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
EF ped complete soy based
Low
$0
Average
$31
Median
$2
High
$362
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
25 payers; the 90th percentile is 36.3× 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 · +4 other terms | 69 | $5 | $8 | $5 | 60% | — | $0 – $14 |
| 2 | Blue Cross Blue Shield fee schedule · outpatient · +6 other terms | 47 | $3 | $4 | $3 | 95% | — | $0 – $18 |
| 3 | Aetna fee schedule · outpatient · +6 other terms | 19 | $0 | $1 | $1 | 106% | — | $0 – $5 |
| 4 | Wellmark fee schedule · both · +1 other terms | 13 | $1 | $1 | $0 | 8% | — | $1 – $1 |
| 5 | Bcbs Mn fee schedule · outpatient · +3 other terms | 12 | $487 | $310 | $271 | 87% | — | $1 – $610 |
| 6 | Bcbs Nj fee schedule · outpatient | 12 | $2 | $2 | — | — | — | $2 – $2 |
| 7 | Highmark fee schedule · outpatient · +3 other terms | 12 | $3 | $3 | $0 | 7% | — | $2 – $3 |
| 8 | UnitedHealthcare fee schedule · outpatient · +2 other terms | 12 | $2 | $2 | $0 | 23% | — | $1 – $2 |
| 9 | Anthem professional · fee schedule · outpatient · +3 other terms | 10 | $1 | $1 | $0 | 57% | — | $0 – $1 |
| 10 | Cigna professional · fee schedule · outpatient · +4 other terms | 10 | $1 | $1 | — | — | — | $1 – $1 |
| 11 | Premera fee schedule · outpatient · +1 other terms | 9 | $3 | $3 | $1 | 16% | — | $2 – $4 |
| 12 | Aetna Better Health fee schedule · inpatient · +1 other terms | 7 | $0 | $0 | — | — | — | $0 – $0 |
| 13 | Bcbs La fee schedule · outpatient · +1 other terms | 6 | $0 | $0 | — | — | — | $0 – $0 |
| 14 | Bcbs Id facility · fee schedule · outpatient · +1 other terms | 3 | $1 | $2 | $1 | 69% | — | $0 – $3 |
| 15 | Bcbs Ks fee schedule · outpatient · +1 other terms | 3 | $1 | $1 | $0 | 6% | — | $1 – $1 |
| 16 | First Health professional · fee schedule · both | 3 | $0 | $0 | — | — | — | $0 – $0 |
| 17 | Molina facility · fee schedule · outpatient | 3 | $0 | $2 | $2 | 111% | — | $0 – $4 |
| 18 | Sanford Health Plan facility · fee schedule · outpatient | 2 | $1 | $1 | — | — | — | $1 – $1 |
| 19 | Tricare facility · fee schedule · outpatient | 2 | $3 | $3 | — | — | — | $3 – $3 |
| 20 | Bcbs Il professional · fee schedule · both | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 21 | Bcbs Nc facility · fee schedule · outpatient | 1 | $2 | $2 | $2 | 70% | — | $0 – $3 |
| 22 | Bcbs Nv fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 23 | Bcbs Vt professional · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 24 | Healthpartners facility · fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 25 | MultiPlan facility · percent of total billed charges · bothfrom % of charges | 1 | $328 | $328 | — | — | — | $328 – $328 |
← Hospitals reporting HCPCS B4159 · Snapshot 20261112T124536Z-e251e855