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  4. /NDC 50242004164

NDC 50242004164

alteplase 2 mg Powder-Inj at Northwest Sahurita Hospital LLC

Sahuarita, AZ

Pricing by billing methodology

Price type

All methodologies

$94

Aggregated across all available billing methodologies for this code.

Case rate

$77

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

Fee schedule

$94

Reflects negotiated fee schedule rates with commercial payers.

Per diem

$95

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

Percent of billed charges

$65

Reflects a negotiated percentage of total billed charges.

Other

$75

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

Last updated: Apr 1, 2026

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