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
$107
Average
$2.3k
Median
$546
High
$16.9k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
9 payers; the 90th percentile is 18.1× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Aetna facility · fee schedule · outpatient · +3 other terms | 4 | $861 | $3.2k | $5.4k | 169% | — | $124 – $13.9k |
| 2 | Blue Cross Blue Shield fee schedule · outpatient | 4 | $417 | $393 | $132 | 34% | — | $217 – $578 |
| 3 | Cigna fee schedule · outpatient | 2 | $597 | $632 | $100 | 16% | — | $492 – $703 |
| 4 | Anthem fee schedule · inpatient · +2 other terms | 1 | $659 | $659 | $25 | 4% | — | $624 – $676 |
| 5 | Caresource fee schedule · outpatient · +1 other terms | 1 | $280 | $280 | — | — | — | $280 – $280 |
| 6 | Humana fee schedule · inpatient · +2 other terms | 1 | $404 | $404 | — | — | — | $404 – $404 |
| 7 | Medical Mutual fee schedule · inpatient · +1 other terms | 1 | $574 | $574 | $16 | 3% | — | $558 – $590 |
| 8 | Molina fee schedule · outpatient | 1 | $275 | $275 | — | — | — | $275 – $275 |
| 9 | UnitedHealthcare fee schedule · inpatient · +1 other terms | 1 | $735 | $735 | — | — | — | $735 – $735 |
← Hospitals reporting CPT 76375 · Snapshot 20261113T090226Z-3ce6c0b8