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
$1
Average
$308
Median
$2
High
$8.2k
Each hospital's average Cigna rate, under the methodology and billing class chosen below.
27 hospitals; the 90th percentile is 28.3× 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.
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33 hospital rates
iThe hospitals that file a Cigna rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Adena Fayette Medical Center Washington Court House, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 2 | Adena Fayette Medical Center Washington Court House, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 3 | Adena Health System Chillicothe, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 4 | Adena Health System Chillicothe, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 5 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 6 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 7 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 8 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 2 | $2 | $2 | — | — | — | $2 – $2 |
| 9 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 10 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $4 | $4 | $0 | 9% | — | $3 – $4 |
| 11 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · outpatient | 1 | $7 | $7 | $1 | 9% | — | $7 – $8 |
| 12 | Geisinger Bloomsburg Hospital Bloomsburg, PA percent of total billed charges · outpatientfrom % of charges | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 13 | Geisinger Community Medical Center Scranton, PA percent of total billed charges · outpatientfrom % of charges | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 14 | Geisinger Lewistown Hospital Lewistown, PA case rate · inpatient | 1 | $16.3k | $16.3k | — | — | — | $16.3k – $16.3k |
| 15 | Geisinger Lewistown Hospital Lewistown, PA percent of total billed charges · outpatientfrom % of charges | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 16 | Geisinger Medical Center Muncy, PA percent of total billed charges · outpatientfrom % of charges | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 17 | Geisinger Wyoming Valley Wilkes-Barre, PA percent of total billed charges · outpatientfrom % of charges | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 18 | Greenfield Area Medical Center Greenfield, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 19 | Greenfield Area Medical Center Greenfield, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 20 | Maine Coast Regional Health Facilities Ellsworth, ME professional · fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 21 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 2 | $2 | $2 | — | — | — | $2 – $2 |
| 22 | Mayo Regional Hospital Dover Foxcroft, ME professional · fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 23 | Memorial Hospital of Laramie County Cheyenne, WY fee schedule · both | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 24 | Mercy Hospital Portland, ME professional · fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 25 | Munson Healthcare Cadillac Cadillac, MI facility · fee schedule · outpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
← Payers reporting HCPCS B4103 · Snapshot 20261111T120946Z-9134e7f7