NDC 25021-0207-51
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)
Low
$2
Average
$63
Median
$5
High
$1.5k
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Reflects negotiated fee schedule rates with commercial payers.
Showing only prices reported under the fee schedule methodology. Choose another in the filter above to change the chart. 150 hospitals; the 90th percentile is 28.1× 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 | $11 | $11 | — | — | 1–10 | $11 – $11 |
| 2 | Central Iowa Hospital Corporation Des Moines, IA | $3 | $3 | — | — | — | $3 – $76 |
| 3 | Central Iowa Hospital Corporation Des Moines, IA | $3 | $3 | — | — | — | $3 – $76 |
| 4 | Allen Memorial Hospital Corporation Waterloo, IA | $3 | $3 | — | — | — | $1 – $46 |
| 5 | IOM Health System LP Fort Wayne, IN | $7 | $7 | $0 | 3% | — | $5 – $17 |
| 6 | Lutheran Musculoskeletal Center LLC Fort Wayne, IN | $7 | $7 | — | — | — | $3 – $31 |
| 7 | St. Joseph Health System, LLC Wayne, IN | $7 | $7 | $0 | 1% | — | $7 – $34 |
| 8 | Dupont Hospital LLC Wayne, IN | $8 | $8 | — | — | — | $8 – $28 |
| 9 | Poplar Bluff Regional Medical Center LLC Poplar Bluff, MO | $3 | $11 | $15 | 130% | — | $3 – $100 |
| 10 | Mercy Health Services-Iowa Corp. Mason City, IA | $60 | $60 | — | — | — | $60 – $612 |
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