NDC 00004-6912-06
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
UNCLASSIFIED DRUGS
Reported by 2 hospitals in the network under the other methodology.
Low
$123
Average
$205
Median
$205
High
$287
Filter by billing methodology
Reflects a payer-specific billing methodology not covered by the standard categories.
| # | Hospital | Location | Approximate number of payer billing records behind this hospital’s price. CMS privacy rules cap small counts as a range (e.g. “1–10”) rather than an exact number — more samples means a more reliable price. | |||||
|---|---|---|---|---|---|---|---|---|
| 1 | Glendale Adventist Medical Center | Glendale, CA | $288 | $287 | $100 | — | $86 | $719 |
| 2 | White Memorial Medical Center | Angeles, CA | $123 | $123 | $32 | — | $24 | $353 |
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