CPT 91122

Test - Miscellaneous

Retired code28 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.

This code is retired. Some hospitals still list it.

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 91122 by hospital
Hospital	Medicaid managed care rates (lowest – highest)	Cash price	List price (before discounts)
Legacy Salmon Creek Medical CenterVancouverFile dated 2026-04-01	—	$157 – $497	$241 – $764
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01	—	$1,124	$2,248
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01	—	$1,196	$1,708
Providence St Joseph HospitalChewelahFile dated 2026-04-01	—	$624	$891
Seattle Children's HospitalSeattle	$170 – $1809 plansDoctor’s fee: $51.21 – $54.69	$359	$359Doctor’s fee: $268
Skagit Valley HospitalMount Vernon	$101 – $2884 plans	$1,100	$1,375
Swedish IssaquahIssaquahFile dated 2026-04-01	—	$790	$1,646
Swedish Medical CenterSeattleFile dated 2026-04-01	—	$790	$1,646
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01	—	$790	$1,646
Virginia Mason Medical CenterSeattle	—	$652	$1,279

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

CMS publishes no national amount for this code.