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 powder 17 gm MIRALAX - 1
Reported by 4 hospitals in the network under the other methodology.
Low
$3
Average
$5
Median
$4
High
$11
Filter by billing methodology
Reflects a payer-specific billing methodology not covered by the standard categories.
| # | Hospital | ||||||
|---|---|---|---|---|---|---|---|
| 1 | USC Arcadia Hospital Arcadia, CA | $11 | $11 | $1 | 13% | 1–10 | $7 – $20 |
| 2 | The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA | $5 | $4 | $2 | 47% | — | $1 – $5 |
| 3 | Allina Health Systems Ulm, MN | $3 | $3 | $1 | 30% | — | $1 – $6 |
| 4 | Hospital Service District #1, Parish of Terrebonne, State of Louisiana dba Terrebonne General Health System Houma, LA | $2 | $3 | $2 | 85% | — | $1 – $8 |
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