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  5. /Percent of billed charges

NDC 9999911141

MOMETASONE-FORMOTEROL HFA 200 MCG-5 MCG/ACTUATION AEROSOL BULK INHALER

Reported by 20 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

$158

Average

$207

Median

$209

High

$275

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$164$178$70—$81$302
2Catholic Health Initiatives ColoradoSalt Lake City, UT$186$211$62—$123$343
3Catholic Health Initiatives ColoradoColorado Springs, CO$171$198$69—$93$302
4Catholic Health Initiatives ColoradoLehi, UT$185$210$62—$123$343
5St Francis HospitalColorado Springs, CO$156$167$62—$81$291
6Longmont United HospitalLongmont, CO$137$168$73—$81$308
7Catholic Health Initiatives ColoradoFrisco, CO$206$226$73—$93$315
8Commonspirit Kansas, Inc.Ulysses, KS$286$239$91—$110$325
9Commonspirit Kansas, Inc.Dodge City, KS$274$263$48—$120$308
10Catholic Health Initiatives ColoradoPueblo, CO$199$202$69—$95$302
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Look up this code directly

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