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
DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION
Lebanon, NH
See all hospitals reporting HCPCS J3490 →Price type
Mary Hitchcock Memorial Hospital’s median price of $10 is 80% below the median hospital's median price ($48), higher than 18% of the 1,749 hospitals reporting HCPCS J3490. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 47 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | Amerihealth Caritas amerihealth caritas - nh managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $1.12 | $1.79 | $0.61 – $6.16 |
| 2 | UnitedHealthcare uhc - freedom plan facility · percent of total billed charges · outpatientfrom % of charges | $4.86 | $7.74 | $2.64 – $26.71 |
| 3 | UnitedHealthcare uhc - freedom plan facility · percent of total billed charges · inpatientfrom % of charges | $5.03 | $8.01 | $2.73 – $27.64 |
| 4 | Bcbs Vt bcbs of vermont - the vermont health plan facility · fee schedule · outpatient | $8.17 | $8.17 | $8.17 – $8.17 |
| 5 | Bcbs Vt bcbs of vermont - vermont health partnership facility · fee schedule · outpatient | $8.17 | $8.17 | $8.17 – $8.17 |
| 6 | Bcbs Vt bcbs of vermont - the vermont health plan facility · percent of total billed charges · outpatientfrom % of charges | $5.42 | $8.64 | $2.95 – $29.81 |
| 7 | Bcbs Vt bcbs of vermont - vermont health partnership facility · percent of total billed charges · outpatientfrom % of charges | $5.42 | $8.64 | $2.95 – $29.81 |
| 8 | Cigna cigna hmo-pos facility · percent of total billed charges · outpatientfrom % of charges | $5.98 | $9.54 | $3.25 – $32.91 |
| 9 | Aetna aetna hmo/pos/ppo - arnb facility · percent of total billed charges · inpatientfrom % of charges | $6.07 | $9.69 | $3.30 – $33.40 |
| 10 | Aetna aetna hmo/pos/ppo - arnb facility · percent of total billed charges · outpatientfrom % of charges | $6.07 | $9.69 | $3.30 – $33.40 |
| 11 | Bcbs Vt bcbs of vermont non-managed care plans facility · fee schedule · outpatient | $9.96 | $9.96 | $9.96 – $9.96 |
| 12 | Bcbs Vt bcbs of vermont non-managed care plans facility · percent of total billed charges · outpatientfrom % of charges | $6.61 | $10.54 | $3.59 – $36.34 |
| 13 | Cigna cigna ppo facility · percent of total billed charges · outpatientfrom % of charges | $6.79 | $10.82 | $3.69 – $37.32 |
| 14 | Aetna aetna hmo/pos/ppo facility · percent of total billed charges · inpatientfrom % of charges | $6.95 | $11.08 | $3.78 – $38.19 |
| 15 | Aetna aetna hmo/pos/ppo facility · percent of total billed charges · outpatientfrom % of charges | $6.95 | $11.08 | $3.78 – $38.19 |
| 16 | UnitedHealthcare uhc - hmo/pos/ppo facility · percent of total billed charges · inpatientfrom % of charges | $7.30 | $11.64 | $3.97 – $40.15 |
| 17 | UnitedHealthcare uhc - hmo/pos/ppo facility · percent of total billed charges · outpatientfrom % of charges | $7.60 | $12.12 | $4.13 – $41.78 |
| 18 | Anthem anthem - federal employee program facility · percent of total billed charges · inpatientfrom % of charges | $8.12 | $12.95 | $4.41 – $44.64 |
| 19 | Anthem anthem - indemnity facility · percent of total billed charges · inpatientfrom % of charges | $8.12 | $12.95 | $4.41 – $44.64 |
| 20 | First Health first health/hcvm facility · percent of total billed charges · inpatientfrom % of charges | $8.61 | $13.73 | $4.68 – $47.33 |
| 21 | First Health first health/hcvm facility · percent of total billed charges · outpatientfrom % of charges | $8.61 | $13.73 | $4.68 – $47.33 |
| 22 | Anthem anthem - federal employee program facility · percent of total billed charges · outpatientfrom % of charges | $8.62 | $13.75 | $4.69 – $47.40 |
| 23 | Phcs phcs - ppo facility · percent of total billed charges · inpatientfrom % of charges | $8.90 | $14.20 | $4.84 – $48.96 |
| 24 | Phcs phcs - ppo facility · percent of total billed charges · outpatientfrom % of charges | $8.90 | $14.20 | $4.84 – $48.96 |
| 25 | Amerihealth Caritas amerihealth caritas - nh managed medicaid professional · percent of total billed charges · outpatientfrom % of charges | $15.14 | $18.42 | $1.05 – $54.81 |
Last updated: Jan 1, 2026
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