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  4. /NDC 0113017060

NDC 0113017060

NICOTINE (POLACRILEX) 4 MG GUM at Commonspirit Kansas, Inc.

Dodge City, KS

Pricing by billing methodology

Price type

All methodologies

$5

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

Not reported

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

$5

Reflects a negotiated percentage of total billed charges.

Other

—

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

Last updated: Feb 5, 2026

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