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
Bronx, NY
See all hospitals reporting CPT 0755T →Price type
Montefiore Medical Center’s median price of $86 is 22% above the median hospital's median price ($71), higher than 54% 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: 1 payer, 7 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 | Anthem connection sg fee schedule · outpatient | $76.88 | $76.88 | $76.88 – $76.88 |
| 2 | Anthem sg epo/ppo fee schedule · outpatient | $81.67 | $81.67 | $81.67 – $81.67 |
| 3 | Anthem blue access fee schedule · outpatient | $86.46 | $86.46 | $86.46 – $86.46 |
| 4 | Anthem connection lg fee schedule · outpatient | $86.46 | $86.46 | $86.46 – $86.46 |
| 5 | Anthem epo ppo fee schedule · outpatient | $96.17 | $96.17 | $96.17 – $96.17 |
| 6 | Anthem hmo fee schedule · outpatient | $100.00 | $100.00 | $100.00 – $100.00 |
| 7 | Anthem indemnity fee schedule · outpatient | $114.23 | $114.23 | $114.23 – $114.23 |
Last updated: Sep 28, 2026
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