CPT 0875T
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
Prgrm subq prtl asct pmp sys
Low
$35
Average
$62
Median
$38
High
$193
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41 hospital rates
iThe hospitals that file a Cigna 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 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 2 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 3 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 4 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 5 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 6 | CLOVIS COMMUNITY MEDICAL CENTER Clovis, CA facility · case rate · outpatient | 2 | $48 | $48 | — | — | — | $48 – $48 |
| 7 | CRAWFORD LONG HOSPITAL Atlanta, GA facility · fee schedule · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 8 | Cleveland Clinic Mercy Hospital Canton, OH facility · fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 9 | DEKALB MEDICAL CENTER, INC Decatur, GA facility · fee schedule · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 10 | EMORY UNIVERSITY Atlanta, GA facility · fee schedule · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 11 | FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER Fresno, CA facility · fee schedule · outpatient | 2 | $38 | $38 | — | — | — | $38 – $38 |
| 12 | Fairview Hospital Cleveland, OH facility · fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 13 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $179 | $179 | — | — | — | $179 – $179 |
| 14 | Kadlec Regional Medical Center Kennewick, WA fee schedule · outpatient | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 15 | LUTHERAN HOSPITAL Cleveland, OH facility · fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 16 | Legacy Salmon Creek Medical Center Vancouver, WA fee schedule · outpatient | 1 | $46 | $46 | — | — | — | $46 – $46 |
| 17 | MARYMOUNT HOSPITAL INC Garfield Heights, OH facility · fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 18 | MEDINA HOSPITAL Medina, OH facility · fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 19 | MultiCare Auburn Medical Center Auburn, WA fee schedule · outpatient | 1 | $179 | $179 | — | — | — | $179 – $179 |
| 20 | MultiCare Capital Medical Center Lacey, WA fee schedule · outpatient | 1 | $193 | $193 | — | — | — | $193 – $193 |
| 21 | MultiCare Covington Medical Center Covington, WA fee schedule · outpatient | 1 | $179 | $179 | — | — | — | $179 – $179 |
| 22 | MultiCare Deaconess Hospital Spokane, WA fee schedule · outpatient | 1 | $117 | $117 | — | — | — | $117 – $117 |
| 23 | MultiCare Valley Hospital Spokane Valley, WA fee schedule · outpatient | 1 | $117 | $117 | — | — | — | $117 – $117 |
| 24 | MultiCare Yakima Valley Memorial Hospital Association Union Gap, WA fee schedule · outpatient | 1 | $45 | $45 | — | — | — | $45 – $45 |
| 25 | Naples Community Hospital Naples, FL fee schedule · outpatient | 1 | $40 | $40 | — | — | — | $40 – $40 |
← Payers reporting CPT 0875T · Snapshot 20261113T090226Z-3ce6c0b8