NDC 143968201
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 - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A)
Based on 54–153 billing samples across every hospital reporting.
Low
$4
Average
$620
Median
$23
High
$5.0k
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Showing prices across every billing methodology. Pick one in the filter above to narrow the chart. 43 hospitals; the 90th percentile is 585.2× 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 | ||||||
|---|---|---|---|---|---|---|---|
| 1 | St. Peter's Health Helena, MT | $5 | $4 | $2 | 49% | 31–49 | $1 – $5 |
| 2 | Sanford Fargo Medical Center Fargo, ND | $10 | $9 | $8 | 86% | 14 | $0 – $19 |
| 3 | Pekin Memorial Hospital Pekin, IL | $16 | $18 | $10 | 60% | 2–20 | $1 – $36 |
| 4 | Methodist Medical Center of Illinois Peoria, IL | $20 | $18 | $10 | 58% | 2–20 | $1 – $36 |
| 5 | Proctor Community Hospital Peoria, IL | $21 | $21 | $10 | 46% | 2–20 | $1 – $36 |
| 6 | Sanford Chamberlain Medical Center Chamberlain, SD | $58 | $54 | $15 | 29% | 1–10 | $27 – $70 |
| 7 | Sanford Vermillion Hospital Vermillion, SD | $55 | $51 | $18 | 35% | 1–10 | $23 – $71 |
| 8 | Boulder Community Health Boulder, CO | $68 | $60 | $28 | 48% | 1–10 | $1 – $94 |
| 9 | IOM Health System LP Fort Wayne, IN | $91 | $102 | $37 | 37% | — | $47 – $170 |
| 10 | Lutheran Musculoskeletal Center LLC Fort Wayne, IN | $86 | $93 | $33 | 35% | — | $42 – $176 |
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