NDC 67457-0790-05
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
67457-0790-05 - levETIRAcetam 100 mg/mL Soln
Reported by 37 hospitals in the network under the other methodology.
Based on 6–60 billing samples across every hospital reporting.
Low
$0
Average
$25
Median
$10
High
$265
Filter by billing methodology
Reflects a payer-specific billing methodology not covered by the standard categories.
Showing only prices reported under the other methodology. Choose another in the filter above to change the chart. 37 hospitals; the 90th percentile is 322.0× 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 | Location | Approximate number of payer billing records behind this hospital’s price. CMS privacy rules cap small counts as a range (e.g. “1–10”) rather than an exact number — more samples means a more reliable price. | |||||
|---|---|---|---|---|---|---|---|---|
| 1 | Norton Hospitals INC | Louisville, KY | $9 | $9 | — | 2–20 | $0 | $49 |
| 2 | Norton Hospitals INC | Louisville, KY | $40 | $40 | — | 2–20 | $0 | $49 |
| 3 | Norton Hospitals INC | Louisville, KY | $40 | $40 | — | 2–20 | $0 | $49 |
| 4 | Bluffton Health System LLC | Bluffton, IN | $15 | $15 | — | — | $14 | $51 |
| 5 | Dukes Health System LLC | Peru, IN | $51 | $50 | $9 | — | $30 | $160 |
| 6 | St. Joseph Health System, LLC | Wayne, IN | $178 | $178 | — | — | $43 | $178 |
| 7 | Natchez Hospital Company LLC | Natchez, MS | $13 | $13 | $12 | — | $0 | $32 |
| 8 | Naples HMA LLC | Naples, FL | $0 | $0 | $0 | — | $0 | $0 |
| 9 | Naples HMA LLC | Naples, FL | $0 | $0 | $0 | — | $0 | $0 |
| 10 | Naples HMA LLC | Naples, FL | $0 | $0 | $0 | — | $0 | $0 |
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