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
$45
Average
$73
Median
$57
High
$189
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48 hospital rates
iThe hospitals that file a Ucare 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 | Allina Health Systems MN; 1175 Nininger Road. Hastings, MN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 2 | Allina Health Systems MN 55443; 550 Osborne Road NE. Fridley, MN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 3 | Allina Health Systems Minneapolis, MN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $57 | $57 | — | — | — | $57 – $57 |
| 4 | Fairview Bethesda Hospital St. Paul, MN fee schedule · both | 3 | $55 | $54 | $4 | 7% | — | $49 – $58 |
| 5 | Fairview Bethesda Hospital St. Paul, MN fee schedule · outpatient | 1 | $46 | $46 | — | — | — | $46 – $46 |
| 6 | Fairview Health Services Edina, MN fee schedule · both | 3 | $55 | $54 | $4 | 7% | — | $49 – $58 |
| 7 | Fairview Health Services Edina, MN fee schedule · outpatient | 1 | $46 | $46 | — | — | — | $46 – $46 |
| 8 | Fairview Health Services Minneapolis, MN fee schedule · both | 5 | $55 | $54 | $4 | 7% | — | $49 – $58 |
| 9 | Fairview Health Services Minneapolis, MN fee schedule · outpatient | 2 | $46 | $46 | — | — | — | $46 – $46 |
| 10 | Fairview Health Services Burnsville, MN fee schedule · both | 3 | $55 | $54 | $4 | 7% | — | $49 – $58 |
| 11 | Fairview Health Services Burnsville, MN fee schedule · outpatient | 1 | $46 | $46 | — | — | — | $46 – $46 |
| 12 | Fairview Health Services Wyoming, MN fee schedule · both | 3 | $55 | $54 | $4 | 7% | — | $49 – $58 |
| 13 | Fairview Health Services Wyoming, MN fee schedule · outpatient | 1 | $46 | $46 | — | — | — | $46 – $46 |
| 14 | Fairview Health Services Princeton, MN fee schedule · both | 3 | $55 | $54 | $4 | 7% | — | $49 – $58 |
| 15 | Fairview Health Services Princeton, MN fee schedule · outpatient | 1 | $46 | $46 | — | — | — | $46 – $46 |
| 16 | Fairview Maple Grove Surgery Center Maple Grove, MN fee schedule · both | 3 | $55 | $54 | $4 | 7% | — | $49 – $58 |
| 17 | GILLETTE CHILDREN'S SPECIALTY HEALTHCARE PAUL, MN facility · fee schedule · outpatient | 1 | $41 | $41 | — | — | — | $41 – $41 |
| 18 | GILLETTE CHILDREN'S SPECIALTY HEALTHCARE PAUL, MN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $72 | $72 | — | — | — | $72 – $72 |
| 19 | Grand Itasca Clinic and Hospital Grand Rapids, MN facility · fee schedule · outpatient | 1 | $49 | $49 | — | — | — | $49 – $49 |
| 20 | Grand Itasca Clinic and Hospital Grand Rapids, MN professional · fee schedule · both | 1 | $53 | $53 | — | — | — | $53 – $53 |
| 21 | HealthEast St John's Hospital Maplewood, MN fee schedule · both | 3 | $55 | $54 | $4 | 7% | — | $49 – $58 |
| 22 | HealthEast St John's Hospital Maplewood, MN fee schedule · outpatient | 1 | $46 | $46 | — | — | — | $46 – $46 |
| 23 | HealthEast Woodwinds Hospital Woodbury, MN fee schedule · both | 3 | $55 | $54 | $4 | 7% | — | $49 – $58 |
| 24 | HealthEast Woodwinds Hospital Woodbury, MN fee schedule · outpatient | 1 | $46 | $46 | — | — | — | $46 – $46 |
| 25 | Mayo Clinic Health System Mankato 56001-4752 professional · fee schedule · outpatient | 2 | $63 | $63 | $2 | 4% | — | $61 – $65 |
← Payers reporting CPT 90875 · Snapshot 20261113T090226Z-3ce6c0b8