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
PEDIALYTE GRAPE
Low
$0
Average
$66
Median
$4
High
$981
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
28 payers; the 90th percentile is 166.3× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
Filter by billing methodology
Filter by billing class
| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Humana fee schedule · outpatient · +7 other terms | 69 | $10 | $18 | $11 | 62% | — | $3 – $32 |
| 2 | Blue Cross Blue Shield facility · fee schedule · outpatient · +7 other terms | 34 | $4 | $6 | $5 | 96% | — | $1 – $24 |
| 3 | Aetna fee schedule · outpatient · +9 other terms | 19 | $3 | $7 | $6 | 83% | — | $3 – $22 |
| 4 | UnitedHealthcare fee schedule · outpatient · +5 other terms | 16 | $5 | $4 | $1 | 35% | — | $1 – $5 |
| 5 | Wellmark fee schedule · both · +1 other terms | 13 | $5 | $5 | $1 | 19% | — | $5 – $11 |
| 6 | Bcbs Mn fee schedule · outpatient · +3 other terms | 12 | $487 | $310 | $271 | 88% | — | $1 – $610 |
| 7 | Bcbs Nj fee schedule · outpatient | 12 | $3 | $3 | — | — | — | $3 – $3 |
| 8 | Highmark fee schedule · outpatient · +3 other terms | 12 | $3 | $3 | $0 | 2% | — | $3 – $4 |
| 9 | Anthem professional · fee schedule · outpatient · +4 other terms | 10 | $3 | $3 | $2 | 57% | — | $0 – $5 |
| 10 | Cigna professional · fee schedule · outpatient · +7 other terms | 10 | $2 | $2 | — | — | — | $2 – $2 |
| 11 | Premera fee schedule · outpatient · +1 other terms | 9 | $6 | $5 | $1 | 16% | — | $4 – $7 |
| 12 | Aetna Better Health fee schedule · inpatient · +1 other terms | 7 | $4 | $4 | — | — | — | $4 – $4 |
| 13 | Bcbs La fee schedule · outpatient · +1 other terms | 6 | $1 | $1 | — | — | — | $1 – $1 |
| 14 | Medicaid fee schedule · outpatient | 5 | $1 | $1 | — | — | — | $1 – $1 |
| 15 | MultiPlan percent of total billed charges · inpatientfrom % of charges · +3 other terms | 5 | $46 | $40 | $10 | 25% | — | $17 – $46 |
| 16 | Medical Mutual facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms | 4 | $1 | $1 | $0 | 14% | — | $0 – $1 |
| 17 | Bcbs Id facility · fee schedule · outpatient · +1 other terms | 3 | $4 | $5 | $3 | 61% | — | $2 – $8 |
| 18 | Bcbs Ks fee schedule · outpatient · +1 other terms | 3 | $1 | $1 | $0 | 6% | — | $1 – $1 |
| 19 | Caresource facility · percent of total billed charges · outpatientfrom % of charges | 3 | $0 | $0 | $0 | 30% | — | $0 – $0 |
| 20 | First Health professional · fee schedule · both · +2 other terms | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 21 | Molina facility · fee schedule · outpatient · +1 other terms | 3 | $2 | $3 | $3 | 82% | — | $1 – $7 |
| 22 | Sanford Health Plan facility · fee schedule · outpatient | 2 | $3 | $3 | — | — | — | $3 – $3 |
| 23 | Tricare facility · fee schedule · outpatient | 2 | $8 | $8 | — | — | — | $8 – $8 |
| 24 | Bcbs Il professional · fee schedule · both | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 25 | Bcbs Nc facility · fee schedule · outpatient | 1 | $4 | $4 | $3 | 71% | — | $0 – $7 |
← Hospitals reporting HCPCS B4103 · Snapshot 20261111T120946Z-9134e7f7