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
$102
Median
$2
High
$305
Each hospital's average Molina rate, under the methodology and billing class chosen below.
6 hospitals; the 90th percentile is 814.0× 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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6 hospital rates
iThe hospitals that file a Molina 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 | GRITMAN MEDICAL CENTER INC Moscow, ID facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 2 | Texas Children's Hospital The Woodlands, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $338 | $305 | $143 | 47% | — | $63 – $498 |
| 3 | Texas Children's Hospital - Austin Austin, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $338 | $305 | $143 | 47% | — | $63 – $498 |
| 4 | Tri-City Medical Center Oceanside, CA facility · percent of total billed charges · outpatientfrom % of charges | 2 | $3 | $3 | — | — | — | $3 – $3 |
| 5 | United Memorial Medical Center Batavia, NY facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 6 | WEISER VALLEY HOSPITAL DISTRICT Weiser, ID facility · fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
← Payers reporting HCPCS B4104 · Snapshot 20261112T124536Z-e251e855