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
$52
Median
$1
High
$607
Each hospital's average Cigna rate, under the methodology and billing class chosen below.
24 hospitals; the 90th percentile is 47.0× 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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35 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 | Abbeville Area Medical Center Abbeville, SC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 2 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 3 | Blue Hill Memorial Hospital Hill, ME facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 4 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 5 | Charles A. Dean Memorial Hospital Greenville, ME facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 6 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 7 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 8 | Eastern Maine Medical Center Bangor, ME facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 9 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 10 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 1 | $0 | $0 | $0 | 9% | — | $0 – $0 |
| 11 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · outpatient | 1 | $1 | $1 | $0 | 9% | — | $1 – $1 |
| 12 | Maine Coast Regional Health Facilities Ellsworth, ME facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 13 | Maine Coast Regional Health Facilities Ellsworth, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 14 | Mary Hitchcock Memorial Hospital Lebanon, NH professional · fee schedule · outpatient | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 15 | Mayo Regional Hospital Dover Foxcroft, ME facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 16 | Mayo Regional Hospital Dover Foxcroft, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 17 | Memorial Hospital of Laramie County Cheyenne, WY fee schedule · both | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 18 | Mercy Hospital Portland, ME facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 19 | Mercy Hospital Portland, ME professional · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 20 | Munson Healthcare Cadillac Cadillac, MI facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 21 | Munson Healthcare Grayling Grayling, MI facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 22 | Munson Healthcare Manistee Hospital Manistee, MI facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 23 | Munson Healthcare Otsego Memorial Hospital Gaylord, MI facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 24 | Munson Medical Center Traverse City, MI facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 25 | Sebasticook Valley Health Pittsfield, ME facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
← Payers reporting HCPCS B4104 · Snapshot 20261112T124536Z-e251e855