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
DGTZ GLS MCRSCP SLD LEVEL V
Smithville, TX
See all hospitals reporting CPT 0754T →Price type
Ascension Seton’s median price of $1.1k is 1509% above the median hospital's median price ($68), higher than 86% of the 543 hospitals reporting CPT 0754T. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 1 payer, 5 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | Blue Cross Blue Shield 4127_blue cross blue shield bav exchange 20250101 fee schedule · outpatient | $538.48 | $538.48 | $538.48 – $538.48 |
| 2 | Blue Cross Blue Shield 4440_blue cross blue shield hpn 20250501 fee schedule · outpatient | $1,094 | $1,094 | $1,094 – $1,094 |
| 3 | Blue Cross Blue Shield 4497_blue cross blue shield hpn (dell, williamson,hays) 20250501 fee schedule · outpatient | $1,094 | $1,094 | $1,094 – $1,094 |
| 4 | Blue Cross Blue Shield 4095_blue cross blue shield hmo essentials 20250101 fee schedule · outpatient | $1,207 | $1,207 | $1,207 – $1,207 |
| 5 | Blue Cross Blue Shield 4094_blue cross blue shield ppo 20250101 fee schedule · outpatient | $1,335 | $1,335 | $1,335 – $1,335 |
Last updated: Jan 1, 2026
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