NDC 57896-0489-14
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
57896-0489-14 - polyethylene glycol 3350 238 gm Gr
Reported by 17 hospitals in the network under the other methodology.
Based on 2–20 billing samples across every hospital reporting.
Low
$0
Average
$24
Median
$14
High
$98
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. 17 hospitals; the 90th percentile is 5140.4× 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 | 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 | $7 | $7 | — | 2–20 | $1 | $16 |
| 2 | Bluffton Health System LLC | Bluffton, IN | $5 | $5 | — | — | $5 | $18 |
| 3 | Dukes Health System LLC | Peru, IN | $15 | $14 | $3 | — | $9 | $46 |
| 4 | St. Joseph Health System, LLC | Wayne, IN | $50 | $50 | — | — | $12 | $50 |
| 5 | Naples HMA LLC | Naples, FL | $44 | $41 | $10 | — | $8 | $44 |
| 6 | Naples HMA LLC | Naples, FL | $44 | $39 | $10 | — | $8 | $44 |
| 7 | Naples HMA LLC | Naples, FL | $44 | $41 | $10 | — | $8 | $44 |
| 8 | Metro Knoxville HMA LLC | Powell, TN | $28 | $28 | — | — | $13 | $65 |
| 9 | Triad of Alabama LLC | Dothan, AL | $54 | $54 | — | — | $54 | $54 |
| 10 | Affinity Hospital LLC | Birmingham, AL | $98 | $98 | $25 | — | $18 | $123 |
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