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NDC 904517416

00904-5174-16 - diphenhydrAMINE 12.5 mg/5 mL Liqui

Reported by 8 hospitals in the network.

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.

National pricing summary

Based on 5,999,999,998–6,000,000,034 billing samples across every hospital reporting.

Low

$1

Average

$3571.4k

Median

$2

High

$28571.4k

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.
1St. Joseph Health System, LLCWayne, IN$2$28571.4k$166598.6k5,999,999,994$1$4
2Oro Valley Hospital LLCTucson, AZ$2$3$22–20$1$6
3Laredo Texas Hospital Company LPLaredo, TX$2$2$22–20$0$4
4IOM Health System LPFort Wayne, IN$1$2$1—$1$3
5Lutheran Musculoskeletal Center LLCFort Wayne, IN$1$1$0—$0$2
6Northwest Hospital LLCTucson, AZ$2$2$2—$1$6
7Metro Knoxville HMA LLCPowell, TN$4$4$2—$1$7
8Poplar Bluff Regional Medical Center LLCPoplar Bluff, MO$1$1$0—$0$1

Look up this code directly

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