CPT 90875
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
90875
Low
$0
Average
$197
Median
$116
High
$2.1k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
52 payers; the 90th percentile is 4.4× 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 | Humana fee schedule · outpatient · +16 other terms | 137 | $57 | $188 | $840 | 448% | — | $7 – $8.3k |
| 2 | UnitedHealthcare fee schedule · outpatient · +21 other terms | 97 | $58 | $98 | $187 | 192% | — | $0 – $1.6k |
| 3 | Aetna fee schedule · outpatient · +20 other terms | 82 | $60 | $522 | $1.5k | 290% | — | $55 – $8.4k |
| 4 | Blue Cross Blue Shield fee schedule · outpatient · +24 other terms | 66 | $116 | $147 | $108 | 74% | — | $0 – $459 |
| 5 | Anthem fee schedule · outpatient · +19 other terms | 61 | $60 | $62 | $10 | 17% | — | $54 – $132 |
| 6 | Molina facility · case rate · outpatient · +14 other terms | 39 | $104 | $96 | $32 | 33% | — | $31 – $188 |
| 7 | Cigna fee schedule · outpatient · +18 other terms | 37 | $60 | $78 | $36 | 46% | — | $5 – $171 |
| 8 | Kaiser fee schedule · outpatient · +9 other terms | 26 | $60 | $68 | $36 | 52% | — | $5 – $129 |
| 9 | Devoted fee schedule · outpatient · +8 other terms | 21 | $57 | $59 | $1 | 3% | — | $57 – $60 |
| 10 | Caresource facility · case rate · outpatient · +6 other terms | 20 | $115 | $113 | $31 | 27% | — | $54 – $191 |
| 11 | Medicare fee schedule · outpatient · +2 other terms | 18 | $60 | $60 | — | — | — | $60 – $60 |
| 12 | Regence fee schedule · outpatient · +6 other terms | 15 | $68 | $84 | $30 | 35% | — | $53 – $173 |
| 13 | Aetna Better Health professional · fee schedule · both · +8 other terms | 14 | $31 | $33 | $17 | 51% | — | $0 – $69 |
| 14 | Optum facility · case rate · outpatient · +10 other terms | 14 | $99 | $101 | $31 | 31% | — | $58 – $170 |
| 15 | WellCare case rate · outpatient · +6 other terms | 14 | $60 | $61 | $4 | 6% | — | $54 – $66 |
| 16 | Highmark fee schedule · outpatient · +7 other terms | 13 | $69 | $69 | $3 | 5% | — | $37 – $70 |
| 17 | Medcost professional · percent of total billed charges · outpatientfrom % of charges · +3 other terms | 13 | $192 | $190 | $23 | 12% | — | $160 – $257 |
| 18 | Wellmark fee schedule · both · +6 other terms | 13 | $81 | $82 | $1 | 1% | — | $81 – $89 |
| 19 | Bcbs Mn fee schedule · outpatient · +6 other terms | 12 | $99 | $107 | $42 | 39% | — | $50 – $233 |
| 20 | Cigna Healthspring fee schedule · outpatient · +2 other terms | 12 | $58 | $58 | — | — | — | $58 – $58 |
| 21 | Medica fee schedule · outpatient · +9 other terms | 12 | $198 | $197 | $55 | 28% | — | $90 – $262 |
| 22 | Medicaid per diem · both · +7 other terms | 11 | $175 | $169 | $15 | 9% | — | $159 – $191 |
| 23 | Medical Mutual facility · fee schedule · outpatient · +2 other terms | 10 | $59 | $73 | $15 | 21% | — | $59 – $93 |
| 24 | Ambetter facility · fee schedule · outpatient · +9 other terms | 9 | $106 | $101 | $15 | 15% | — | $57 – $106 |
| 25 | Amerihealth Caritas facility · fee schedule · outpatient · +6 other terms | 9 | $53 | $60 | $21 | 34% | — | $51 – $119 |
← Hospitals reporting CPT 90875 · Snapshot 20261113T090226Z-3ce6c0b8