NDC 70954-0258-10

SULFAMETHOXAZOLE 200 MG-TRIMETHOPRIM 40 MG/5 ML ORAL SUSPENSION

Reported by 9 hospitals in the network under the fee schedule methodology.

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Reflects negotiated fee schedule rates with commercial payers.

National pricing summary

Low

Average

$79

Median

$92

High

$147

#	Hospital	Location
1	Alegent Creighton Health	Omaha, NE	$94	$91	$35	—	$25	$133
2	Alegent Creighton Health	Papillion, NE	$94	$92	$34	—	$28	$133
3	Alegent Health Bergan Mercy Health System	Omaha, NE	$114	$95	$37	—	$27	$133
4	Alegent Health Immanuel Medical Center	Omaha, NE	$94	$92	$34	—	$22	$133
5	Alegent Health - Mercy Hospital, Corning Iowa	Corning, IA	$151	$147	$39	—	$68	$349
6	Alegent Health Bergan Mercy Health System	Council Bluffs, IA	$94	$94	$31	—	$24	$133
7	Alegent Health Bergan Mercy Health System	Omaha, NE	$94	$92	$34	—	$27	$133
8	Nebraska Medical Center	Omaha, NE	$2	$2	$0	—	$0	$4
9	Bellevue Medical Center Llc	Bellevue, NE	$2	$2	$0	—	$0	$4

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