NDC 409233924
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
$0
Average
$3
Median
$0
High
$29
Filter by billing methodology
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. 28 hospitals; the 90th percentile is 57.0× 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 | $0 | $0 | — | — | 1–10 | $0 – $0 |
| 2 | Victoria of Texas LP Victoria, TX | $3 | $4 | $2 | 53% | — | $3 – $41 |
| 3 | Victoria of Texas LP Victoria, TX | $3 | $4 | $2 | 53% | — | $3 – $41 |
| 4 | Piney Woods Healthcare System LP Lufkin, TX | $2 | $2 | $0 | 15% | — | $1 – $13 |
| 5 | Sanford USD Medical Center Sioux Falls, SD | $0 | $0 | — | — | — | $0 – $355 |
| 6 | Hmh Hospitals Corporation Brick, NJ | $0 | $0 | — | — | — | $0 – $0 |
| 7 | City of Hope National Medical Center Duarte, CA | $0 | $1 | $1 | 103% | — | $0 – $133 |
| 8 | Southeastern Regional Medical Center, Inc. Newnan, GA | $0 | $1 | $0 | 42% | — | $0 – $14 |
| 9 | The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA | $0 | $3 | $9 | 280% | — | $0 – $33 |
| 10 | Pennsylvania Hospital of the University of Pennsylvania Health System Philadelphia, PA | $0 | $2 | $8 | 321% | — | $0 – $33 |
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