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
$15
Average
$40
Median
$38
High
$126
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
117 hospitals; the 90th percentile is 2.1× 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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120 hospital rates
iThe hospitals that file a UnitedHealthcare 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 · case rate · outpatient | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 2 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 3 | Blessing Hospital Quincy, IL facility · case rate · outpatient | 1 | $43 | $43 | — | — | — | $43 – $43 |
| 4 | Boone Hospital Center Columbia, MO fee schedule · outpatient | 2 | $38 | $38 | $0 | 1% | — | $37 – $38 |
| 5 | Boulder Community Health Lafayette, CO facility · case rate · outpatient | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 6 | Boulder Community Health Lafayette, CO professional · fee schedule · both | 1 | $40 | $40 | — | — | — | $40 – $40 |
| 7 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $20 | $20 | — | — | — | $20 – $20 |
| 8 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 9 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 10 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 11 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $23 | $23 | — | — | — | $23 – $23 |
| 12 | CLOVIS COMMUNITY MEDICAL CENTER Clovis, CA facility · case rate · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 13 | COMMUNITY MEMORIAL HOSPITAL Hill, VA case rate · outpatient | 1 | $55 | $55 | — | — | — | $55 – $55 |
| 14 | Carle BroMenn Medical Center Normal, IL case rate · outpatient | 2 | $40 | $40 | — | — | — | $40 – $40 |
| 15 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA case rate · outpatient | 1 | $37 | $37 | — | — | — | $37 – $37 |
| 16 | Cleveland Clinic Mercy Hospital Canton, OH facility · case rate · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 17 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 18 | Craig Hospital Englewood, CO facility · case rate · outpatient | 1 | $38 | $38 | — | — | — | $38 – $38 |
| 19 | Davis Medical Center Elkins, WV facility · case rate · outpatient | 1 | $36 | $36 | — | — | — | $36 – $36 |
| 20 | Doctors’ Hospital of Williamsburg Williamsburg, VA fee schedule · outpatient | 1 | $48 | $48 | — | — | — | $48 – $48 |
| 21 | FRESNO COMMUNITY HOSPITAL AND MEDICAL CENTER Fresno, CA facility · case rate · outpatient | 1 | $39 | $39 | — | — | — | $39 – $39 |
| 22 | Fairview Hospital Cleveland, OH facility · case rate · outpatient | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 23 | Fisher-Titus Medical Center Norwalk, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 24 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $44 | $44 | — | — | — | $44 – $44 |
| 25 | Good Samaritan Regional Health Center Mount Vernon, IL fee schedule · outpatient | 1 | $42 | $42 | — | — | — | $42 – $42 |
← Payers reporting CPT 0875T · Snapshot 20261113T090226Z-3ce6c0b8