▸ Hospital · IL · CCN 140184
Heartland Regional Medical Center
917 WEST MAIN ST, MARION, IL, 140184
Compliance grade
A
100/100
Procedures tracked
201
of 209 target codes
Payers
25
with negotiated rates
Rates published
117,164
last crawl 2026-05-23
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 16 | — | — | $10,455 | $11,170 | $31,365 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 23 | $350 | $122.5 | $122.11 | $167.49 | $477.33 |
| Psychiatric eval with medical services | CPT | 90792 | 23 | $380 | $133 | $124.44 | $167.49 | $477.33 |
| Psychotherapy 30 minutes | CPT | 90832 | 23 | $159 | $55.65 | $46.98 | $102.34 | $477.33 |
| Psychotherapy 45 minutes | CPT | 90834 | 23 | $188 | $65.8 | $62.03 | $135.14 | $477.33 |
| Psychotherapy 60 minutes | CPT | 90837 | 23 | $298 | $104.3 | $91.58 | $167.49 | $477.33 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 23 | $295 | $103.25 | $88.59 | $167.49 | $477.33 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 25 | $779.83 | $148.17 | $10.42 | $92.7 | $701.85 |
| ED visit level 2 | CPT | 99282 | 25 | $1,288.75 | $244.87 | $28.88 | $165.08 | $1,159.88 |
| ED visit level 3 | CPT | 99283 | 25 | $2,056.4 | $390.72 | $49.16 | $288.64 | $1,850.76 |
| ED visit level 4 | CPT | 99284 | 25 | $3,273.78 | $622.02 | $83.69 | $443.88 | $2,946.4 |
| ED visit level 5 | CPT | 99285 | 25 | $4,836.98 | $919.03 | $121.28 | $639.11 | $4,353.28 |
| Critical care, first hour | CPT | 99291 | 25 | $7,100.79 | $1,349.16 | $145.5 | $878.35 | $6,390.71 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 25 | $3,007.29 | $571.39 | $35.78 | $116.39 | $2,706.56 |
| CT head with contrast | CPT | 70460 | 25 | $5,026.52 | $955.04 | $82.4 | $399.9 | $4,523.87 |
| CT head with and without contrast | CPT | 70470 | 25 | $5,644.06 | $1,072.38 | $82.25 | $299 | $5,079.65 |
| CT neck with contrast | CPT | 70491 | 25 | $5,026.52 | $955.04 | $61.14 | $296.91 | $4,523.87 |
| MRI brain without contrast | CPT | 70551 | 25 | $5,019.53 | $953.72 | $109.58 | $465.85 | $4,517.58 |
| MRI brain with contrast | CPT | 70552 | 25 | $6,088.78 | $1,156.87 | $136.14 | $892.14 | $5,479.9 |
| MRI brain with and without contrast | CPT | 70553 | 25 | $7,689.05 | $1,460.92 | $151.2 | $702.1 | $6,920.15 |
| Chest X-ray single view | CPT | 71045 | 25 | $503.72 | $95.71 | $5.7 | $40.49 | $453.35 |
| Chest X-ray 2 views | CPT | 71046 | 25 | $641.5 | $121.89 | $7.03 | $52.02 | $577.35 |
| Chest X-ray 3 views | CPT | 71047 | 25 | $849.46 | $161.4 | $18.5 | $92.25 | $764.51 |
| CT chest without contrast | CPT | 71250 | 25 | $3,202.76 | $608.53 | $45.31 | $159.34 | $2,882.48 |
| CT chest with contrast | CPT | 71260 | 25 | $5,026.52 | $955.04 | $48.82 | $194.85 | $4,523.87 |
| CT chest with and without contrast | CPT | 71270 | 25 | $5,644.06 | $1,072.38 | $66.23 | $346.85 | $5,079.65 |
| MRI chest without contrast | CPT | 71550 | 25 | $5,019.53 | $953.72 | $111.8 | $793.92 | $4,517.58 |
| MRI chest with contrast | CPT | 71551 | 25 | $6,088.78 | $1,156.87 | $132.4 | $951.48 | $5,479.9 |
| MRI chest with and without contrast | CPT | 71552 | 25 | $7,689.05 | $1,460.92 | $172.8 | $1,093 | $6,920.15 |
| Lumbosacral spine X-ray | CPT | 72100 | 25 | $968.25 | $183.97 | $14.35 | $90.1 | $871.43 |
| CT cervical spine without contrast | CPT | 72125 | 25 | $3,202.76 | $608.53 | $44.53 | $235.55 | $2,882.48 |
| CT thoracic spine without contrast | CPT | 72128 | 25 | $3,301.09 | $627.21 | $44.53 | $235.2 | $2,970.98 |
| CT lumbar spine without contrast | CPT | 72131 | 25 | $3,301.09 | $627.21 | $41.66 | $168.73 | $2,970.98 |
| MRI cervical spine without contrast | CPT | 72141 | 25 | $5,019.53 | $953.72 | $62.31 | $258.27 | $4,517.58 |
| MRI thoracic spine without contrast | CPT | 72146 | 25 | $5,019.53 | $953.72 | $62.31 | $258.27 | $4,517.58 |
| MRI lumbar spine without contrast | CPT | 72148 | 25 | $5,019.53 | $953.72 | $62.31 | $262.05 | $4,517.58 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 25 | $6,088.78 | $1,156.87 | $75.63 | $372.28 | $5,479.9 |
| MRI cervical spine with and without contrast | CPT | 72156 | 25 | $7,689.05 | $1,460.92 | $175 | $703.15 | $6,920.15 |
| MRI lumbar spine with contrast | CPT | 72158 | 25 | $7,689.05 | $1,460.92 | $91.95 | $390.89 | $6,920.15 |
| CT pelvis without contrast | CPT | 72192 | 25 | $3,301.09 | $627.21 | $44.22 | $119.18 | $2,970.98 |
| CT pelvis with contrast | CPT | 72193 | 25 | $5,026.52 | $955.04 | $49.54 | $194.85 | $4,523.87 |
| Shoulder X-ray | CPT | 73030 | 25 | $683.23 | $129.82 | $11.26 | $87.2 | $614.91 |
| Humerus X-ray | CPT | 73060 | 25 | $704.2 | $133.8 | $10.3 | $75.65 | $633.78 |
| Hand X-ray 3 views | CPT | 73130 | 25 | $783.26 | $148.82 | $11.98 | $77.35 | $704.93 |
| MRI upper extremity joint without contrast | CPT | 73221 | 25 | $5,019.53 | $953.72 | $96.1 | $433.3 | $4,517.58 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 25 | $7,689.05 | $1,460.92 | $165 | $1,061 | $6,920.15 |
| Hip X-ray 2 views | CPT | 73510 | 11 | $118 | $41.3 | $25.9 | $63.9 | $106.2 |
| Knee X-ray 1-2 views | CPT | 73560 | 25 | $683.23 | $129.82 | $11.03 | $83.3 | $614.91 |
| Ankle X-ray 3 views | CPT | 73610 | 25 | $796.51 | $151.34 | $13.6 | $77.7 | $716.86 |
| MRI lower extremity joint without contrast | CPT | 73721 | 25 | $5,019.53 | $953.72 | $96.25 | $431.2 | $4,517.58 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 25 | $7,689.05 | $1,460.92 | $164.5 | $1,061 | $6,920.15 |
| CT abdomen without contrast | CPT | 74150 | 25 | $3,301.09 | $627.21 | $45.47 | $128.89 | $2,970.98 |
| CT abdomen with contrast | CPT | 74160 | 25 | $5,026.52 | $955.04 | $53.37 | $194.85 | $4,523.87 |
| CT abdomen with and without contrast | CPT | 74170 | 25 | $5,644.06 | $1,072.38 | $58.38 | $220.22 | $5,079.65 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 25 | $6,014.6 | $1,142.78 | $55.48 | $300.9 | $5,413.14 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 25 | $9,158.33 | $1,740.09 | $57.95 | $390.89 | $8,242.5 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 25 | $11,288 | $2,144.74 | $63.87 | $443.85 | $10,159 |
| MRI abdomen without contrast | CPT | 74181 | 25 | $5,019.53 | $953.72 | $93.05 | $416.85 | $4,517.58 |
| MRI abdomen with and without contrast | CPT | 74183 | 25 | $7,689.05 | $1,460.92 | $159.98 | $701.4 | $6,920.15 |
| Abdominal ultrasound complete | CPT | 76700 | 25 | $1,812.08 | $344.3 | $26.56 | $111.98 | $1,630.87 |
| Abdominal ultrasound limited | CPT | 76705 | 25 | $1,398.78 | $265.77 | $21.32 | $100.53 | $1,258.9 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 25 | $1,809.03 | $343.72 | $37.95 | $116.39 | $1,628.13 |
| Obstetric ultrasound first trimester | CPT | 76801 | 25 | $1,125.94 | $213.93 | $31.49 | $110.85 | $1,013.35 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 25 | $1,875.07 | $356.27 | $31.69 | $121.42 | $1,687.56 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 25 | $732.43 | $209.65 | $60.07 | $248.84 | $718.13 |
| Transvaginal ultrasound | CPT | 76830 | 25 | $1,676.91 | $318.62 | $29.17 | $110.85 | $1,509.22 |
| Pelvic ultrasound complete | CPT | 76856 | 25 | $1,676.91 | $318.62 | $28.89 | $110.85 | $1,509.22 |
| Scrotal ultrasound | CPT | 76870 | 25 | $1,698.78 | $322.77 | $26.84 | $110.85 | $1,528.9 |
| Diagnostic mammography unilateral | CPT | 77065 | 25 | $605.85 | $115.12 | $57.75 | $202.8 | $545.27 |
| Diagnostic mammography bilateral | CPT | 77066 | 25 | $768.06 | $145.94 | $70 | $256.95 | $691.25 |
| Screening mammography bilateral | CPT | 77067 | 25 | $616.63 | $117.16 | $50.4 | $206.57 | $2,186 |
| EKG complete | CPT | 93000 | 22 | $82 | $28.7 | $12.32 | $13.62 | $73.8 |
| EKG tracing only | CPT | 93005 | 25 | $504.12 | $95.79 | $5.47 | $61.92 | $453.71 |
| EKG interpretation only | CPT | 93010 | 22 | $49 | $17.15 | $7.07 | $7.81 | $44.1 |
| Transthoracic echocardiogram complete | CPT | 93306 | 25 | $12,745 | $2,421.59 | $45.71 | $353.72 | $11,471 |
| Transthoracic echocardiogram | CPT | 93307 | 25 | $8,386.71 | $1,593.48 | $32.76 | $181.3 | $7,548.04 |
| Stress echocardiogram | CPT | 93350 | 25 | $7,095.41 | $1,348.13 | $59.88 | $225.39 | $6,385.87 |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 16 | — | — | $14,906 | $15,926 | $44,719 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 16 | — | — | $7,653.98 | $8,177.68 | $22,962 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 16 | — | — | $5,292.05 | $5,654.14 | $15,876 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 16 | — | — | $11,657 | $12,455 | $34,972 |
| COPD w MCC | MS-DRG | 190 | 16 | — | — | $8,359.86 | $8,931.85 | $25,080 |
| COPD w CC | MS-DRG | 191 | 16 | — | — | $6,441.48 | $6,882.22 | $19,324 |
| COPD w/o CC/MCC | MS-DRG | 192 | 16 | — | — | $4,984.76 | $5,325.83 | $14,954 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 16 | — | — | $6,172.62 | $6,594.95 | $18,518 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 16 | — | — | $4,886.91 | $5,221.28 | $14,661 |
| AMI discharged alive w MCC | MS-DRG | 280 | 16 | — | — | $11,957 | $12,776 | $35,872 |
| AMI discharged alive w CC | MS-DRG | 281 | 16 | — | — | $6,993.02 | $7,471.49 | $20,979 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 16 | — | — | $5,572.53 | $5,953.81 | $16,718 |
| Heart failure & shock w MCC | MS-DRG | 291 | 16 | — | — | $9,636.14 | $10,295 | $28,908 |
| Heart failure & shock w CC | MS-DRG | 292 | 16 | — | — | $6,484.97 | $6,928.68 | $19,455 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 16 | — | — | $4,433.95 | $4,737.33 | $13,302 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 16 | — | — | $9,057.79 | $9,677.54 | $27,173 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 16 | — | — | $5,663.83 | $6,051.36 | $16,992 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 16 | — | — | $4,434.68 | $4,738.1 | $13,304 |
| GI hemorrhage w CC | MS-DRG | 378 | 16 | — | — | $7,439.46 | $7,948.48 | $22,318 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 16 | — | — | $4,900.68 | $5,235.99 | $14,702 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 16 | — | — | $5,982.01 | $6,391.31 | $17,946 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 16 | — | — | $11,694 | $12,494 | $35,081 |
| Kidney/UTI w MCC | MS-DRG | 689 | 16 | — | — | $8,741.09 | $9,339.17 | $26,223 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 16 | — | — | $6,198.7 | $6,622.83 | $18,596 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 16 | — | — | $14,410 | $15,396 | $43,230 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 16 | — | — | $7,748.2 | $8,278.34 | $23,245 |
| Initial hospital care, low complexity | CPT | 99221 | 22 | $218 | $76.3 | $61.76 | $78.31 | $213.96 |
| Initial hospital care, moderate complexity | CPT | 99222 | 22 | $322 | $112.7 | $88.82 | $122.84 | $339.62 |
| Initial hospital care, high complexity | CPT | 99223 | 22 | $468 | $163.8 | $121.97 | $163.56 | $453.32 |
| Hospital discharge, <30 min | CPT | 99238 | 22 | $191 | $66.85 | $54.59 | $76.12 | $211.64 |
| Hospital discharge, >30 min | CPT | 99239 | 22 | $263 | $92.05 | $77.02 | $107.49 | $299.7 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 25 | $365.14 | $69.38 | $3.5 | $13.54 | $328.63 |
| General health panel | CPT | 80050 | 10 | $145 | $50.75 | $3.5 | $110.49 | $130.5 |
| Electrolyte panel | CPT | 80051 | 25 | $302.76 | $57.53 | $3.5 | $18.22 | $272.48 |
| Comprehensive metabolic panel | CPT | 80053 | 25 | $394.28 | $74.92 | $3.5 | $28.7 | $354.85 |
| Lipid panel | CPT | 80061 | 25 | $499.74 | $94.96 | $3.5 | $30.1 | $449.77 |
| Renal function panel | CPT | 80069 | 25 | $374.47 | $71.15 | $3.5 | $21.82 | $337.02 |
| Hepatic function panel | CPT | 80076 | 25 | $352.48 | $66.98 | $3.5 | $13.07 | $317.23 |
| Urinalysis non-automated | CPT | 81002 | 24 | $18 | $6.3 | $3.31 | $3.53 | $16.2 |
| Urinalysis automated | CPT | 81003 | 25 | $97.01 | $18.44 | $2.14 | $3.6 | $87.31 |
| Glucose quantitative | CPT | 82947 | 25 | $169.28 | $32.17 | $3.5 | $6.29 | $152.35 |
| Hemoglobin A1c | CPT | 83036 | 25 | $418.74 | $79.57 | $3.5 | $15.54 | $376.87 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 25 | $626.57 | $119.05 | $3.5 | $81.6 | $563.91 |
| Complete blood count with automated differential | CPT | 85025 | 25 | $290.1 | $55.12 | $3.5 | $17.37 | $261.09 |
| Complete blood count without differential | CPT | 85027 | 25 | $270.94 | $51.48 | $2.11 | $16.05 | $243.85 |
| Urine culture bacterial | CPT | 87086 | 25 | $174.28 | $33.12 | $3.5 | $12.91 | $156.85 |
| Urine culture identification | CPT | 87088 | 24 | $59 | $20.65 | $3.5 | $8.09 | $53.1 |
| Tissue exam by pathologist level IV | CPT | 88305 | 25 | $1,340.31 | $254.66 | $22.47 | $58.48 | $1,206.28 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 25 | $689.32 | $130.98 | $7.9 | $116 | $620.39 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 22 | $6,700 | $2,345 | $1,840.25 | $2,372.62 | $6,581.99 |
| Vaginal delivery only | CPT | 59409 | 22 | $3,200 | $1,120 | $754.44 | $1,984 | $9,446.06 |
| Vaginal delivery with postpartum | CPT | 59410 | 22 | $3,663 | $1,282.05 | $896.73 | $1,072.54 | $3,296.7 |
| Routine obstetric care with C-section | CPT | 59510 | 22 | $7,200 | $2,520 | $2,046.31 | $2,652.52 | $7,365.44 |
| C-section delivery only | CPT | 59514 | 22 | $3,268 | $1,143.8 | $745.8 | $915.12 | $2,941.2 |
| C-section with postpartum | CPT | 59515 | 22 | $3,524 | $1,233.4 | $1,070.45 | $1,336.85 | $3,709.68 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 23 | $172 | $60.2 | $32.21 | $65.78 | $187.46 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 23 | $249 | $87.15 | $55.95 | $102.28 | $291.5 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 23 | $369 | $129.15 | $90.81 | $153.78 | $438.26 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 23 | $451 | $157.85 | $123.49 | $202.95 | $578.4 |
| Office visit, established patient, 5 min | CPT | 99211 | 23 | $55 | $19.25 | $7.76 | $19.25 | $60.39 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 23 | $105 | $36.75 | $24.25 | $51.76 | $147.51 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 23 | $170 | $59.5 | $44.67 | $83.88 | $239.06 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 23 | $248 | $86.8 | $65.79 | $118.14 | $336.7 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 23 | $327 | $114.45 | $97.69 | $166.04 | $473.21 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 23 | $905 | $316.75 | $110.04 | $319.01 | $2,785.39 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 23 | $1,075 | $376.25 | $123.49 | $376.25 | $2,785.39 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 23 | $389 | $136.15 | $54.73 | $209.84 | $2,708.6 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 23 | $525 | $183.75 | $65.22 | $188.02 | $2,708.6 |
| Colonoscopy diagnostic | CPT | 45378 | 23 | $1,269 | $444.15 | $165.78 | $481.13 | $2,708.6 |
| Colonoscopy with biopsy | CPT | 45380 | 23 | $1,517 | $530.95 | $180.37 | $530.95 | $3,502.93 |
| Colonoscopy with polyp removal | CPT | 45385 | 23 | $1,698 | $594.3 | $226.96 | $661.2 | $3,502.93 |
| surgery | ||||||||
| Total shoulder arthroplasty | CPT | 23472 | 22 | $5,450 | $1,907.5 | $1,329.16 | $3,379 | $54,635 |
| Hip hemiarthroplasty | CPT | 27125 | 22 | $5,080 | $1,778 | $969.41 | $1,098.67 | $4,572 |
| Total hip replacement | CPT | 27130 | 22 | $6,157 | $2,154.95 | $1,184.66 | $3,426.64 | $38,226 |
| Total knee replacement | CPT | 27447 | 22 | $6,094 | $2,132.9 | $1,183.11 | $3,420.96 | $38,226 |
| Knee revision arthroplasty single component | CPT | 27486 | 22 | $4,453 | $1,558.55 | $972.13 | $1,362.92 | $4,007.7 |
| Knee revision arthroplasty all components | CPT | 27487 | 22 | $6,529 | $2,285.15 | $1,473.3 | $1,699.86 | $5,876.1 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 22 | $3,876 | $1,356.6 | $145.18 | $168.37 | $3,488.4 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 22 | $4,850 | $1,697.5 | $738.81 | $2,843.32 | $21,223 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 22 | $3,400 | $1,190 | $186.55 | $946.77 | $9,639.4 |
| ACL reconstruction | CPT | 29888 | 22 | $6,870 | $2,404.5 | $673.62 | $3,812.85 | $21,223 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 16 | — | — | $33,645 | $35,947 | $100,934 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 16 | — | — | $17,705 | $18,917 | $53,116 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 16 | — | — | $12,529 | $13,386 | $37,586 |
| CABG single arterial graft | CPT | 33533 | 22 | $8,296 | $2,903.6 | $1,540.26 | $1,837 | $7,466.4 |
| CABG 2 arterial grafts | CPT | 33534 | 22 | $9,863 | $3,452.05 | $1,809.17 | $2,159.06 | $8,876.7 |
| CABG 3 arterial grafts | CPT | 33535 | 22 | $10,505 | $3,676.75 | $2,010.73 | $2,397.4 | $9,454.5 |
| CABG 4+ arterial grafts | CPT | 33536 | 22 | $5,992 | $2,097.2 | $2,097.2 | $2,393.35 | $7,081.3 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 16 | — | — | $12,592 | $13,453 | $37,775 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 16 | — | — | $10,230 | $10,930 | $30,691 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 16 | — | — | $25,025 | $26,737 | $75,074 |
| Open appendectomy | CPT | 44950 | 22 | $2,310 | $808.5 | $453.3 | $1,432.2 | $18,538 |
| Laparoscopic appendectomy | CPT | 44970 | 22 | $1,950 | $682.5 | $424.25 | $1,215.53 | $17,333 |
| Major joint replacement w MCC | MS-DRG | 469 | 16 | — | — | $22,315 | $23,842 | $66,944 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 16 | — | — | $14,311 | $15,291 | $42,934 |
| Laparoscopic cholecystectomy | CPT | 47562 | 22 | $2,906 | $1,017.1 | $619.25 | $1,793.04 | $17,333 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 22 | $3,421 | $1,197.35 | $506.77 | $1,950.32 | $17,333 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 16 | — | — | $21,439 | $22,905 | $64,316 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 16 | — | — | $15,512 | $16,573 | $46,535 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 16 | — | — | $12,152 | $12,984 | $36,457 |
| Open umbilical hernia repair | CPT | 49560 | 11 | $2,558 | $895.3 | $895.3 | $1,918.5 | $2,302.2 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 11 | $1,828 | $639.8 | $639.8 | $1,371 | $1,645.2 |
| Lap inguinal hernia repair | CPT | 49650 | 22 | $1,889 | $661.15 | $387.05 | $1,171.18 | $17,333 |
| Lap incisional hernia repair | CPT | 49652 | 11 | $2,800 | $980 | $980 | $2,100 | $2,520 |
| Total abdominal hysterectomy | CPT | 58150 | 22 | $4,520 | $1,582 | $772.7 | $983.24 | $4,068 |
| Vaginal hysterectomy | CPT | 58260 | 22 | $4,413 | $1,544.55 | $725.6 | $2,449.22 | $14,666 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 22 | $4,250 | $1,487.5 | $725.6 | $2,362.24 | $17,333 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 22 | $4,381 | $1,533.35 | $725 | $2,624.82 | $30,931 |
| Lap salpingo-oophorectomy | CPT | 58661 | 22 | $4,000 | $1,400 | $480 | $2,220 | $17,333 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 16 | — | — | $21,258 | $22,713 | $63,774 |
| OR procedure for obesity w CC | MS-DRG | 620 | 16 | — | — | $11,930 | $12,746 | $35,790 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 16 | — | — | $11,264 | $12,035 | $33,792 |
| Complex cataract surgery | CPT | 66982 | 22 | $3,938 | $1,378.3 | $587.6 | $2,185.59 | $6,775.81 |
| Cataract surgery with lens implant | CPT | 66984 | 22 | $3,841 | $1,344.35 | $473.52 | $2,131.76 | $6,775.81 |
| Intravitreal injection | CPT | 67028 | 23 | $790 | $276.5 | $81.18 | $276.5 | $985.42 |
| Vitrectomy mechanical | CPT | 67042 | 22 | $4,421 | $1,547.35 | $753.46 | $2,741.02 | $11,952 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 16 | — | — | $9,323.77 | $9,961.71 | $27,971 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 16 | — | — | $15,183 | $16,221 | $45,548 |
| PCI single major coronary artery | CPT | 92920 | 22 | $1,446 | $506.1 | $366.81 | $896.52 | $16,939 |
| PCI with drug-eluting stent | CPT | 92928 | 22 | $1,650 | $577.5 | $408.11 | $1,023 | $33,692 |
| PCI bypass graft | CPT | 92937 | 22 | $1,650 | $577.5 | $408.19 | $1,023 | $33,692 |
| Left heart catheterization | CPT | 93452 | 25 | $59,492 | $11,304 | $162.24 | $1,993.5 | $53,543 |
| Coronary angiography with cath | CPT | 93455 | 25 | $51,223 | $9,732.34 | $191.06 | $2,364.3 | $46,101 |
| Coronary angiography with bypass cath | CPT | 93458 | 25 | $62,136 | $11,806 | $202.36 | $2,437.2 | $55,923 |
Payer mix (top 25)
| Payer | Codes covered | Median rate |
|---|---|---|
| prime health services | 201 | $353.67 |
| Humana | 201 | $266.03 |
| UnitedHealthcare | 201 | $325.5 |
| Aetna | 201 | $211.3 |
| alter-net medical services, inc. | 200 | $402.6 |
| alliance coal | 200 | $264.84 |
| Blue Cross Blue Shield | 197 | $222.06 |
| WellCare | 196 | $125.68 |
| care improvement plus | 196 | $379.73 |
| deaconess onecare | 196 | $198.16 |
| hope trust | 196 | $1,061 |
| meridian health plan | 196 | $124.44 |
| Molina | 196 | $115.86 |
| mytru advantage | 196 | $162.55 |
| noncontracted | 196 | $260.08 |
| umwa | 196 | $162.55 |
| First Health | 158 | $701.85 |
| Cigna | 158 | $432.81 |
| national provider network | 158 | $662.86 |
| healthcare's finest network (hfn) | 158 | $662.86 |
| Self-Pay (Cash) | 158 | $235.38 |
| Multiplan | 153 | $442.85 |
| healthlink | 108 | $748.32 |
| dhp encore combine | 87 | $877.04 |
| dhp encore prime | 87 | $789.33 |