▸ Hospital · TX · CCN 450469
WILSON N JONES REGIONAL MEDICAL CTR
500 NORTH HIGHLAND AVENUE, SHERMAN, TX, 75092
214 bedsAcute Care Hospitals6
Compliance grade
A
100/100
Procedures tracked
200
of 209 target codes
Payers
12
with negotiated rates
Rates published
46,830
last crawl 2026-05-24
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 2 | — | — | $18,019 | $19,049 | $20,078 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 12 | $405 | $324 | $127.98 | $202.34 | $368.89 |
| Psychiatric eval with medical services | CPT | 90792 | 8 | $453 | $362.4 | $158.78 | $233.2 | $419.07 |
| Psychotherapy 30 minutes | CPT | 90832 | 12 | $210 | $168 | $47.15 | $95.96 | $170.59 |
| Psychotherapy 45 minutes | CPT | 90834 | 12 | $262 | $209.6 | $87.56 | $130.19 | $241.2 |
| Psychotherapy 60 minutes | CPT | 90837 | 8 | $392 | $313.6 | $131.89 | $195.9 | $333.11 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 8 | $409 | $327.2 | $127.19 | $189.7 | $342.39 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 12 | $182.41 | $145.93 | $10.3 | $49.06 | $160.2 |
| ED visit level 2 | CPT | 99282 | 12 | $297.05 | $237.64 | $19.97 | $68.9 | $297.05 |
| ED visit level 3 | CPT | 99283 | 12 | $520.9 | $416.72 | $19.97 | $116.3 | $520.9 |
| ED visit level 4 | CPT | 99284 | 12 | $810.53 | $648.43 | $19.97 | $198.4 | $810.53 |
| ED visit level 5 | CPT | 99285 | 12 | $1,163.81 | $931.05 | $19.97 | $287.6 | $1,163.81 |
| Critical care, first hour | CPT | 99291 | 12 | $1,794.29 | $1,435.44 | $194 | $735.21 | $1,794.29 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 12 | $2,228.77 | $1,783.02 | $37.24 | $150.72 | $2,228.77 |
| CT head with contrast | CPT | 70460 | 12 | $2,969.33 | $2,375.47 | $49.4 | $216.61 | $2,969.33 |
| CT head with and without contrast | CPT | 70470 | 12 | $3,044.81 | $2,435.85 | $55.55 | $260.31 | $3,044.81 |
| CT neck with contrast | CPT | 70491 | 12 | $3,055.71 | $2,444.57 | $60.29 | $317.85 | $3,055.71 |
| MRI brain without contrast | CPT | 70551 | 12 | $3,749.77 | $2,999.82 | $64.56 | $362.77 | $3,749.77 |
| MRI brain with contrast | CPT | 70552 | 12 | $4,145.88 | $3,316.71 | $77.96 | $516.14 | $4,145.88 |
| MRI brain with and without contrast | CPT | 70553 | 12 | $5,746.95 | $4,597.56 | $100.21 | $596.06 | $5,746.95 |
| Chest X-ray single view | CPT | 71045 | 12 | $331.29 | $265.04 | $8.04 | $31.68 | $331.29 |
| Chest X-ray 2 views | CPT | 71046 | 12 | $509.23 | $407.39 | $9.63 | $41.82 | $509.23 |
| Chest X-ray 3 views | CPT | 71047 | 12 | $509.23 | $407.39 | $12.13 | $52.56 | $509.23 |
| CT chest without contrast | CPT | 71250 | 12 | $1,586.53 | $1,269.23 | $47.19 | $226.06 | $1,586.53 |
| CT chest with contrast | CPT | 71260 | 12 | $2,651.42 | $2,121.14 | $50.96 | $292.85 | $2,651.42 |
| CT chest with and without contrast | CPT | 71270 | 12 | $2,651.42 | $2,121.14 | $54.61 | $350.5 | $2,651.42 |
| MRI chest without contrast | CPT | 71550 | 12 | $3,171.24 | $2,537 | $63.91 | $658.6 | $3,171.24 |
| MRI chest with contrast | CPT | 71551 | 12 | $3,531.28 | $2,825.03 | $75.45 | $755.82 | $3,531.28 |
| MRI chest with and without contrast | CPT | 71552 | 12 | $4,869.26 | $3,895.41 | $98.95 | $939.77 | $4,869.26 |
| Lumbosacral spine X-ray | CPT | 72100 | 12 | $372.76 | $298.21 | $9.92 | $56.67 | $372.76 |
| CT cervical spine without contrast | CPT | 72125 | 12 | $3,035.73 | $2,428.59 | $43.57 | $223.7 | $3,035.73 |
| CT thoracic spine without contrast | CPT | 72128 | 12 | $2,350.04 | $1,880.04 | $43.57 | $223 | $2,350.04 |
| CT lumbar spine without contrast | CPT | 72131 | 12 | $2,881.56 | $2,305.25 | $43.57 | $222.3 | $2,881.56 |
| MRI cervical spine without contrast | CPT | 72141 | 12 | $2,791.03 | $2,232.83 | $64.86 | $347.39 | $2,791.03 |
| MRI thoracic spine without contrast | CPT | 72146 | 12 | $2,791.03 | $2,232.83 | $64.86 | $347.39 | $2,791.03 |
| MRI lumbar spine without contrast | CPT | 72148 | 12 | $2,791.03 | $2,232.83 | $64.86 | $345.24 | $2,791.03 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 12 | $3,202.69 | $2,562.16 | $78.25 | $515 | $3,202.69 |
| MRI cervical spine with and without contrast | CPT | 72156 | 12 | $4,243.51 | $3,394.81 | $100.51 | $598.52 | $4,243.51 |
| MRI lumbar spine with contrast | CPT | 72158 | 12 | $4,240.38 | $3,392.31 | $100.51 | $596.99 | $4,240.38 |
| CT pelvis without contrast | CPT | 72192 | 12 | $2,338.55 | $1,870.84 | $47.51 | $186.38 | $2,338.55 |
| CT pelvis with contrast | CPT | 72193 | 12 | $3,908.18 | $3,126.55 | $50.66 | $390.39 | $3,908.18 |
| Shoulder X-ray | CPT | 73030 | 12 | $330.75 | $264.6 | $8.33 | $49.79 | $330.75 |
| Humerus X-ray | CPT | 73060 | 12 | $287.93 | $230.35 | $7.1 | $46.21 | $287.93 |
| Hand X-ray 3 views | CPT | 73130 | 12 | $287.93 | $230.35 | $7.71 | $55.97 | $287.93 |
| MRI upper extremity joint without contrast | CPT | 73221 | 12 | $2,723.12 | $2,178.5 | $59.32 | $386.99 | $2,723.12 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 12 | $4,144.45 | $3,315.56 | $94.35 | $758.16 | $4,144.45 |
| Knee X-ray 1-2 views | CPT | 73560 | 12 | $287.93 | $230.35 | $7.39 | $50.78 | $287.93 |
| Ankle X-ray 3 views | CPT | 73610 | 12 | $287.93 | $230.35 | $7.71 | $54.73 | $287.93 |
| MRI lower extremity joint without contrast | CPT | 73721 | 12 | $2,778.17 | $2,222.54 | $59.32 | $386.22 | $2,778.17 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 12 | $4,133.43 | $3,306.75 | $94.35 | $755.23 | $4,133.43 |
| CT abdomen without contrast | CPT | 74150 | 12 | $2,082.54 | $1,666.04 | $51.93 | $184.92 | $2,082.54 |
| CT abdomen with contrast | CPT | 74160 | 12 | $3,384.42 | $2,707.54 | $55.55 | $365.25 | $3,384.42 |
| CT abdomen with and without contrast | CPT | 74170 | 12 | $3,625 | $2,900 | $60.94 | $415.82 | $3,625 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 12 | $4,158.66 | $3,326.93 | $76.07 | $245.32 | $4,158.66 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 12 | $6,526.92 | $5,221.54 | $79.84 | $483.34 | $6,526.92 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 12 | $6,526.92 | $5,221.54 | $87.76 | $560.37 | $6,526.92 |
| MRI abdomen without contrast | CPT | 74181 | 12 | $2,559.64 | $2,047.72 | $63.62 | $363.19 | $2,559.64 |
| MRI abdomen with and without contrast | CPT | 74183 | 12 | $5,562.79 | $4,450.24 | $96.27 | $1,745.21 | $5,562.79 |
| Abdominal ultrasound complete | CPT | 76700 | 12 | $916.24 | $733 | $35.36 | $162.32 | $916.24 |
| Abdominal ultrasound limited | CPT | 76705 | 12 | $613.24 | $490.6 | $25.73 | $123 | $613.24 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 12 | $770.81 | $616.65 | $32.21 | $152.67 | $770.81 |
| Obstetric ultrasound first trimester | CPT | 76801 | 12 | $590.85 | $472.68 | $43.54 | $150.03 | $590.85 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 12 | $957.93 | $766.35 | $43.84 | $179.51 | $957.93 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 8 | $527 | $421.6 | $77.82 | $161.43 | $466.39 |
| Transvaginal ultrasound | CPT | 76830 | 12 | $756.31 | $605.05 | $30.44 | $171.13 | $756.31 |
| Pelvic ultrasound complete | CPT | 76856 | 12 | $1,197.42 | $957.94 | $30.15 | $149.2 | $1,197.42 |
| Scrotal ultrasound | CPT | 76870 | 12 | $725.05 | $580.04 | $27.94 | $125.98 | $725.05 |
| Diagnostic mammography unilateral | CPT | 77065 | 12 | $529.14 | $423.32 | $35.36 | $163.74 | $529.14 |
| Diagnostic mammography bilateral | CPT | 77066 | 12 | $656.33 | $525.07 | $43.57 | $208.36 | $656.33 |
| Screening mammography bilateral | CPT | 77067 | 12 | $576.05 | $460.84 | $33.44 | $172.15 | $576.05 |
| EKG complete | CPT | 93000 | 8 | $47 | $37.6 | $12.88 | $28.7 | $42.87 |
| EKG tracing only | CPT | 93005 | 12 | $268.06 | $214.45 | $5.46 | $109.84 | $268.06 |
| EKG interpretation only | CPT | 93010 | 8 | $24 | $19.2 | $7.42 | $16 | $21.83 |
| Transthoracic echocardiogram complete | CPT | 93306 | 12 | $2,500.74 | $2,000.6 | $63.17 | $372.1 | $2,500.74 |
| Transthoracic echocardiogram | CPT | 93307 | 12 | $1,639.06 | $1,311.25 | $39.95 | $243.77 | $1,639.06 |
| Stress echocardiogram | CPT | 93350 | 8 | $561 | $448.8 | $63.17 | $173.01 | $615.19 |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 2 | — | — | $24,854 | $26,274 | $27,695 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 2 | — | — | $13,388 | $14,153 | $14,918 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 2 | — | — | $9,512.83 | $10,056 | $10,600 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 2 | — | — | $20,459 | $21,628 | $22,797 |
| COPD w MCC | MS-DRG | 190 | 2 | — | — | $14,639 | $15,476 | $16,312 |
| COPD w CC | MS-DRG | 191 | 2 | — | — | $11,527 | $12,186 | $12,844 |
| COPD w/o CC/MCC | MS-DRG | 192 | 2 | — | — | $9,028.15 | $9,544.04 | $10,060 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 2 | — | — | $11,066 | $11,698 | $12,331 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 2 | — | — | $8,739.22 | $9,238.61 | $9,737.99 |
| AMI discharged alive w MCC | MS-DRG | 280 | 2 | — | — | $20,753 | $21,938 | $23,124 |
| AMI discharged alive w CC | MS-DRG | 281 | 2 | — | — | $12,266 | $12,967 | $13,668 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 2 | — | — | $9,946.79 | $10,515 | $11,084 |
| Heart failure & shock w MCC | MS-DRG | 291 | 2 | — | — | $16,783 | $17,742 | $18,701 |
| Heart failure & shock w CC | MS-DRG | 292 | 2 | — | — | $11,552 | $12,212 | $12,872 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 2 | — | — | $7,866.51 | $8,316.03 | $8,765.54 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 2 | — | — | $15,617 | $16,509 | $17,402 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 2 | — | — | $10,114 | $10,692 | $11,270 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 2 | — | — | $7,993.91 | $8,450.71 | $8,907.5 |
| GI hemorrhage w CC | MS-DRG | 378 | 2 | — | — | $13,022 | $13,766 | $14,511 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 2 | — | — | $8,904.33 | $9,413.15 | $9,921.97 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 2 | — | — | $10,598 | $11,203 | $11,809 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 2 | — | — | $19,379 | $20,486 | $21,593 |
| Kidney/UTI w MCC | MS-DRG | 689 | 2 | — | — | $15,197 | $16,065 | $16,934 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 2 | — | — | $10,861 | $11,481 | $12,102 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 2 | — | — | $24,535 | $25,936 | $27,338 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 2 | — | — | $13,554 | $14,329 | $15,103 |
| Initial hospital care, low complexity | CPT | 99221 | 8 | $227 | $181.6 | $74.73 | $135.5 | $226.16 |
| Initial hospital care, moderate complexity | CPT | 99222 | 8 | $308 | $246.4 | $118.66 | $213.8 | $307.11 |
| Initial hospital care, high complexity | CPT | 99223 | 8 | $453 | $362.4 | $158.4 | $284.9 | $452.74 |
| Hospital discharge, <30 min | CPT | 99238 | 8 | $185 | $148 | $73.92 | $133.3 | $162.91 |
| Hospital discharge, >30 min | CPT | 99239 | 8 | $262 | $209.6 | $104.69 | $188.4 | $239.49 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 12 | $85.7 | $68.56 | $5.08 | $37.71 | $85.7 |
| General health panel | CPT | 80050 | 12 | $88 | $70.4 | $25.73 | $43.71 | $85.7 |
| Electrolyte panel | CPT | 80051 | 12 | $85.7 | $68.56 | $4.21 | $37.71 | $85.7 |
| Comprehensive metabolic panel | CPT | 80053 | 12 | $85.7 | $68.56 | $6.34 | $37.71 | $85.7 |
| Lipid panel | CPT | 80061 | 12 | $85.7 | $68.56 | $8.03 | $37.71 | $85.7 |
| Renal function panel | CPT | 80069 | 12 | $85.7 | $68.56 | $5.21 | $37.71 | $85.7 |
| Hepatic function panel | CPT | 80076 | 12 | $85.7 | $68.56 | $4.9 | $37.71 | $85.7 |
| Urinalysis non-automated | CPT | 81002 | 12 | $32.14 | $25.72 | $3.48 | $14.14 | $32.14 |
| Urinalysis automated | CPT | 81003 | 12 | $32.14 | $25.72 | $2.25 | $14.14 | $32.14 |
| Glucose quantitative | CPT | 82947 | 12 | $41.96 | $33.57 | $3.93 | $18.46 | $41.96 |
| Hemoglobin A1c | CPT | 83036 | 12 | $41.96 | $33.57 | $5.83 | $18.93 | $41.96 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 12 | $68.75 | $55 | $10.08 | $32.6 | $68.75 |
| Complete blood count with automated differential | CPT | 85025 | 12 | $41.96 | $33.57 | $4.66 | $18.46 | $41.96 |
| Complete blood count without differential | CPT | 85027 | 12 | $41.96 | $33.57 | $3.88 | $18.46 | $41.96 |
| Urine culture bacterial | CPT | 87086 | 12 | $48.22 | $38.58 | $4.84 | $21.22 | $48.22 |
| Urine culture identification | CPT | 87088 | 12 | $48.22 | $38.58 | $4.85 | $21.22 | $48.22 |
| Tissue exam by pathologist level IV | CPT | 88305 | 12 | $205 | $164 | $28.96 | $63.55 | $182.28 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 12 | $460.07 | $368.06 | $17.87 | $89.07 | $460.07 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 8 | $5,690 | $4,552 | $2,106.28 | $3,033 | $5,372.16 |
| Vaginal delivery only | CPT | 59409 | 12 | $2,858.65 | $2,286.92 | $691.99 | $1,443.62 | $2,858.65 |
| Vaginal delivery with postpartum | CPT | 59410 | 8 | $2,641 | $2,112.8 | $936.78 | $1,353.2 | $2,640.42 |
| Routine obstetric care with C-section | CPT | 59510 | 8 | $5,924 | $4,739.2 | $2,322.97 | $3,369.1 | $5,923.56 |
| C-section delivery only | CPT | 59514 | 8 | $2,305 | $1,844 | $778.91 | $1,133.3 | $2,304.69 |
| C-section with postpartum | CPT | 59515 | 8 | $3,196 | $2,556.8 | $1,153.4 | $1,678.5 | $3,195.11 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 8 | $167 | $133.6 | $42.93 | $66.3 | $112.29 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 8 | $237 | $189.6 | $74.5 | $116 | $168.46 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 8 | $362 | $289.6 | $121.61 | $188.8 | $288.21 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 8 | $459 | $367.2 | $165.2 | $257 | $376.67 |
| Office visit, established patient, 5 min | CPT | 99211 | 8 | $51 | $40.8 | $8.04 | $12.3 | $20.76 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 8 | $104 | $83.2 | $32.24 | $49.59 | $66.6 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 8 | $201 | $160.8 | $60.36 | $93.2 | $124.66 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 8 | $240 | $192 | $88.83 | $137.3 | $184.05 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 8 | $332 | $265.6 | $131.48 | $203 | $272.53 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 8 | $878.06 | $702.45 | $109.69 | $234.2 | $385.3 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 8 | $1,143 | $914.4 | $123.53 | $263.1 | $435.4 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 8 | $534 | $427.2 | $50.95 | $109.7 | $174.48 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 8 | $840 | $672 | $64.93 | $139.3 | $224.58 |
| Colonoscopy diagnostic | CPT | 45378 | 8 | $1,471.83 | $1,177.47 | $82.56 | $172.9 | $582.44 |
| Colonoscopy with biopsy | CPT | 45380 | 8 | $1,690.25 | $1,352.2 | $179.1 | $382.5 | $695.6 |
| Colonoscopy with polyp removal | CPT | 45385 | 8 | $2,009.19 | $1,607.36 | $226.39 | $482 | $825.61 |
| surgery | ||||||||
| Total shoulder arthroplasty | CPT | 23472 | 8 | $8,950 | $7,160 | $1,290.01 | $2,807 | $4,475 |
| Hip hemiarthroplasty | CPT | 27125 | 8 | $6,968 | $5,574.4 | $1,013.18 | $2,208.3 | $3,483.37 |
| Total hip replacement | CPT | 27130 | 8 | $8,344 | $6,675.2 | $1,146 | $2,498.3 | $4,171.24 |
| Total knee replacement | CPT | 27447 | 8 | $8,336 | $6,668.8 | $1,144.67 | $2,495.1 | $4,167.04 |
| Knee revision arthroplasty single component | CPT | 27486 | 8 | $8,660 | $6,928 | $1,254.09 | $2,733.9 | $4,329.42 |
| Knee revision arthroplasty all components | CPT | 27487 | 8 | $10,830 | $8,664 | $1,560.09 | $3,401.3 | $5,414.21 |
| Shoulder arthroscopy with decompression | CPT | 29826 | 8 | $1,326 | $1,060.8 | $151.83 | $330.5 | $538.56 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 8 | $6,590 | $5,272 | $958.1 | $2,083.8 | $3,294.92 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 8 | $3,324 | $2,659.2 | $490.7 | $1,067.9 | $1,661.93 |
| ACL reconstruction | CPT | 29888 | 8 | $6,040 | $4,832 | $874.13 | $1,899.6 | $3,019.58 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 2 | — | — | $55,547 | $58,721 | $61,895 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 2 | — | — | $29,270 | $30,943 | $32,616 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 2 | — | — | $20,866 | $22,058 | $23,250 |
| CABG single arterial graft | CPT | 33533 | 8 | $5,709 | $4,567.2 | $1,610.12 | $3,690.6 | $5,708.4 |
| CABG 2 arterial grafts | CPT | 33534 | 8 | $6,708 | $5,366.4 | $1,891.26 | $4,335.1 | $6,707.71 |
| CABG 3 arterial grafts | CPT | 33535 | 8 | $7,481 | $5,984.8 | $2,102.11 | $4,815.5 | $7,480.06 |
| CABG 4+ arterial grafts | CPT | 33536 | 8 | $8,063 | $6,450.4 | $2,263.84 | $5,187.2 | $8,062.01 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 2 | — | — | $20,953 | $22,150 | $23,348 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 2 | — | — | $16,934 | $17,902 | $18,869 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 2 | — | — | $43,019 | $45,477 | $47,935 |
| Open appendectomy | CPT | 44950 | 8 | $1,971 | $1,576.8 | $565.44 | $1,246.3 | $1,970.89 |
| Laparoscopic appendectomy | CPT | 44970 | 8 | $1,957.06 | $1,565.65 | $532.67 | $1,173.8 | $1,840.94 |
| Major joint replacement w MCC | MS-DRG | 469 | 2 | — | — | $39,943 | $42,225 | $44,508 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 2 | — | — | $23,631 | $24,982 | $26,332 |
| Laparoscopic cholecystectomy | CPT | 47562 | 8 | $3,382.97 | $2,706.38 | $583.24 | $1,287.4 | $2,017.34 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 8 | $3,550.51 | $2,840.41 | $633.75 | $1,399.7 | $2,195.8 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 2 | — | — | $36,078 | $38,140 | $40,202 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 2 | — | — | $25,865 | $27,343 | $28,821 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 2 | — | — | $20,104 | $21,253 | $22,402 |
| Open umbilical hernia repair | CPT | 49560 | 1 | — | — | $1,405 | $1,405 | $1,652 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 1 | — | — | $854 | $854 | $1,005 |
| Lap inguinal hernia repair | CPT | 49650 | 8 | $2,632 | $2,105.6 | $384.86 | $848.4 | $1,315.76 |
| Lap incisional hernia repair | CPT | 49652 | 1 | — | — | $1,356 | $1,356 | $1,596 |
| Total abdominal hysterectomy | CPT | 58150 | 8 | $3,151 | $2,520.8 | $912.58 | $1,935.5 | $3,150.41 |
| Vaginal hysterectomy | CPT | 58260 | 8 | $2,609 | $2,087.2 | $751.29 | $1,592.5 | $2,608.44 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 8 | $2,758 | $2,206.4 | $791.18 | $1,677 | $2,757.27 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 8 | $3,073 | $2,458.4 | $879.56 | $1,864.2 | $3,072.25 |
| Lap salpingo-oophorectomy | CPT | 58661 | 8 | $4,064 | $3,251.2 | $584.08 | $1,238.8 | $2,031.54 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 2 | — | — | $33,549 | $35,466 | $37,383 |
| OR procedure for obesity w CC | MS-DRG | 620 | 2 | — | — | $20,229 | $21,385 | $22,541 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 2 | — | — | $18,635 | $19,699 | $20,764 |
| Complex cataract surgery | CPT | 66982 | 8 | $4,656 | $3,724.8 | $669.56 | $1,392.7 | $2,327.87 |
| Cataract surgery with lens implant | CPT | 66984 | 8 | $3,394 | $2,715.2 | $488.93 | $1,016.9 | $1,702.14 |
| Intravitreal injection | CPT | 67028 | 8 | $630 | $504 | $83.2 | $172.7 | $306.78 |
| Vitrectomy mechanical | CPT | 67042 | 8 | $7,152 | $5,721.6 | $1,024.83 | $2,129.6 | $3,575.49 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 2 | — | — | $15,532 | $16,419 | $17,307 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 2 | — | — | $24,439 | $25,836 | $27,232 |
| PCI single major coronary artery | CPT | 92920 | 8 | $1,434 | $1,147.2 | $452.43 | $1,033.6 | $1,489.06 |
| PCI with drug-eluting stent | CPT | 92928 | 8 | $1,594 | $1,275.2 | $502.96 | $1,148.3 | $1,652.56 |
| PCI bypass graft | CPT | 92937 | 8 | $1,592 | $1,273.6 | $502.63 | $1,147.7 | $1,651.24 |
| Left heart catheterization | CPT | 93452 | 8 | $2,434 | $1,947.2 | $203.9 | $757.63 | $2,403.26 |
| Coronary angiography with cath | CPT | 93455 | 8 | $2,771 | $2,216.8 | $240.23 | $851.56 | $2,782.43 |
| Coronary angiography with bypass cath | CPT | 93458 | 8 | $2,855 | $2,284 | $253.81 | $878.86 | $2,862.85 |
Payer mix (top 12)
| Payer | Codes covered | Median rate |
|---|---|---|
| Blue Cross Blue Shield | 157 | $198.4 |
| amerivantage | 154 | $118.7 |
| UnitedHealthcare | 154 | $194.7 |
| health partners open network | 154 | $240.28 |
| Humana | 154 | $118.7 |
| iowa health | 154 | $124.47 |
| Aetna | 154 | $261.95 |
| Cigna | 154 | $271.88 |
| medica exchange insure | 130 | $2,505.63 |
| medica exchange inspire | 130 | $2,237.28 |
| amerigroup | 87 | $339.16 |
| iowa total care | 87 | $339.16 |