NDC 00517-8575-10
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 5 hospitals in the network under the other methodology.
Low
$106
Average
$202
Median
$119
High
$433
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Reflects a payer-specific billing methodology not covered by the standard categories.
Showing only prices reported under the other methodology. Choose another in the filter above to change the chart. 5 hospitals; the 90th percentile is 3.2× 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.
Click a bar to filter the hospitals table to that price range.
| # | 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 | Sierra Vista Hospital Inc | Obispo, CA | $433 | $433 | — | — | $113 | $433 |
| 2 | White Memorial Medical Center | Angeles, CA | $231 | $231 | $60 | — | $44 | $666 |
| 3 | Allina Health Systems | Buffalo, MN | $122 | $119 | $51 | — | $0 | $238 |
| 4 | Allina Health Systems | Faribualt, MN | $122 | $119 | $51 | — | $0 | $238 |
| 5 | Allina Health Systems | River Falls, WI | $106 | $106 | $12 | — | $48 | $238 |
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