NDC 904693181
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
polyethylene glycol 3350 Oral Pwdr for Recon 17 g packet [CITY]
Reported by 39 hospitals in the network.
Based on 461–488 billing samples across every hospital reporting.
Low
$1
Average
$794
Median
$11
High
$5.0k
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Showing prices across every billing methodology. Pick one in the filter above to narrow the chart. 39 hospitals; the 90th percentile is 1060.3× 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 | ||||||
|---|---|---|---|---|---|---|---|
| 1 | Tri-City Medical Center Oceanside, CA | $8 | $10 | $5 | 45% | 460–478 | $3 – $18 |
| 2 | USC Arcadia Hospital Arcadia, CA | $15 | $14 | $4 | 27% | 1–10 | $7 – $20 |
| 3 | Sanford USD Medical Center Sioux Falls, SD | $1 | $1 | $0 | 35% | — | $1 – $2 |
| 4 | IHC Health Services Inc., DBA Intermountain Health Utah Valley Hospital Provo, UT | $6 | $5 | $1 | 27% | — | $0 – $7 |
| 5 | Saint Joseph Hospital, Inc. Dba Intermountain Nhealth Saint Joseph Hospital DENVER, CO | $11 | $11 | $5 | 43% | — | $4 – $19 |
| 6 | St. Mary's Hospital & Medical Center, Inc. Dba Intermountain Health St. Mary's Regional Hospital JUNCTION, CO | $9 | $8 | $2 | 23% | — | $4 – $11 |
| 7 | Intermountain Front Range Inc. Dba Intermountain Health Lutheran Hospital WHEAT RIDGE, CO | $11 | $11 | $4 | 42% | — | $4 – $19 |
| 8 | Good Samaritan Medical Center, Llc Dba LAFAYETTE, CO | $11 | $11 | $5 | 41% | — | $4 – $19 |
| 9 | Holy Rosary Healthcare Dba Intermountain Health Holy Rosary Hospital CITY, MT | $10 | $10 | $1 | 9% | — | $5 – $11 |
| 10 | University Medical Center, Inc. Louisville, KY | $5 | $4 | $2 | 48% | — | $1 – $7 |
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