NDC 64281-0100-00
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
$57
Median
$3
High
$433
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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. 128 hospitals; the 90th percentile is 148.4× 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 | $5 | — | — | 100 | $5 – $5 |
| 2 | Columbus Regional Hospital Columbus, IN | $303 | $338 | $49 | 15% | 2–20 | $303 – $408 |
| 3 | Sanford Fargo Medical Center Fargo, ND | $1 | $1 | — | — | — | $1 – $176 |
| 4 | Sanford USD Medical Center Sioux Falls, SD | $1 | $1 | — | — | — | $1 – $57 |
| 5 | Dignity Community Care Woodland, CA | $82 | $74 | $75 | 101% | — | $1 – $200 |
| 6 | Dignity Health Sacramento, CA | $3 | $49 | $69 | 141% | — | $1 – $160 |
| 7 | Saint Marys Hospital Waterbury, CT | $215 | $240 | $35 | 15% | — | $126 – $294 |
| 8 | The Mercy Hospital Inc Springfield, MA | $190 | $201 | $52 | 26% | — | $74 – $392 |
| 9 | Saint Francis Hospital and Medical Center Hartford, CT | $242 | $218 | $38 | 18% | — | $113 – $242 |
| 10 | Saint Alphonsus Medical Center - Nampa Nampa, ID | $197 | $200 | $51 | 25% | — | $137 – $442 |
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