average

$19

Median

$7

High

$64

Hospitals reporting this code

#HospitalLocation
1St. Joseph Health System, LLCIN 46802, IN$9$64$64$90$26
2Wesley Health System LLCHattiesburg, MS$5$40$40$46$6
3Naples HMA LLCFL 34114, FL$3$16$14$16$4
4Metro Knoxville HMA LLCKnoxville, TN$2$4$4$6—
5Metro Knoxville HMA LLCPowell, TN$2$4$4$9—
6Affinity Hospital LLCBirmingham, AL$5$26$26$32$6
7Laredo Texas Hospital Company LPLaredo, TX$1$6$6$108$5
8La Porte Hospital Company LLCLa Porte, IN$3$3$3$10—
9Knox Hospital Company LLCKnox, IN$7$7$7$24—

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