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NDC 9999910469

MOMETASONE-FORMOTEROL HFA 100 MCG-5 MCG/ACTUATION AEROSOL BULK INHALER

Reported by 20 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

Low

$97

Average

$128

Median

$128

High

$169

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.
1Catholic Health Initiatives ColoradoColorado Springs, CO$101$109$43—$50$185
2Catholic Health Initiatives ColoradoSalt Lake City, UT$114$130$38—$75$211
3Catholic Health Initiatives ColoradoColorado Springs, CO$105$122$42—$57$185
4Catholic Health Initiatives ColoradoLehi, UT$114$129$38—$75$211
5St Francis HospitalColorado Springs, CO$96$103$38—$50$179
6Longmont United HospitalLongmont, CO$84$103$45—$50$190
7Catholic Health Initiatives ColoradoFrisco, CO$126$139$45—$57$194
8Commonspirit Kansas, Inc.Ulysses, KS$176$147$56—$67$200
9Commonspirit Kansas, Inc.Dodge City, KS$169$162$29—$74$190
10Catholic Health Initiatives ColoradoPueblo, CO$122$124$43—$58$185
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