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  4. /NDC 41100082076

NDC 41100082076

polyethylene glycol 3350 Granule-Recon 119 gm at Laredo Texas Hospital Company LP

Laredo, TX

Pricing by billing methodology

Price type

All methodologies

$255

Aggregated across all available billing methodologies for this code.

Case rate

Not reported

Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.

Fee schedule

$30

Reflects negotiated fee schedule rates with commercial payers.

Per diem

$30

Reflects a negotiated per diem rate paid per day of care.

Percent of billed charges

$394

Reflects a negotiated percentage of total billed charges.

Other

$55

Reflects a payer-specific billing methodology not covered by the standard categories.

Last updated: Apr 1, 2026

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