Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Pharmacy
Low
$201
Average
$396
Median
$409
High
$685
Each hospital's average Molina rate, under the methodology and billing class chosen below.
6 hospitals; the 90th percentile is 2.9× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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6 hospital rates
iThe hospitals that file a Molina rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Gottlieb Memorial Hospital Melrose Park, IL facility · case rate · outpatient | 1 | $473 | $473 | — | — | — | $473 – $473 |
| 2 | Gundersen Luthern Medical Center Inc La Crosse, WI facility · fee schedule · outpatient | 1 | $201 | $201 | — | — | — | $201 – $201 |
| 3 | Gundersen Palmer Lutheran Hospital and Clinic Inc West Union, IA facility · fee schedule · outpatient | 1 | $201 | $201 | — | — | — | $201 – $201 |
| 4 | Loyola University Medical Center Maywood, IL facility · case rate · outpatient | 1 | $685 | $685 | — | — | — | $685 – $685 |
| 5 | MacNeal Hospital Berwyn, IL facility · case rate · outpatient | 1 | $473 | $473 | — | — | — | $473 – $473 |
| 6 | University of Florida Health Gainesville, FL facility · case rate · outpatient | 1 | $345 | $345 | — | — | — | $345 – $345 |
← Payers reporting HCPCS C9034 · Snapshot 20261112T181611Z-3fa9fb76