CPT 0628T
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
Perq njx algc fluor lmbr ea
Low
$76
Average
$873
Median
$440
High
$4.4k
Each hospital's average Medica rate, under the methodology and billing class chosen below.
26 hospitals; the 90th percentile is 33.0× 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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40 hospital rates
iThe hospitals that file a Medica 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 | Altru Hospital Grand Forks, ND facility · fee schedule · outpatient | 4 | $219 | $327 | $390 | 119% | — | $25 – $1.3k |
| 2 | Altru Hospital Devils Lake Devils Lake, ND facility · fee schedule · outpatient | 4 | $219 | $327 | $390 | 119% | — | $25 – $1.3k |
| 3 | Banner Fort Collins Medical Center Fort Collins, CO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $4.4k | $4.4k | — | — | — | $4.4k – $4.4k |
| 4 | Banner North Colorado Medical Center Greeley, CO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $4.4k | $4.4k | — | — | — | $4.4k – $4.4k |
| 5 | Banner North Colorado Medical Center - Loveland Campus Loveland, CO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $4.4k | $4.4k | — | — | — | $4.4k – $4.4k |
| 6 | Children's Mercy Hospital Kansas City, MO facility · percent of total billed charges · inpatientfrom % of charges | 1 | $902 | $902 | — | — | — | $902 – $902 |
| 7 | Children's Mercy Hospital Kansas City, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $902 | $902 | — | — | — | $902 – $902 |
| 8 | Children's Mercy Hospital Kansas City, MO professional · percent of total billed charges · inpatientfrom % of charges | 1 | $192 | $192 | — | — | — | $192 – $192 |
| 9 | Children's Mercy Hospital Kansas City, MO professional · percent of total billed charges · outpatientfrom % of charges | 1 | $192 | $192 | — | — | — | $192 – $192 |
| 10 | Children's Mercy Hospital Kansas Overland Park, KS facility · percent of total billed charges · inpatientfrom % of charges | 1 | $902 | $902 | — | — | — | $902 – $902 |
| 11 | Children's Mercy Hospital Kansas Overland Park, KS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $902 | $902 | — | — | — | $902 – $902 |
| 12 | Children's Mercy Hospital Kansas Overland Park, KS professional · percent of total billed charges · inpatientfrom % of charges | 1 | $192 | $192 | — | — | — | $192 – $192 |
| 13 | Children's Mercy Hospital Kansas Overland Park, KS professional · percent of total billed charges · outpatientfrom % of charges | 1 | $192 | $192 | — | — | — | $192 – $192 |
| 14 | Curators of the University of Missouri Jefferson City, MO facility · case rate · outpatient | 1 | $943 | $943 | — | — | — | $943 – $943 |
| 15 | Fairview Bethesda Hospital St. Paul, MN fee schedule · both | 7 | $143 | $124 | $32 | 26% | — | $73 – $152 |
| 16 | Fairview Health Services Edina, MN case rate · outpatient | 7 | $870 | $756 | $241 | 32% | — | $321 – $967 |
| 17 | Fairview Health Services Edina, MN fee schedule · both | 7 | $143 | $124 | $32 | 26% | — | $73 – $152 |
| 18 | Fairview Health Services Minneapolis, MN case rate · outpatient | 7 | $946 | $818 | $269 | 33% | — | $320 – $1.1k |
| 19 | Fairview Health Services Minneapolis, MN fee schedule · both | 7 | $143 | $124 | $32 | 26% | — | $73 – $152 |
| 20 | Fairview Health Services Burnsville, MN case rate · outpatient | 7 | $911 | $769 | $250 | 32% | — | $321 – $967 |
| 21 | Fairview Health Services Burnsville, MN fee schedule · both | 7 | $143 | $124 | $32 | 26% | — | $73 – $152 |
| 22 | Fairview Health Services Wyoming, MN case rate · outpatient | 7 | $946 | $819 | $267 | 33% | — | $321 – $1.1k |
| 23 | Fairview Health Services Wyoming, MN fee schedule · both | 7 | $143 | $124 | $32 | 26% | — | $73 – $152 |
| 24 | Fairview Health Services Princeton, MN case rate · outpatient | 7 | $946 | $819 | $267 | 33% | — | $321 – $1.1k |
| 25 | Fairview Health Services Princeton, MN fee schedule · both | 7 | $143 | $124 | $32 | 26% | — | $73 – $152 |
← Payers reporting CPT 0628T · Snapshot 20261113T090226Z-3ce6c0b8