NDC 69023801
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
$13
Average
$158
Median
$65
High
$1.5k
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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. 79 hospitals; the 90th percentile is 23.9× 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 | $22 | $22 | — | — | 30 | $22 – $22 |
| 2 | Victoria of Texas LP Victoria, TX | $27 | $36 | $31 | 86% | — | $13 – $709 |
| 3 | Victoria of Texas LP Victoria, TX | $27 | $36 | $31 | 86% | — | $13 – $709 |
| 4 | Triad of Alabama LLC Dothan, AL | $13 | $72 | $240 | 334% | — | $13 – $1.1k |
| 5 | Affinity Hospital LLC Birmingham, AL | $13 | $16 | $6 | 36% | — | $13 – $293 |
| 6 | Crestview Hospital Corporation Crestview, FL | $33 | $568 | $577 | 102% | — | $13 – $3.9k |
| 7 | Laredo Texas Hospital Company LP Laredo, TX | $19 | $20 | $8 | 42% | — | $13 – $358 |
| 8 | Las Cruces Medical Center LLC Las Cruces, NM | $14 | $16 | $4 | 27% | — | $13 – $27 |
| 9 | Sanford Fargo Medical Center Fargo, ND | $26 | $25 | $2 | 7% | — | $22 – $1.0k |
| 10 | Sanford Medical Center Bismarck Bismarck, ND | $26 | $26 | — | — | — | $26 – $953 |
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