NDC 517100101
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
$17
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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. 24 hospitals; the 90th percentile is 122.5× 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 | $9 | $9 | — | — | 25 | $9 – $9 |
| 2 | Sanford Fargo Medical Center Fargo, ND | $1 | $1 | — | — | — | $1 – $19 |
| 3 | Sanford USD Medical Center Sioux Falls, SD | $1 | $1 | — | — | — | $1 – $178 |
| 4 | City of Hope National Medical Center Duarte, CA | $0 | $3 | $7 | 197% | — | $0 – $109 |
| 5 | Western Regional Medical Center, Inc. Goodyear, AZ | $0 | $0 | $0 | 55% | — | $0 – $14 |
| 6 | Southeastern Regional Medical Center, Inc. Newnan, GA | $0 | $0 | $0 | 40% | — | $0 – $25 |
| 7 | The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA | $0 | $6 | $18 | 310% | — | $0 – $62 |
| 8 | Pennsylvania Hospital of the University of Pennsylvania Health System Philadelphia, PA | $0 | $4 | $15 | 375% | — | $0 – $62 |
| 9 | Lancaster General Health Lancaster, PA | $0 | $5 | $11 | 238% | — | $0 – $13.5k |
| 10 | Presbyterian Medical Center of the University of Pennsylvania Health System D/B/A Penn Presbyterian Medical Center Philadelphia, PA | $0 | $5 | $15 | 318% | — | $0 – $62 |
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