▸ Hospital · OH · CCN 361331
Adena Fayette Medical Center
1430 COLUMBUS AVE, WASHINGTON COURT HOUSE, OH, 43160
25 bedsCritical Access Hospitals2
Compliance grade
A
100/100
Procedures tracked
108
of 209 target codes
Payers
18
with negotiated rates
Rates published
35,844
last crawl 2026-05-24
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychotherapy 30 minutes | CPT | 90832 | 18 | $562.35 | $281.18 | $191.2 | $372.84 | $635.46 |
| Psychotherapy 45 minutes | CPT | 90834 | 18 | $562.35 | $281.18 | $191.2 | $372.84 | $635.46 |
| Psychotherapy 60 minutes | CPT | 90837 | 18 | $562.35 | $281.18 | $191.2 | $372.84 | $635.46 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 18 | $339.79 | $169.9 | $115.53 | $225.28 | $383.96 |
| ED visit level 2 | CPT | 99282 | 18 | $554.26 | $277.13 | $188.45 | $367.47 | $626.31 |
| ED visit level 3 | CPT | 99283 | 18 | $1,087.3 | $543.65 | $369.68 | $720.88 | $1,228.65 |
| ED visit level 4 | CPT | 99284 | 18 | $1,772.81 | $886.41 | $602.76 | $1,175.37 | $2,003.28 |
| ED visit level 5 | CPT | 99285 | 18 | $2,145.85 | $1,072.93 | $729.59 | $1,422.7 | $2,424.81 |
| Critical care, first hour | CPT | 99291 | 18 | $2,949.14 | $1,474.57 | $1,002.71 | $1,955.28 | $3,332.53 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 18 | $1,528.63 | $764.32 | $519.73 | $1,013.48 | $1,727.35 |
| CT head with contrast | CPT | 70460 | 18 | $2,016.23 | $1,008.12 | $685.52 | $1,281.31 | $2,278.34 |
| CT head with and without contrast | CPT | 70470 | 18 | $2,390.46 | $1,195.23 | $812.76 | $1,519.14 | $2,701.22 |
| CT neck with contrast | CPT | 70491 | 18 | $2,016.23 | $1,008.12 | $685.52 | $1,281.31 | $2,278.34 |
| MRI brain without contrast | CPT | 70551 | 18 | $2,319.65 | $1,159.83 | $788.68 | $1,537.93 | $2,621.2 |
| MRI brain with contrast | CPT | 70552 | 18 | $2,517.04 | $1,258.52 | $855.79 | $1,668.8 | $2,844.26 |
| MRI brain with and without contrast | CPT | 70553 | 18 | $2,990.35 | $1,495.18 | $1,016.72 | $1,982.6 | $3,379.1 |
| Chest X-ray single view | CPT | 71045 | 18 | $346.87 | $173.44 | $117.94 | $238.99 | $391.96 |
| Chest X-ray 2 views | CPT | 71046 | 18 | $346.87 | $173.44 | $117.94 | $238.99 | $391.96 |
| Chest X-ray 3 views | CPT | 71047 | 18 | $346.87 | $173.44 | $117.94 | $238.99 | $391.96 |
| CT chest without contrast | CPT | 71250 | 18 | $1,528.63 | $764.32 | $519.73 | $1,013.48 | $1,727.35 |
| CT chest with contrast | CPT | 71260 | 18 | $2,016.23 | $1,008.12 | $685.52 | $1,281.31 | $2,278.34 |
| CT chest with and without contrast | CPT | 71270 | 18 | $2,390.46 | $1,195.23 | $812.76 | $1,519.14 | $2,701.22 |
| MRI chest without contrast | CPT | 71550 | 18 | $1,697.4 | $848.7 | $577.12 | $1,125.38 | $2,000 |
| MRI chest with contrast | CPT | 71551 | 18 | $2,924.57 | $1,462.29 | $994.35 | $1,938.99 | $3,304.76 |
| MRI chest with and without contrast | CPT | 71552 | 18 | $3,207.35 | $1,603.68 | $1,090.5 | $2,038.27 | $3,624.31 |
| Lumbosacral spine X-ray | CPT | 72100 | 18 | $372.19 | $186.1 | $126.54 | $256.44 | $420.57 |
| CT cervical spine without contrast | CPT | 72125 | 18 | $1,528.63 | $764.32 | $519.73 | $1,013.48 | $1,727.35 |
| CT thoracic spine without contrast | CPT | 72128 | 18 | $1,528.63 | $764.32 | $519.73 | $1,013.48 | $1,727.35 |
| CT lumbar spine without contrast | CPT | 72131 | 18 | $1,528.63 | $764.32 | $519.73 | $1,013.48 | $1,727.35 |
| MRI cervical spine without contrast | CPT | 72141 | 18 | $2,301.92 | $1,150.96 | $782.65 | $1,526.17 | $2,601.17 |
| MRI thoracic spine without contrast | CPT | 72146 | 18 | $2,311.27 | $1,155.64 | $785.83 | $1,532.37 | $2,611.74 |
| MRI lumbar spine without contrast | CPT | 72148 | 18 | $2,288.5 | $1,144.25 | $778.09 | $1,517.28 | $2,586.01 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 18 | $2,587.5 | $1,293.75 | $879.75 | $1,715.51 | $2,923.88 |
| MRI cervical spine with and without contrast | CPT | 72156 | 18 | $2,975.49 | $1,487.75 | $1,011.67 | $1,972.75 | $3,362.3 |
| MRI lumbar spine with contrast | CPT | 72158 | 18 | $2,932.5 | $1,466.25 | $997.05 | $1,944.25 | $3,313.73 |
| CT pelvis without contrast | CPT | 72192 | 18 | $1,528.63 | $764.32 | $519.73 | $1,013.48 | $1,727.35 |
| CT pelvis with contrast | CPT | 72193 | 18 | $2,016.23 | $1,008.12 | $685.52 | $1,281.31 | $2,278.34 |
| Shoulder X-ray | CPT | 73030 | 18 | $707.02 | $353.51 | $240.39 | $487.14 | $798.93 |
| Humerus X-ray | CPT | 73060 | 18 | $353.51 | $176.76 | $120.19 | $243.57 | $399.47 |
| Hand X-ray 3 views | CPT | 73130 | 18 | $707.02 | $353.51 | $240.39 | $487.14 | $798.93 |
| MRI upper extremity joint without contrast | CPT | 73221 | 18 | $2,188.24 | $1,094.12 | $744 | $1,450.8 | $2,472.71 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 18 | $3,022.06 | $1,511.03 | $1,027.5 | $2,000 | $3,414.93 |
| Knee X-ray 1-2 views | CPT | 73560 | 18 | $707.02 | $353.51 | $240.39 | $487.14 | $798.93 |
| Ankle X-ray 3 views | CPT | 73610 | 18 | $707.02 | $353.51 | $240.39 | $487.14 | $798.93 |
| MRI lower extremity joint without contrast | CPT | 73721 | 18 | $4,232 | $2,116 | $1,438.88 | $2,689.44 | $4,782.16 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 18 | $5,750 | $2,875 | $1,955 | $3,654.13 | $6,497.5 |
| CT abdomen without contrast | CPT | 74150 | 18 | $1,528.63 | $764.32 | $519.73 | $1,013.48 | $1,727.35 |
| CT abdomen with contrast | CPT | 74160 | 18 | $2,016.23 | $1,008.12 | $685.52 | $1,281.31 | $2,278.34 |
| CT abdomen with and without contrast | CPT | 74170 | 18 | $2,390.46 | $1,195.23 | $812.76 | $1,519.14 | $2,701.22 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 18 | $3,053.6 | $1,526.8 | $1,038.22 | $1,940.56 | $3,450.57 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 18 | $4,032.45 | $2,016.23 | $1,250 | $2,562.62 | $4,556.67 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 18 | $4,780.93 | $2,390.47 | $1,250 | $3,038.28 | $5,402.45 |
| MRI abdomen without contrast | CPT | 74181 | 18 | $2,317.25 | $1,158.63 | $787.87 | $1,536.34 | $2,618.49 |
| MRI abdomen with and without contrast | CPT | 74183 | 18 | $3,151 | $1,575.5 | $1,071.34 | $2,002.46 | $3,560.63 |
| Abdominal ultrasound complete | CPT | 76700 | 18 | $818.4 | $409.2 | $278.26 | $542.6 | $924.79 |
| Abdominal ultrasound limited | CPT | 76705 | 18 | $818.4 | $409.2 | $278.26 | $542.6 | $924.79 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 18 | $743.83 | $371.92 | $252.9 | $493.16 | $840.53 |
| Obstetric ultrasound first trimester | CPT | 76801 | 18 | $818.4 | $409.2 | $278.26 | $542.6 | $924.79 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 18 | $818.4 | $409.2 | $278.26 | $542.6 | $924.79 |
| Transvaginal ultrasound | CPT | 76830 | 18 | $818.4 | $409.2 | $278.26 | $542.6 | $924.79 |
| Pelvic ultrasound complete | CPT | 76856 | 18 | $818.4 | $409.2 | $278.26 | $542.6 | $924.79 |
| Scrotal ultrasound | CPT | 76870 | 18 | $818.4 | $409.2 | $278.26 | $542.6 | $924.79 |
| Diagnostic mammography unilateral | CPT | 77065 | 18 | $652.05 | $326.03 | $221.7 | $432.31 | $736.82 |
| Diagnostic mammography bilateral | CPT | 77066 | 18 | $749.8 | $374.9 | $254.93 | $497.12 | $847.27 |
| Screening mammography bilateral | CPT | 77067 | 18 | $287.5 | $143.75 | $97.75 | $190.61 | $324.88 |
| EKG tracing only | CPT | 93005 | 18 | $307.67 | $153.84 | $104.61 | $203.99 | $347.67 |
| Transthoracic echocardiogram complete | CPT | 93306 | 18 | $4,778.55 | $2,389.28 | $1,237.97 | $2,743.93 | $5,399.76 |
| Transthoracic echocardiogram | CPT | 93307 | 18 | $782.36 | $391.18 | $266 | $518.7 | $884.07 |
| Stress echocardiogram | CPT | 93350 | 18 | $2,058.37 | $1,029.19 | $699.85 | $1,364.7 | $2,325.96 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 18 | $40.22 | $20.11 | $3.47 | $26.67 | $60.93 |
| General health panel | CPT | 80050 | 18 | $634.7 | $317.35 | $17.1 | $403.35 | $717.21 |
| Electrolyte panel | CPT | 80051 | 18 | $25.2 | $12.6 | $2.14 | $16.71 | $50.48 |
| Comprehensive metabolic panel | CPT | 80053 | 18 | $57.93 | $28.97 | $5 | $38.41 | $76.07 |
| Lipid panel | CPT | 80061 | 18 | $69.76 | $34.88 | $6.02 | $46.25 | $96.45 |
| Renal function panel | CPT | 80069 | 18 | $47.62 | $23.81 | $4.11 | $31.57 | $62.52 |
| Hepatic function panel | CPT | 80076 | 18 | $34.66 | $17.33 | $2.99 | $22.98 | $58.85 |
| Urinalysis non-automated | CPT | 81002 | 18 | $12.65 | $6.33 | $2.77 | $8.39 | $25.07 |
| Urinalysis automated | CPT | 81003 | 18 | $12.32 | $6.16 | $1.06 | $8.17 | $16.21 |
| Glucose quantitative | CPT | 82947 | 18 | $18.73 | $9.37 | $5.13 | $12.42 | $28.32 |
| Hemoglobin A1c | CPT | 83036 | 18 | $46.28 | $23.14 | $9 | $30.68 | $69.94 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 18 | $80.12 | $40.06 | $7.95 | $53.12 | $121 |
| Complete blood count with automated differential | CPT | 85025 | 18 | $42.63 | $21.32 | $3.68 | $28.26 | $55.96 |
| Complete blood count without differential | CPT | 85027 | 18 | $35.47 | $17.74 | $3.06 | $23.52 | $46.59 |
| Urine culture bacterial | CPT | 87086 | 18 | $44.01 | $22.01 | $9.61 | $21.29 | $58.11 |
| Urine culture identification | CPT | 87088 | 18 | $44.14 | $22.07 | $9.54 | $29.26 | $58.27 |
| Tissue exam by pathologist level IV | CPT | 88305 | 18 | $195.5 | $97.75 | $66.47 | $129.62 | $278.02 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 18 | $704.1 | $352.05 | $239.39 | $466.82 | $795.63 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 18 | $132.3 | $66.15 | $44.98 | $87.71 | $149.5 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 18 | $180.6 | $90.3 | $61.4 | $119.74 | $204.08 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 18 | $219.45 | $109.73 | $74.61 | $145.5 | $247.98 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 18 | $245.7 | $122.85 | $83.54 | $162.9 | $277.64 |
| Office visit, established patient, 5 min | CPT | 99211 | 18 | $87.15 | $43.58 | $29.63 | $57.78 | $98.48 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 18 | $103.95 | $51.98 | $35.34 | $68.92 | $117.46 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 18 | $131.25 | $65.63 | $44.63 | $87.02 | $148.31 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 18 | $164.85 | $82.43 | $56.05 | $109.3 | $186.28 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 18 | $203.7 | $101.85 | $69.26 | $135.05 | $230.18 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 18 | $4,942.57 | $2,471.29 | $1,680.47 | $3,276.92 | $5,585.1 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 18 | $5,492 | $2,746 | $1,867.28 | $3,641.2 | $6,205.96 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 18 | $4,136.74 | $2,068.37 | $1,406.49 | $2,742.66 | $4,674.52 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 18 | $4,910.52 | $2,455.26 | $1,669.58 | $3,255.67 | $5,548.89 |
| Colonoscopy diagnostic | CPT | 45378 | 18 | $5,695.76 | $2,847.88 | $1,936.56 | $3,776.29 | $6,436.21 |
| Colonoscopy with biopsy | CPT | 45380 | 18 | $6,355.05 | $3,177.53 | $2,160.72 | $4,213.4 | $7,181.21 |
| Colonoscopy with polyp removal | CPT | 45385 | 18 | $6,133.02 | $3,066.51 | $2,085.23 | $4,066.19 | $6,930.31 |
| surgery | ||||||||
| PCI single major coronary artery | CPT | 92920 | 18 | $22,012 | $11,006 | $7,484.24 | $14,594 | $24,874 |
| PCI with drug-eluting stent | CPT | 92928 | 18 | $59,875 | $29,937 | $20,357 | $39,697 | $67,658 |
| PCI bypass graft | CPT | 92937 | 18 | $81,889 | $40,945 | $27,842 | $54,292 | $92,535 |
| Coronary angiography with cath | CPT | 93455 | 18 | $18,505 | $9,252.48 | $6,291.69 | $12,269 | $20,911 |
| Coronary angiography with bypass cath | CPT | 93458 | 18 | $23,854 | $11,927 | $8,110.46 | $15,815 | $26,955 |
Payer mix (top 18)
| Payer | Codes covered | Median rate |
|---|---|---|
| Aetna | 108 | $648.17 |
| Anthem BCBS | 108 | $542.6 |
| buckeye community health plan | 108 | $390.67 |
| care source | 108 | $398.48 |
| care source just4me | 108 | $703.21 |
| Cigna | 108 | $656.52 |
| First Health | 108 | $852.44 |
| Humana | 108 | $390.67 |
| medical mutual of ohio | 108 | $616.75 |
| medical mutual of ohio supermed | 108 | $718.07 |
| medigold | 108 | $390.67 |
| Molina | 108 | $407.45 |
| Multiplan | 108 | $905.21 |
| ohio health choice | 108 | $758.47 |
| ohio ppo connect | 108 | $667 |
| sidecar health | 108 | $1,076.72 |
| the health plan | 108 | $667 |
| UnitedHealthcare | 108 | $601.8 |