CPT 86930
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
HC FREEZE, EACH UNIT
Low
$13
Average
$139
Median
$99
High
$279
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19 hospital rates
iThe hospitals that file a Medicaid 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 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $174 | $174 | — | — | — | $174 – $174 |
| 2 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · case rate · outpatient | 1 | $54 | $54 | — | — | — | $54 – $54 |
| 3 | Dupont Hospital LLC Wayne, IN facility · per diem · outpatient | 1 | $279 | $279 | — | — | — | $279 – $279 |
| 4 | Henry Ford Health Novi, MI other · outpatient | 1 | $97 | $97 | — | — | — | $97 – $97 |
| 5 | Henry Ford Health Twp, MI other · outpatient | 1 | $100 | $100 | — | — | — | $100 – $100 |
| 6 | Henry Ford Health Southfield, MI other · outpatient | 1 | $97 | $97 | — | — | — | $97 – $97 |
| 7 | Henry Ford Health Rochester, MI other · outpatient | 1 | $91 | $91 | — | — | — | $91 – $91 |
| 8 | INDIAN RIVER MEMORIAL HOSPITAL INC Vero Beach, FL facility · case rate · outpatient | 1 | $54 | $54 | — | — | — | $54 – $54 |
| 9 | IOM Health System LP Fort Wayne, IN facility · per diem · outpatient | 1 | $279 | $279 | — | — | — | $279 – $279 |
| 10 | Lake Charles Memorial Hospital Charles., LA fee schedule · outpatient | 1 | $13 | $13 | — | — | — | $13 – $13 |
| 11 | Lutheran Musculoskeletal Center LLC Fort Wayne, IN facility · per diem · outpatient | 1 | $279 | $279 | — | — | — | $279 – $279 |
| 12 | Mercy Hospital Lincoln Troy, MO facility · fee schedule · outpatient | 1 | $205 | $205 | — | — | — | $205 – $205 |
| 13 | Mercy Hospital Lincoln Troy, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $65 | $65 | — | — | — | $65 – $65 |
| 14 | Mercy Hospitals East Communities dba Mercy Hospital Washington Washington, MO facility · fee schedule · outpatient | 1 | $146 | $146 | — | — | — | $146 – $146 |
| 15 | Montefiore Medical Center Bronx, NY fee schedule · outpatient | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 16 | Montefiore Mount Vernon Hospital Mount Vernon, NY fee schedule · outpatient | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 17 | Montefiore New Rochelle Hospital New Rochelle, NY fee schedule · outpatient | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 18 | St. Joseph Health System, LLC Wayne, IN facility · per diem · outpatient | 1 | $279 | $279 | — | — | — | $279 – $279 |
| 19 | Warsaw Health System LLC Warsaw, IN facility · per diem · outpatient | 1 | $279 | $279 | — | — | — | $279 – $279 |
← Payers reporting CPT 86930 · Snapshot 20261113T090226Z-3ce6c0b8