CPT 0504T
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
Fee Schedule
Low
$0
Average
$418
Median
$371
High
$1.5k
Each hospital's average Blue Cross Blue Shield rate, under the methodology and billing class chosen below.
58 hospitals; the 90th percentile is 10.0× 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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60 hospital rates
iThe hospitals that file a Blue Cross Blue Shield 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 | Adventhealth Central Texas Killeen, TX fee schedule · outpatient | 2 | $573 | $573 | $40 | 7% | — | $533 – $613 |
| 2 | Adventhealth Rollins Brook Lampasas, TX fee schedule · outpatient | 2 | $573 | $573 | $40 | 7% | — | $533 – $613 |
| 3 | Ascension Providence Waco, TX fee schedule · outpatient | 3 | $307 | $293 | $45 | 15% | — | $232 – $339 |
| 4 | Ascension Providence Waco, TX other · outpatient | 1 | $291 | $291 | — | — | — | $291 – $291 |
| 5 | Benson Hospital Corporation Benson, AZ facility · fee schedule · outpatient | 1 | $563 | $563 | — | — | — | $563 – $563 |
| 6 | Blessing Hospital Quincy, IL professional · fee schedule · both | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 7 | COLUMBIA MEMORIAL HOSPITAL Hudson, NY facility · fee schedule · outpatient | 4 | $203 | $206 | $18 | 9% | — | $185 – $232 |
| 8 | Conway Hospital, Inc. Conway, SC professional · fee schedule · outpatient | 1 | $78 | $78 | — | — | — | $78 – $78 |
| 9 | Covenant Medical Center Lubbock, TX fee schedule · outpatient | 4 | $679 | $681 | $56 | 8% | — | $603 – $761 |
| 10 | Duncan Regional Hospital Duncan, OK case rate · outpatient | 5 | $100 | $100 | — | — | — | $100 – $100 |
| 11 | East Alabama Medical Center OPELIKA, AL facility · fee schedule · outpatient | 1 | $426 | $426 | — | — | — | $426 – $426 |
| 12 | East Alabama Medical Center OPELIKA, AL professional · fee schedule · outpatient | 1 | $426 | $426 | — | — | — | $426 – $426 |
| 13 | Edward Hospital Plainfield, IL fee schedule · outpatient | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 14 | Elmhurst Memorial Hospital Elmhurst, IL fee schedule · outpatient | 1 | $104 | $104 | — | — | — | $104 – $104 |
| 15 | Endeavor Health Clinical Operations Skokie, IL fee schedule · outpatient | 3 | $165 | $166 | $11 | 7% | — | $152 – $179 |
| 16 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · outpatient | 3 | $266 | $233 | $51 | 22% | — | $161 – $271 |
| 17 | Garnet Health Medical Center Middletown, NY facility · fee schedule · outpatient | 2 | $554 | $554 | $104 | 19% | — | $450 – $658 |
| 18 | Garnet Health Medical Center Catskills Harris, NY facility · fee schedule · outpatient | 1 | $588 | $588 | — | — | — | $588 – $588 |
| 19 | Henry Ford Health Detroit, MI other · both | 2 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 20 | Hoag Memorial Hospital Presbyterian Irvine, CA facility · fee schedule · outpatient | 1 | $398 | $398 | — | — | — | $398 – $398 |
| 21 | Jefferson County Hospital OK Waurika, OK case rate · outpatient | 5 | $100 | $100 | — | — | — | $100 – $100 |
| 22 | Keck Hospital of USC Los Angeles, CA facility · fee schedule · outpatient | 2 | $575 | $575 | $11 | 2% | — | $564 – $585 |
| 23 | LaSalle Parish Hospital Service District No. 1 Olla, LA facility · fee schedule · outpatient | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 24 | Lubbock Heritage Hospital LLC Lubbock, TX fee schedule · outpatient | 4 | $679 | $681 | $56 | 8% | — | $603 – $761 |
| 25 | Mercyhealth Crystal Lake Hospital & Medical Center Crystal Lake, IL fee schedule · outpatient | 2 | $238 | $238 | $28 | 12% | — | $210 – $266 |
← Payers reporting CPT 0504T · Snapshot 20261113T090226Z-3ce6c0b8