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
$63
Median
$5
High
$1.3k
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
22 hospitals; the 90th percentile is 6.1× 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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25 hospital rates
iThe hospitals that file a UnitedHealthcare 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 | Hospital Service District No 1 Parish of Avoyelles State of Louisiana Bunkie, LA percent of total billed charges · bothfrom % of charges | 1 | $5 | $5 | — | — | 2–20 | $5 – $5 |
| 2 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
| 3 | Adena Fayette Medical Center Washington Court House, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 4 | Adena Fayette Medical Center Washington Court House, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 5 | Adena Health System Chillicothe, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 6 | CANONSBURG GENERAL HOSPITAL CANONSBURG, PA fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
| 7 | GROVE CITY MEDICAL CENTER GROVE CITY, PA fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
| 8 | Geisinger Bloomsburg Hospital Bloomsburg, PA case rate · inpatient | 1 | $3.9k | $3.9k | — | — | — | $3.9k – $3.9k |
| 9 | Geisinger Bloomsburg Hospital Bloomsburg, PA fee schedule · outpatient | 2 | $2 | $2 | $1 | 26% | — | $1 – $3 |
| 10 | Geisinger Community Medical Center Scranton, PA fee schedule · outpatient | 2 | $2 | $2 | $1 | 35% | — | $1 – $3 |
| 11 | Geisinger Lewistown Hospital Lewistown, PA fee schedule · outpatient | 2 | $2 | $2 | $1 | 26% | — | $1 – $3 |
| 12 | Geisinger Medical Center Muncy, PA fee schedule · outpatient | 2 | $2 | $2 | $1 | 26% | — | $1 – $3 |
| 13 | Geisinger Wyoming Valley Wilkes-Barre, PA fee schedule · outpatient | 2 | $2 | $2 | $1 | 26% | — | $1 – $3 |
| 14 | Greenfield Area Medical Center Greenfield, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 15 | Greenfield Area Medical Center Greenfield, OH facility · percent of total billed charges · outpatientfrom % of charges | 2 | $1 | $1 | $0 | 37% | — | $0 – $1 |
| 16 | JEFFERSON REGIONAL MEDICAL CENTER JEFFERSON HILLS, PA fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
| 17 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · fee schedule · outpatient | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 18 | Pike Health Services Inc Waverly, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 19 | SAINT VINCENT HEALTH CENTER ERIE, PA fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
| 20 | South Shore Hospital South Weymouth, MA fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 21 | WEST PENN ALLEGHENY HEALTH SYSTEM INC WEXFORD, PA fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
| 22 | WEST PENN ALLEGHENY HEALTH SYSTEM INC PITTSBURGH, PA fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
| 23 | WEST PENN ALLEGHENY HEALTH SYSTEM INC MONROEVILLE, PA fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
| 24 | WEST PENN ALLEGHENY HEALTH SYSTEM INC PITTSBURGH, PA fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
| 25 | WESTFIELD MEMORIAL HOSPITAL INC WESTFIELD, NY fee schedule · outpatient | 2 | $5 | $5 | — | — | — | $5 – $5 |
← Payers reporting HCPCS B4103 · Snapshot 20261111T120946Z-9134e7f7