CPT 76375
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
3d/holograph reconstr add-on
Low
$59
Average
$513
Median
$630
High
$703
Each hospital's average Cigna rate, under the methodology and billing class chosen below.
5 hospitals; the 90th percentile is 3.0× 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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5 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 | Boone Memorial Hospital Madison, WV percent of total billed charges · bothfrom % of charges | 1 | $681 | $681 | — | — | — | $681 – $681 |
| 2 | HOULTON REGIONAL HOSPITAL HOULTON, ME percent of total billed charges · outpatientfrom % of charges | 1 | $59 | $59 | — | — | — | $59 – $59 |
| 3 | Norwalk Hospital Norwalk, CT fee schedule · outpatient | 1 | $492 | $492 | — | — | — | $492 – $492 |
| 4 | Physicians Medical Center_F HOUMA, LA facility · per diem · outpatient | 1 | $630 | $630 | — | — | — | $630 – $630 |
| 5 | TWIN CITY HOSPITAL CORPORATION Dennison, OH fee schedule · outpatient | 2 | $703 | $703 | — | — | — | $703 – $703 |
← Payers reporting CPT 76375 · Snapshot 20261113T090226Z-3ce6c0b8