NDC 00904-6312-56
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
DEXTROMETHORPHAN POLISTIREX ER 30 MG/5ML PO SUER
Reported by 1 hospital in the network under the other methodology.
Low
$7
Average
$7
Median
$7
High
$7
Filter by billing methodology
Reflects a payer-specific billing methodology not covered by the standard categories.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | Norton Hospitals INC Louisville, KY | $7 | $7 | — | — | 2–20 | $1 – $16 |
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