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
Additive for enteral formula
Low
$0
Average
$133
Median
$3
High
$888
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
27 payers; the 90th percentile is 5096.4× 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 · +5 other terms | 69 | $0 | $0 | $0 | 77% | — | $0 – $1 |
| 2 | Aetna fee schedule · outpatient · +6 other terms | 28 | $0 | $0 | $0 | 85% | — | $0 – $1 |
| 3 | Blue Cross Blue Shield facility · fee schedule · outpatient · +8 other terms | 24 | $13 | $13 | $6 | 49% | — | $0 – $25 |
| 4 | Cigna facility · fee schedule · outpatient · +5 other terms | 14 | $1 | $1 | $1 | 64% | — | $0 – $1 |
| 5 | Wellmark fee schedule · both · +1 other terms | 13 | $3 | $3 | $0 | 14% | — | $3 – $5 |
| 6 | Bcbs Mn fee schedule · outpatient · +3 other terms | 12 | $487 | $315 | $265 | 84% | — | $15 – $610 |
| 7 | Bcbs Nj fee schedule · outpatient | 12 | $0 | $0 | — | — | — | $0 – $0 |
| 8 | Highmark fee schedule · outpatient · +3 other terms | 12 | $0 | $0 | — | — | — | $0 – $0 |
| 9 | Anthem professional · fee schedule · outpatient · +2 other terms | 10 | $1 | $1 | $0 | 57% | — | $0 – $1 |
| 10 | Premera fee schedule · outpatient · +1 other terms | 9 | $0 | $0 | $0 | 17% | — | $0 – $0 |
| 11 | Aetna Better Health fee schedule · inpatient · +1 other terms | 7 | $0 | $0 | — | — | — | $0 – $0 |
| 12 | Bcbs La fee schedule · outpatient · +1 other terms | 6 | $0 | $0 | — | — | — | $0 – $0 |
| 13 | UnitedHealthcare facility · fee schedule · outpatient · +2 other terms | 5 | $0 | $0 | $0 | 38% | — | $0 – $0 |
| 14 | Bcbs Id facility · fee schedule · outpatient · +1 other terms | 3 | $0 | $0 | $0 | 111% | — | $0 – $1 |
| 15 | Bcbs Ks fee schedule · outpatient · +1 other terms | 3 | $6 | $6 | $0 | 6% | — | $6 – $7 |
| 16 | First Health professional · fee schedule · both · +2 other terms | 3 | $0 | $0 | — | — | — | $0 – $0 |
| 17 | Molina facility · fee schedule · outpatient · +1 other terms | 3 | $1 | $1 | $0 | 52% | — | $0 – $1 |
| 18 | MultiPlan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms | 3 | $916 | $888 | $450 | 51% | — | $6 – $1.5k |
| 19 | Sanford Health Plan fee schedule · outpatient · +1 other terms | 3 | $4 | $4 | — | — | — | $4 – $4 |
| 20 | Bcbs Ca facility · percent of total billed charges · outpatientfrom % of charges | 1 | $4 | $4 | $1 | 30% | — | $3 – $5 |
| 21 | Bcbs Il professional · fee schedule · both | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 22 | Bcbs Nc facility · fee schedule · outpatient | 1 | $1 | $1 | $0 | 57% | — | $0 – $1 |
| 23 | Bcbs Nv fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 24 | Bcbs Vt professional · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 25 | Healthpartners facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
← Hospitals reporting HCPCS B4104 · Snapshot 20261112T124536Z-e251e855