▸ Hospital · OK · CCN 371305
Ascension St. John Nowata
237 S LOCUST, NOWATA, OK, 74048-3660
25 bedsCritical Access Hospitals2
Compliance grade
A
100/100
Procedures tracked
198
of 209 target codes
Payers
16
with negotiated rates
Rates published
17,695
last crawl 2026-05-24
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 15 | — | — | $600 | $2,375.36 | $18,736 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 2 | $335 | $123.95 | $142.4 | $259.75 | $259.75 |
| Psychiatric eval with medical services | CPT | 90792 | 2 | — | — | $159.8 | $269.11 | $269.11 |
| Psychotherapy 30 minutes | CPT | 90832 | 1 | — | — | $70.84 | $70.84 | $70.84 |
| Psychotherapy 45 minutes | CPT | 90834 | 1 | — | — | $94.45 | $94.45 | $94.45 |
| Psychotherapy 60 minutes | CPT | 90837 | 1 | — | — | $142.05 | $142.05 | $142.05 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 1 | — | — | $148.06 | $148.06 | $148.06 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 3 | $382.75 | $141.62 | $23.74 | $33 | $637 |
| ED visit level 2 | CPT | 99282 | 3 | $851.25 | $314.96 | $46.32 | $65.42 | $849 |
| ED visit level 3 | CPT | 99283 | 3 | $1,431 | $529.47 | $69.41 | $97.83 | $1,061 |
| ED visit level 4 | CPT | 99284 | 3 | $2,048.5 | $757.95 | $131.75 | $186.98 | $1,591 |
| ED visit level 5 | CPT | 99285 | 3 | $3,114.75 | $1,152.46 | $194.56 | $283.61 | $3,183 |
| Critical care, first hour | CPT | 99291 | 3 | $3,275.5 | $1,211.94 | $248.97 | $351.97 | $500 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 3 | $2,410.25 | $891.79 | $53.78 | $337.76 | $337.76 |
| CT head with contrast | CPT | 70460 | 3 | $2,387.25 | $883.28 | $71.19 | $443.05 | $443.05 |
| CT head with and without contrast | CPT | 70470 | 3 | $2,878.75 | $1,065.14 | $80.04 | $448.51 | $448.51 |
| CT neck with contrast | CPT | 70491 | 3 | $2,478.75 | $917.14 | $86.79 | $548.35 | $548.35 |
| MRI brain without contrast | CPT | 70551 | 3 | $2,354 | $870.98 | $92.97 | $873.62 | $1,591 |
| MRI brain with contrast | CPT | 70552 | 3 | $2,663.25 | $985.4 | $112.11 | $977.37 | $1,591 |
| MRI brain with and without contrast | CPT | 70553 | 3 | $3,456.5 | $1,278.91 | $148.26 | $1,147.41 | $1,591 |
| Chest X-ray single view | CPT | 71045 | 2 | $232.5 | $86.03 | $17.06 | $17.71 | $18.98 |
| Chest X-ray 2 views | CPT | 71046 | 2 | $320 | $118.4 | $23.34 | $32.14 | $34.44 |
| Chest X-ray 3 views | CPT | 71047 | 2 | $353.5 | $130.8 | $29.62 | $40.67 | $43.58 |
| CT chest without contrast | CPT | 71250 | 3 | $2,574.75 | $952.66 | $73 | $429.02 | $429.02 |
| CT chest with contrast | CPT | 71260 | 3 | $2,995.5 | $1,108.34 | $77.94 | $535.87 | $535.87 |
| CT chest with and without contrast | CPT | 71270 | 3 | $2,820.25 | $1,043.49 | $86.79 | $648.2 | $648.2 |
| MRI chest without contrast | CPT | 71550 | 3 | $2,437.75 | $901.97 | $91.34 | $953.19 | $1,591 |
| MRI chest with contrast | CPT | 71551 | 3 | $2,506.5 | $927.41 | $108.17 | $1,060.05 | $1,591 |
| MRI chest with and without contrast | CPT | 71552 | 3 | $3,194.75 | $1,182.06 | $142.78 | $1,348.65 | $1,591 |
| Lumbosacral spine X-ray | CPT | 72100 | 3 | $401.25 | $148.46 | $13.8 | $259.34 | $259.34 |
| CT cervical spine without contrast | CPT | 72125 | 3 | $2,233 | $826.21 | $73 | $439.15 | $439.15 |
| CT thoracic spine without contrast | CPT | 72128 | 3 | $2,280.25 | $843.69 | $73 | $429.02 | $429.02 |
| CT lumbar spine without contrast | CPT | 72131 | 3 | $2,280.25 | $843.69 | $73 | $428.23 | $428.23 |
| MRI cervical spine without contrast | CPT | 72141 | 3 | $2,602.75 | $963.02 | $100.19 | $776.91 | $1,591 |
| MRI thoracic spine without contrast | CPT | 72146 | 3 | $2,639.5 | $976.62 | $100.59 | $778.45 | $1,591 |
| MRI lumbar spine without contrast | CPT | 72148 | 3 | $2,499.5 | $924.82 | $92.97 | $765.19 | $1,591 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 3 | $2,851 | $1,054.87 | $112.11 | $963.32 | $1,591 |
| MRI cervical spine with and without contrast | CPT | 72156 | 3 | $3,448.75 | $1,276.04 | $161.19 | $1,150.53 | $1,591 |
| MRI lumbar spine with contrast | CPT | 72158 | 3 | $3,775.25 | $1,396.84 | $147.87 | $1,124 | $1,591 |
| CT pelvis without contrast | CPT | 72192 | 3 | $2,550.5 | $943.69 | $68.92 | $357.24 | $357.24 |
| CT pelvis with contrast | CPT | 72193 | 3 | $2,625 | $971.25 | $73 | $557.71 | $557.71 |
| Shoulder X-ray | CPT | 73030 | 3 | $713 | $263.81 | $11.52 | $259.34 | $259.34 |
| Humerus X-ray | CPT | 73060 | 3 | $335.75 | $124.23 | $10.66 | $259.34 | $259.34 |
| Hand X-ray 3 views | CPT | 73130 | 3 | $710 | $262.7 | $10.66 | $259.34 | $259.34 |
| MRI upper extremity joint without contrast | CPT | 73221 | 3 | $5,544 | $2,051.28 | $84.59 | $567.86 | $1,591 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 3 | $2,894.25 | $1,070.87 | $134.83 | $1,098.27 | $1,591 |
| Hip X-ray 2 views | CPT | 73510 | 3 | — | — | $13.33 | $259.34 | $259.34 |
| Knee X-ray 1-2 views | CPT | 73560 | 3 | $560 | $207.2 | $10.66 | $259.34 | $259.34 |
| Ankle X-ray 3 views | CPT | 73610 | 3 | $729 | $269.73 | $10.66 | $259.34 | $259.34 |
| MRI lower extremity joint without contrast | CPT | 73721 | 3 | $5,280 | $1,953.6 | $84.59 | $567.86 | $1,591 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 3 | $2,894.25 | $1,070.87 | $135.23 | $1,098.27 | $1,591 |
| CT abdomen without contrast | CPT | 74150 | 3 | $2,581 | $954.97 | $74.8 | $365.83 | $365.83 |
| CT abdomen with contrast | CPT | 74160 | 3 | $2,756.25 | $1,019.81 | $80.44 | $568.63 | $568.63 |
| CT abdomen with and without contrast | CPT | 74170 | 3 | $2,954.5 | $1,093.17 | $88.13 | $653.65 | $653.65 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 2 | $2,489 | $920.93 | $114.61 | $474.26 | $474.26 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 2 | $3,209.75 | $1,187.61 | $222.39 | $705.92 | $705.92 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 2 | $3,286.5 | $1,216.01 | $255.45 | $825.26 | $825.26 |
| MRI abdomen without contrast | CPT | 74181 | 3 | $2,646 | $979.02 | $91.74 | $765.98 | $1,591 |
| MRI abdomen with and without contrast | CPT | 74183 | 3 | $3,211.75 | $1,188.35 | $141.98 | $1,177.84 | $1,591 |
| Abdominal ultrasound complete | CPT | 76700 | 3 | $1,423.75 | $526.79 | $50.71 | $289.39 | $289.39 |
| Abdominal ultrasound limited | CPT | 76705 | 3 | $980 | $362.6 | $37.31 | $222.31 | $222.31 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 3 | $1,081.5 | $400.16 | $46.34 | $273.02 | $273.02 |
| Obstetric ultrasound first trimester | CPT | 76801 | 3 | $1,321 | $488.77 | $61.54 | $420.03 | $420.03 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 3 | $1,530.5 | $566.29 | $61.14 | $420.03 | $420.03 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 3 | $1,297 | $479.89 | $87.32 | $420.03 | $420.03 |
| Transvaginal ultrasound | CPT | 76830 | 3 | $1,024 | $378.88 | $42.8 | $156.78 | $156.78 |
| Pelvic ultrasound complete | CPT | 76856 | 3 | $1,311.75 | $485.35 | $43.2 | $256.62 | $256.62 |
| Scrotal ultrasound | CPT | 76870 | 3 | $808.5 | $299.15 | $36.65 | $255.85 | $255.85 |
| Diagnostic mammography unilateral | CPT | 77065 | 2 | $437 | $161.69 | $95.22 | $223.66 | $239.64 |
| Diagnostic mammography bilateral | CPT | 77066 | 2 | $564.5 | $208.87 | $121.8 | $284 | $304.29 |
| Screening mammography bilateral | CPT | 77067 | 2 | $380 | $140.6 | $100.61 | $228.91 | $245.26 |
| EKG complete | CPT | 93000 | 3 | — | — | $18.08 | $30.48 | $32.66 |
| EKG tracing only | CPT | 93005 | 3 | $186 | $68.82 | $8.63 | $16.51 | $124.62 |
| EKG interpretation only | CPT | 93010 | 3 | $34.75 | $12.86 | $9.44 | $14.6 | $23.28 |
| Transthoracic echocardiogram complete | CPT | 93306 | 3 | $2,314.5 | $856.37 | $88.03 | $386.11 | $1,550.72 |
| Transthoracic echocardiogram | CPT | 93307 | 3 | $1,447 | $535.39 | $61.15 | $234.01 | $969.49 |
| Stress echocardiogram | CPT | 93350 | 3 | — | — | $98.62 | $408.72 | $408.72 |
| inpatient | ||||||||
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| COPD w MCC | MS-DRG | 190 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| COPD w CC | MS-DRG | 191 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| COPD w/o CC/MCC | MS-DRG | 192 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| AMI discharged alive w MCC | MS-DRG | 280 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| AMI discharged alive w CC | MS-DRG | 281 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Heart failure & shock w MCC | MS-DRG | 291 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Heart failure & shock w CC | MS-DRG | 292 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| GI hemorrhage w CC | MS-DRG | 378 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Kidney/UTI w MCC | MS-DRG | 689 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Initial hospital care, low complexity | CPT | 99221 | 2 | — | — | $111.73 | $112.11 | $112.48 |
| Initial hospital care, moderate complexity | CPT | 99222 | 2 | — | — | $151.74 | $152.1 | $152.46 |
| Initial hospital care, high complexity | CPT | 99223 | 2 | — | — | $224.49 | $224.56 | $224.63 |
| Hospital discharge, <30 min | CPT | 99238 | 2 | — | — | $79.86 | $80.84 | $81.81 |
| Hospital discharge, >30 min | CPT | 99239 | 2 | — | — | $118.44 | $118.74 | $119.04 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 5 | $85.75 | $31.73 | $8.86 | $42.88 | $109.05 |
| General health panel | CPT | 80050 | 4 | $435.5 | $161.14 | $29.19 | $109.05 | $435.5 |
| Electrolyte panel | CPT | 80051 | 5 | $75 | $27.75 | $7.3 | $60.18 | $75 |
| Comprehensive metabolic panel | CPT | 80053 | 5 | $110.25 | $40.79 | $11.2 | $109.05 | $110.25 |
| Lipid panel | CPT | 80061 | 5 | $179.5 | $66.42 | $16.63 | $74.6 | $179.5 |
| Renal function panel | CPT | 80069 | 5 | $71.75 | $26.55 | $9.12 | $35.88 | $109.05 |
| Hepatic function panel | CPT | 80076 | 5 | $119.75 | $44.31 | $8.6 | $109.05 | $119.75 |
| Urinalysis non-automated | CPT | 81002 | 5 | $50.25 | $18.59 | $2.61 | $20.23 | $50.25 |
| Urinalysis automated | CPT | 81003 | 5 | $58 | $21.46 | $2.35 | $20.23 | $58 |
| Glucose quantitative | CPT | 82947 | 3 | $68.5 | $25.35 | $4.17 | $33.65 | $34.25 |
| Hemoglobin A1c | CPT | 83036 | 5 | $370.5 | $137.09 | $10.16 | $60.18 | $370.5 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 5 | $224.5 | $83.07 | $17.72 | $85.28 | $224.5 |
| Complete blood count with automated differential | CPT | 85025 | 3 | $122.5 | $45.33 | $8.08 | $51.91 | $61.25 |
| Complete blood count without differential | CPT | 85027 | 3 | $80 | $29.6 | $6.78 | $51.91 | $51.91 |
| Urine culture bacterial | CPT | 87086 | 3 | $129.25 | $47.82 | $8.6 | $56.64 | $64.63 |
| Urine culture identification | CPT | 87088 | 3 | $47.25 | $17.48 | $7.62 | $14.96 | $56.64 |
| Tissue exam by pathologist level IV | CPT | 88305 | 3 | $185 | $68.45 | $29.83 | $113.79 | $119.32 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 3 | — | — | $16.93 | $101.41 | $101.41 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 3 | — | — | $2,004.5 | $3,660.2 | $3,921.64 |
| Vaginal delivery only | CPT | 59409 | 3 | $2,618 | $968.66 | $897.66 | $1,764.41 | $1,764.41 |
| Vaginal delivery with postpartum | CPT | 59410 | 3 | — | — | $1,039.17 | $2,247.23 | $2,247.23 |
| Routine obstetric care with C-section | CPT | 59510 | 3 | — | — | $2,269.84 | $4,044.32 | $4,333.2 |
| C-section delivery only | CPT | 59514 | 3 | — | — | $1,035.38 | $1,984.36 | $1,984.36 |
| C-section with postpartum | CPT | 59515 | 2 | — | — | $1,250.16 | $1,335.96 | $1,421.75 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 3 | $354.25 | $131.07 | $55.48 | $78.74 | $84.36 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 3 | $447 | $165.39 | $83.81 | $120.41 | $129.01 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 3 | $616.75 | $228.2 | $140.86 | $205.51 | $220.19 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 3 | $750.5 | $277.69 | $183.33 | $264.56 | $283.45 |
| Office visit, established patient, 5 min | CPT | 99211 | 3 | $251 | $92.87 | $10.21 | $14.48 | $15.51 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 3 | $354.25 | $131.07 | $28.2 | $39.37 | $42.18 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 3 | $447 | $165.39 | $55.58 | $79.88 | $85.59 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 3 | $576.25 | $213.21 | $85.98 | $123.31 | $132.12 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 3 | $714.75 | $264.46 | $122.03 | $173.67 | $186.07 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 3 | — | — | $139.96 | $313.57 | $313.57 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 3 | — | — | $158.31 | $370.51 | $370.51 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 3 | — | — | $63.05 | $137.29 | $137.29 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 3 | — | — | $81.39 | $163.81 | $163.81 |
| Colonoscopy diagnostic | CPT | 45378 | 3 | — | — | $71.28 | $468.79 | $468.79 |
| Colonoscopy with biopsy | CPT | 45380 | 3 | — | — | $229.43 | $559.28 | $559.28 |
| Colonoscopy with polyp removal | CPT | 45385 | 3 | — | — | $291.15 | $664.57 | $664.57 |
| surgery | ||||||||
| Total shoulder arthroplasty | CPT | 23472 | 3 | — | — | $1,617.69 | $3,101.37 | $3,101.37 |
| Hip hemiarthroplasty | CPT | 27125 | 3 | — | — | $1,251.63 | $2,400.12 | $2,400.12 |
| Total hip replacement | CPT | 27130 | 3 | — | — | $1,507.65 | $3,058.45 | $3,058.45 |
| Total knee replacement | CPT | 27447 | 3 | — | — | $1,506.93 | $3,265.16 | $3,265.16 |
| Knee revision arthroplasty single component | CPT | 27486 | 3 | — | — | $1,561.73 | $2,986.69 | $2,986.69 |
| Knee revision arthroplasty all components | CPT | 27487 | 3 | — | — | $1,956.75 | $3,735.51 | $3,735.51 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 3 | — | — | $198.08 | $374.41 | $735.71 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 3 | — | — | $1,167.55 | $2,277.66 | $2,277.66 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 3 | — | — | $593.82 | $1,148.19 | $1,148.19 |
| ACL reconstruction | CPT | 29888 | 3 | — | — | $1,090.38 | $2,096.7 | $2,096.7 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| CABG single arterial graft | CPT | 33533 | 3 | — | — | $2,115.74 | $4,042.84 | $4,042.84 |
| CABG 2 arterial grafts | CPT | 33534 | 3 | — | — | $2,490.43 | $4,779.97 | $4,779.97 |
| CABG 3 arterial grafts | CPT | 33535 | 3 | — | — | $2,781.22 | $5,328.32 | $5,328.32 |
| CABG 4+ arterial grafts | CPT | 33536 | 3 | — | — | $2,998.86 | $5,708.97 | $5,708.97 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Open appendectomy | CPT | 44950 | 3 | — | — | $700.74 | $1,365.04 | $1,365.04 |
| Laparoscopic appendectomy | CPT | 44970 | 3 | — | — | $642.08 | $1,276.89 | $1,276.89 |
| Major joint replacement w MCC | MS-DRG | 469 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Laparoscopic cholecystectomy | CPT | 47562 | 3 | — | — | $735.82 | $1,397.79 | $1,397.79 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 3 | — | — | $799.73 | $1,518.69 | $1,518.69 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Open umbilical hernia repair | CPT | 49560 | 3 | — | — | $801.88 | $1,565.49 | $1,565.49 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 3 | — | — | $469.62 | $943.83 | $943.83 |
| Lap inguinal hernia repair | CPT | 49650 | 3 | — | — | $457.03 | $909.5 | $909.5 |
| Lap incisional hernia repair | CPT | 49652 | 3 | — | — | $832.13 | $1,485.15 | $1,485.15 |
| Total abdominal hysterectomy | CPT | 58150 | 3 | — | — | $1,127.4 | $2,162.21 | $2,162.21 |
| Vaginal hysterectomy | CPT | 58260 | 3 | — | — | $912.1 | $1,789.37 | $1,789.37 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 3 | — | — | $973.9 | $1,910.27 | $1,910.27 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 3 | — | — | $1,092.88 | $2,123.99 | $2,123.99 |
| Lap salpingo-oophorectomy | CPT | 58661 | 3 | — | — | $721.11 | $1,393.11 | $1,393.11 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| OR procedure for obesity w CC | MS-DRG | 620 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Complex cataract surgery | CPT | 66982 | 3 | — | — | $863.63 | $1,733.98 | $1,733.98 |
| Cataract surgery with lens implant | CPT | 66984 | 3 | — | — | $693.12 | $1,393.89 | $1,393.89 |
| Intravitreal injection | CPT | 67028 | 3 | — | — | $109.39 | $217.63 | $217.63 |
| Vitrectomy mechanical | CPT | 67042 | 3 | — | — | $1,253.81 | $3,283.1 | $3,283.1 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 13 | — | — | $1,506 | $5,674.5 | $18,736 |
| PCI single major coronary artery | CPT | 92920 | 3 | — | — | $605.5 | $1,159.88 | $19,696 |
| PCI with drug-eluting stent | CPT | 92928 | 3 | — | — | $673.91 | $1,288.59 | $21,711 |
| PCI bypass graft | CPT | 92937 | 3 | — | — | $673.5 | $1,287.04 | $21,711 |
| Left heart catheterization | CPT | 93452 | 2 | — | — | $591.02 | $1,821.34 | $1,821.34 |
| Coronary angiography with cath | CPT | 93455 | 2 | — | — | $703.11 | $2,166.89 | $2,166.89 |
| Coronary angiography with bypass cath | CPT | 93458 | 2 | — | — | $715.7 | $2,234.76 | $2,234.76 |
Payer mix (top 16)
| Payer | Codes covered | Median rate |
|---|---|---|
| Aetna | 197 | $728.47 |
| Blue Cross Blue Shield | 188 | $953.19 |
| First Health | 177 | $163.55 |
| community care - st john network senior - govt | 51 | $2,284 |
| UnitedHealthcare | 43 | $13,440 |
| va community care network | 40 | $2,110 |
| communitycare (select) | 40 | $2,734.8 |
| communitycare (standard) | 40 | $2,734.8 |
| connect health benefit | 40 | $4,568 |
| medica | 40 | $8,300 |
| smarthealth | 40 | $1,506 |
| TRICARE | 40 | $1,982 |
| kempton group administrators | 40 | $2,284 |
| communitycare senior | 11 | $89.25 |
| community care smarthealth | 1 | $600 |
| community care (select) 7/1/13 | 1 | $600 |