CPT 84620
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
Xylose tolerance test
Low
$11
Average
$22
Median
$13
High
$77
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27 hospital rates
iThe hospitals that file a Excellus 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 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 2 | Clifton Springs Hospital And Clinic Clifton Springs, NY facility · fee schedule · outpatient | 4 | $11 | $12 | $1 | 10% | — | $11 – $14 |
| 3 | Diley Ridge Medical Center Canal Winchester, OH facility · fee schedule · both | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 4 | F.F. Thompson Hospital Canandaigua, NY fee schedule · outpatient | 4 | $13 | $12 | $2 | 19% | — | $9 – $15 |
| 5 | Gouverneur Hospital Gouverneur, NY facility · fee schedule · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 6 | Highland Hospital Rochester, NY fee schedule · outpatient | 6 | $11 | $12 | $1 | 12% | — | $11 – $15 |
| 7 | Margaretville Memorial Hospital Margaretville, NY facility · fee schedule · outpatient | 2 | $77 | $77 | — | — | — | $77 – $77 |
| 8 | Massena Hospital Inc Massena, NY facility · fee schedule · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 9 | Memorial Hosp of Wm F & Gertrude F Jones A/K/A Jones Memorial Hosp Wellsville, NY fee schedule · outpatient | 2 | $15 | $15 | — | — | — | $15 – $15 |
| 10 | Mount Carmel East Reynoldsburg, OH facility · fee schedule · both | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 11 | Mount Carmel Grove City Grove City, OH facility · fee schedule · both | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 12 | Mount Carmel New Albany Surgical Hospital New Albany, OH facility · fee schedule · both | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 13 | Mount Carmel St Ann's Lewis Center, OH facility · fee schedule · both | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 14 | Mount Sinai Rehabilitation Hospital, Inc Hartford, CT facility · fee schedule · both | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 15 | Newark-Wayne Community Hospital Newark, NY facility · fee schedule · outpatient | 3 | $11 | $11 | $2 | 15% | — | $10 – $14 |
| 16 | Nicholas H. Noyes Memorial Hospital Dansville, NY fee schedule · outpatient | 4 | $13 | $12 | $2 | 19% | — | $9 – $15 |
| 17 | Rochester General Hospital Rochester, NY facility · fee schedule · outpatient | 2 | $13 | $13 | $2 | 17% | — | $10 – $16 |
| 18 | Saint Alphonsus Medical Center - Nampa Nampa, ID facility · fee schedule · both | 1 | $63 | $63 | — | — | — | $63 – $63 |
| 19 | Saint Alphonsus Regional Medical Center - Boise Boise, ID facility · fee schedule · both | 1 | $63 | $63 | — | — | — | $63 – $63 |
| 20 | Samaritan Medical Center Watertown, NY facility · case rate · outpatient | 2 | $36 | $36 | $23 | 64% | — | $13 – $59 |
| 21 | Samaritan Medical Center Watertown, NY professional · fee schedule · both | 1 | $12 | $12 | — | — | — | $12 – $12 |
| 22 | St Joseph Mercy Oakland Pontiac, MI facility · fee schedule · both | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 23 | St Peters Hospital Albany, NY facility · fee schedule · both | 5 | $29 | $29 | $17 | 58% | — | $13 – $59 |
| 24 | St. James Hospital Hornell, NY fee schedule · outpatient | 4 | $13 | $12 | $2 | 19% | — | $9 – $15 |
| 25 | Strong Memorial Hospital Rochester, NY fee schedule · outpatient | 4 | $11 | $11 | — | — | — | $11 – $11 |
← Payers reporting CPT 84620 · Snapshot 20261113T090226Z-3ce6c0b8