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
PR RCNST BIF SUPR LAT ORB&LWR FHD
Rochester, MN
See all hospitals reporting CPT 21175 →Price type
Mayo Clinic’s median price of $19.3k is 205% above the median hospital's median price ($6.3k), higher than 100% of the 1,439 hospitals reporting CPT 21175. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 16 payers, 54 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 | Ucare ucare msho medicare advantage plan [598] professional · fee schedule · outpatient | $737 | $737 | — | — | — | $737 – $737 |
| 2 | Ucare ucare connect medicare advantage plan [944] professional · fee schedule · outpatient | $795 | $795 | — | — | — | $795 – $795 |
| 3 | Optum veteran affairs optum [1054] professional · fee schedule · outpatient | $904 | $904 | — | — | — | $904 – $904 |
| 4 | Blue Cross Blue Shield blue cross blue shield medicare advantage plan aco [815] professional · fee schedule · outpatient | $922 | $922 | — | — | — | $922 – $922 |
| 5 | Ucare ucare medicare advantage plan [643] professional · fee schedule · outpatient | $922 | $922 | — | — | — | $922 – $922 |
| 6 | Medica medica advantage solutions by county [1204] professional · fee schedule · outpatient | $931 | $931 | — | — | — | $931 – $931 |
| 7 | Blue Cross Blue Shield blue cross blue shield medicare advantage plan msho [226] professional · fee schedule · outpatient | $949 | $949 | — | — | — | $949 – $949 |
| 8 | Blue Cross Blue Shield blue cross blue shield medicare advantage plan ppo and hmo [1099] professional · fee schedule · outpatient | $949 | $949 | — | — | — | $949 – $949 |
| 9 | Medica medica dual solution msho medicare advantage plan [1004] professional · fee schedule · outpatient | $967 | $967 | — | — | — | $967 – $967 |
| 10 | Blue Cross Blue Shield mc xr pb bcbs platinum blue medicare advantage plan [935] professional · fee schedule · outpatient | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 11 | Ucare ucare essentia care medicare advantage plan [775] professional · fee schedule · outpatient | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 12 | Healthpartners healthpartners part b medicare advantage plan [496] professional · fee schedule · outpatient | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 13 | Blue Cross Blue Shield blue cross blue shield federal retiree [949] professional · fee schedule · outpatient | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 14 | Blue Cross Blue Shield blue cross blue shield mayo aco [612] professional · percent of total billed charges · outpatientfrom % of charges | $17.9k | $17.9k | — | — | — | $17.9k – $17.9k |
| 15 | Ucare swwi ucare ifp [1112] professional · percent of total billed charges · outpatientfrom % of charges | $17.9k | $17.9k | — | — | — | $17.9k – $17.9k |
| 16 | Blue Cross Blue Shield blue cross blue shield fep [869] professional · percent of total billed charges · outpatientfrom % of charges | $18.0k | $18.0k | — | — | — | $18.0k – $18.0k |
| 17 | Anthem blue cross blue shield by payor [178] professional · percent of total billed charges · outpatientfrom % of charges | $18.3k | $18.3k | — | — | — | $18.3k – $18.3k |
| 18 | Blue Cross Blue Shield blue cross blue shield by payor [178] professional · percent of total billed charges · outpatientfrom % of charges | $18.3k | $18.3k | — | — | — | $18.3k – $18.3k |
| 19 | Blue Cross Blue Shield complex care [808] professional · percent of total billed charges · outpatientfrom % of charges | $18.3k | $18.3k | — | — | — | $18.3k – $18.3k |
| 20 | Blue Cross Blue Shield transplant bcbs [1141] professional · percent of total billed charges · outpatientfrom % of charges | $18.3k | $18.3k | — | — | — | $18.3k – $18.3k |
| 21 | Healthpartners complex care [808] professional · percent of total billed charges · outpatientfrom % of charges | $18.3k | $18.3k | — | — | — | $18.3k – $18.3k |
| 22 | Medica deanhp by medica west mc hmo [1263] professional · percent of total billed charges · outpatientfrom % of charges | $18.3k | $18.3k | — | — | — | $18.3k – $18.3k |
| 23 | Medica medica engage [666] professional · percent of total billed charges · outpatientfrom % of charges | $18.3k | $18.3k | — | — | — | $18.3k – $18.3k |
| 24 | Medica medica ifb midlands choice ia and ne [48] professional · percent of total billed charges · outpatientfrom % of charges | $18.3k | $18.3k | — | — | — | $18.3k – $18.3k |
| 25 | Medica medica non mayo employees group [755] professional · percent of total billed charges · outpatientfrom % of charges | $18.3k | $18.3k | — | — | — | $18.3k – $18.3k |
Last updated: Aug 14, 2026
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