NDC 59353-0404-09
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
$1
Average
$215
Median
$2
High
$6.1k
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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. 36 hospitals; the 90th percentile is 95.5× 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.
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| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | St. Peter's Health Helena, MT | $3 | $3 | — | — | 150 | $3 – $3 |
| 2 | University of Iowa Health Care Medical Center Downtown Iowa City, IA | $2 | $2 | $1 | 44% | — | $1 – $1.4k |
| 3 | University of Iowa Health Care Medical Center Iowa City, IA | $2 | $2 | $1 | 44% | — | $1 – $1.4k |
| 4 | Sanford Fargo Medical Center Fargo, ND | $2 | $2 | $0 | 3% | — | $1 – $1.2k |
| 5 | Sanford Medical Center Bismarck Bismarck, ND | $2 | $2 | — | — | — | $1 – $870 |
| 6 | Sanford USD Medical Center Sioux Falls, SD | $2 | $2 | $0 | 3% | — | $1 – $1.3k |
| 7 | Sanford Worthington Medical Center Worthington, MN | $2 | $2 | — | — | — | $1 – $784 |
| 8 | Brfhh Monroe, Llc Monroe, LA | $1 | $2 | $1 | 35% | — | $1 – $1.2k |
| 9 | Fairview Health Services Minneapolis, MN | $1 | $2 | $1 | 49% | — | $1 – $12 |
| 10 | Fairview Health Services Edina, MN | $1 | $2 | $1 | 50% | — | $1 – $12 |
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