NDC 904683873
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
Al hydroxide-Mg hydroxide-simethicone 200 mg-200 m
Low
$0
Average
$8
Median
$10
High
$11
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Reflects negotiated fee schedule rates with commercial payers.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | Laredo Texas Hospital Company LP Laredo, TX | $0 | $0 | $0 | 33% | — | $0 – $3 |
| 2 | The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA | $10 | $10 | — | — | — | $1 – $10 |
| 3 | Stormont Vail Healthcare, Inc Topeka, KS | $12 | $11 | $2 | 20% | — | $9 – $13 |
| 4 | Stormont Vail Healthcare, Inc Topeka, KS | $9 | $9 | $1 | 14% | — | $9 – $12 |
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