NDC 904602561
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
00904-6025-61 - polyethylene glycol 3350 REC Powde
Reported by 33 hospitals in the network.
Based on 465–528 billing samples across every hospital reporting.
Low
$1
Average
$8
Median
$3
High
$64
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Showing prices across every billing methodology. Pick one in the filter above to narrow the chart. 33 hospitals; the 90th percentile is 19.6× 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 | Tri-City Medical Center | Oceanside, CA | $8 | $10 | $5 | 460–478 | $3 | $18 |
| 2 | Naples HMA LLC | Naples, FL | $1 | $1 | $0 | 1–10 | $0 | $2 |
| 3 | Naples HMA LLC | Naples, FL | $1 | $1 | $0 | 1–10 | $0 | $2 |
| 4 | Naples HMA LLC | Naples, FL | $1 | $1 | $0 | 1–10 | $0 | $2 |
| 5 | Northwest Hospital LLC | Tucson, AZ | $1 | $1 | $0 | 1–10 | $0 | $2 |
| 6 | Affinity Hospital LLC | Birmingham, AL | $29 | $27 | $11 | 1–10 | $7 | $48 |
| 7 | IOM Health System LP | Fort Wayne, IN | $3 | $3 | $1 | — | $2 | $6 |
| 8 | Bluffton Health System LLC | Bluffton, IN | $2 | $2 | $1 | — | $1 | $3 |
| 9 | Dukes Health System LLC | Peru, IN | $4 | $4 | $2 | — | $2 | $9 |
| 10 | Warsaw Health System LLC | Warsaw, IN | $6 | $6 | $2 | — | $2 | $9 |
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