CPT 0391T
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
HC Ntergt Eval Inper Leadls Pm
Low
$18
Average
$97
Median
$55
High
$262
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12 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 | Gottlieb Memorial Hospital Melrose Park, IL facility · case rate · outpatient | 1 | $58 | $58 | — | — | — | $58 – $58 |
| 2 | Gundersen Luthern Medical Center Inc La Crosse, WI facility · fee schedule · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 3 | Gundersen Palmer Lutheran Hospital and Clinic Inc West Union, IA facility · fee schedule · outpatient | 1 | $25 | $25 | — | — | — | $25 – $25 |
| 4 | Henry Ford Health Novi, MI fee schedule · both | 1 | $18 | $18 | — | — | — | $18 – $18 |
| 5 | Henry Ford Health Southfield, MI fee schedule · both | 1 | $18 | $18 | — | — | — | $18 – $18 |
| 6 | Loyola University Medical Center Maywood, IL facility · case rate · outpatient | 1 | $84 | $84 | — | — | — | $84 – $84 |
| 7 | MacNeal Hospital Berwyn, IL facility · case rate · outpatient | 1 | $58 | $58 | — | — | — | $58 – $58 |
| 8 | Margaretville Memorial Hospital Margaretville, NY facility · fee schedule · outpatient | 1 | $52 | $52 | — | — | — | $52 – $52 |
| 9 | Montefiore Medical Center Bronx, NY fee schedule · outpatient | 4 | $196 | $257 | $107 | 41% | — | $196 – $442 |
| 10 | Montefiore Mount Vernon Hospital Mount Vernon, NY fee schedule · outpatient | 4 | $200 | $262 | $108 | 41% | — | $200 – $450 |
| 11 | Montefiore New Rochelle Hospital New Rochelle, NY fee schedule · outpatient | 4 | $200 | $260 | $105 | 40% | — | $200 – $442 |
| 12 | University of Florida Health Gainesville, FL facility · case rate · outpatient | 1 | $43 | $43 | — | — | — | $43 – $43 |
← Payers reporting CPT 0391T · Snapshot 20261113T090226Z-3ce6c0b8