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  4. /NDC 13925052201

NDC 13925052201

PENTAMIDINE ISETHIONATE 300 MG IN SOLR at Allen Memorial Hospital Corporation

Waterloo, IA

Pricing by billing methodology

Price type

All methodologies

$80

Aggregated across all available billing methodologies for this code.

Case rate

Not reported

Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.

Fee schedule

$80

Reflects negotiated fee schedule rates with commercial payers.

Per diem

Not reported

Reflects a negotiated per diem rate paid per day of care.

Percent of billed charges

$52

Reflects a negotiated percentage of total billed charges.

Other

—

Reflects a payer-specific billing methodology not covered by the standard categories.

Last updated: Jan 28, 2026

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