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 VI
New York, NY
See all hospitals reporting CPT 0755T →Price type
Hospital for Special Surgery’s median price of $117 is 65% above the median hospital's median price ($71), higher than 58% of the 545 hospitals reporting CPT 0755T. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 5 payers, 58 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 bcbs connection [102217] per diem · both | $98.67 | $98.67 | $98.67 – $98.67 |
| 2 | Cigna allied benefit system - cigna network [133700] percent of total billed charges · bothfrom % of charges | $106.18 | $106.18 | $106.18 – $106.18 |
| 3 | Cigna cigna [103500] percent of total billed charges · bothfrom % of charges | $106.18 | $106.18 | $106.18 – $106.18 |
| 4 | Cigna cigna epo [103502] percent of total billed charges · bothfrom % of charges | $106.18 | $106.18 | $106.18 – $106.18 |
| 5 | Cigna cigna great west [103506] percent of total billed charges · bothfrom % of charges | $106.18 | $106.18 | $106.18 – $106.18 |
| 6 | Cigna cigna hmo [103503] percent of total billed charges · bothfrom % of charges | $106.18 | $106.18 | $106.18 – $106.18 |
| 7 | Cigna cigna indemnity [103505] percent of total billed charges · bothfrom % of charges | $106.18 | $106.18 | $106.18 – $106.18 |
| 8 | Cigna cigna international [103507] percent of total billed charges · bothfrom % of charges | $106.18 | $106.18 | $106.18 – $106.18 |
| 9 | Cigna cigna ppo [103504] percent of total billed charges · bothfrom % of charges | $106.18 | $106.18 | $106.18 – $106.18 |
| 10 | Cigna daniel h cook - cigna [133900] percent of total billed charges · bothfrom % of charges | $106.18 | $106.18 | $106.18 – $106.18 |
| 11 | Cigna local 831 [103508] percent of total billed charges · bothfrom % of charges | $106.18 | $106.18 | $106.18 – $106.18 |
| 12 | Cigna luminare - cigna [136200] percent of total billed charges · bothfrom % of charges | $106.18 | $106.18 | $106.18 – $106.18 |
| 13 | Cigna trustmark - cigna [134300] percent of total billed charges · bothfrom % of charges | $106.18 | $106.18 | $106.18 – $106.18 |
| 14 | Blue Cross Blue Shield emblem bcbs composite [901202] percent of total billed charges · bothfrom % of charges | $107.44 | $107.44 | $107.44 – $107.44 |
| 15 | Blue Cross Blue Shield bcbs nj [102301] percent of total billed charges · bothfrom % of charges | $109.02 | $109.02 | $109.02 – $109.02 |
| 16 | Blue Cross Blue Shield bcbs nj ppo [102302] percent of total billed charges · bothfrom % of charges | $109.02 | $109.02 | $109.02 – $109.02 |
| 17 | Aetna aetna [100300] percent of total billed charges · bothfrom % of charges | $116.92 | $116.92 | $116.92 – $116.92 |
| 18 | Aetna aetna epo [100305] percent of total billed charges · bothfrom % of charges | $116.92 | $116.92 | $116.92 – $116.92 |
| 19 | Aetna aetna geha-asa [100311] percent of total billed charges · bothfrom % of charges | $116.92 | $116.92 | $116.92 – $116.92 |
| 20 | Aetna aetna hmo [100306] percent of total billed charges · bothfrom % of charges | $116.92 | $116.92 | $116.92 – $116.92 |
| 21 | Aetna aetna indemnity [100302] percent of total billed charges · bothfrom % of charges | $116.92 | $116.92 | $116.92 – $116.92 |
| 22 | Aetna aetna international [100301] percent of total billed charges · bothfrom % of charges | $116.92 | $116.92 | $116.92 – $116.92 |
| 23 | Aetna aetna managed choice [100307] percent of total billed charges · bothfrom % of charges | $116.92 | $116.92 | $116.92 – $116.92 |
| 24 | Aetna aetna open choice [100303] percent of total billed charges · bothfrom % of charges | $116.92 | $116.92 | $116.92 – $116.92 |
| 25 | Aetna aetna pos [100308] percent of total billed charges · bothfrom % of charges | $116.92 | $116.92 | $116.92 – $116.92 |
Last updated: Apr 1, 2026
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