CPT 42405

Other Organ Systems

Current code39 hospitals with prices

This name is the CMS category the code belongs to (CMS's Restructured BETOS Classification System), shared with similar codes. The official CPT description belongs to the American Medical Association and isn't shown.

What Washington hospitals publish for this code

Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.

Prices for CPT 42405 by hospital
Hospital	Medicaid managed care rates (lowest – highest)	Cash price	List price (before discounts)
EvergreenHealth Medical CenterKirkland	—	$3,603	$4,504
EvergreenHealth MonroeMonroe	$1,6681 plan	$3,603	$4,504
Harborview Medical CenterSeattleFile dated 2026-04-01	—	$8,678	$12,397
Legacy Salmon Creek Medical CenterVancouverFile dated 2026-04-01	—	$558	$858
Seattle Children's HospitalSeattle	$137 – $1479 plans	—	$958
University of Washington Medical CtrSeattleFile dated 2026-04-01	—	$2,626	$3,751
Virginia Mason Medical CenterSeattle	—	$3,427	$6,720

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.

Doctor's fee, Seattle (King County): $351 in an office; $222 in a hospital or surgery center
Doctor's fee, rest of Washington: $314 in an office; $204 in a hospital or surgery center
Hospital outpatient payment (national): $1,585 (APC 5163)
Surgery center payment (national): $659