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  3. /The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania
  4. /NDC 65628005004

NDC 65628005004

FIRST MOUTHWASH BLM MOUTH THROAT SUSP MAGIC MOUTH at The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania

Philadelphia, PA

Pricing by billing methodology

Price type

All methodologies

$211

Aggregated across all available billing methodologies for this code.

Case rate

$325

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

Fee schedule

$325

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

$190

Reflects a negotiated percentage of total billed charges.

Other

$325

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

Last updated: Feb 10, 2026

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