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  4. /NDC 13925052201

NDC 13925052201

PENTAMIDINE ISETHIONATE 300 MG IN SOLR at Fairview Health Services

Wyoming, MN

Pricing by billing methodology

Price type

All methodologies

$326

166–418 samples

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

$109

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

$428

80–179 samples

Reflects a negotiated percentage of total billed charges.

Other

$39

86–239 samples

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

Last updated: Feb 5, 2026

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