▸ Hospital · TX · CCN 451303
Limestone Medical Center
900 N. ELLIS, GROESBECK, TX, 451303
Compliance grade
A
97/100
Procedures tracked
103
of 209 target codes
Payers
8
with negotiated rates
Rates published
15,865
last crawl 2026-05-24
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychiatric diagnostic evaluation | CPT | 90791 | 8 | $630 | $378 | $102.01 | $231.81 | $504 |
| Psychiatric eval with medical services | CPT | 90792 | 8 | $708.75 | $425.25 | $205.54 | $438.01 | $567 |
| Psychotherapy 30 minutes | CPT | 90832 | 8 | $152.25 | $91.35 | $44.15 | $94.09 | $121.8 |
| Psychotherapy 45 minutes | CPT | 90834 | 8 | $351.75 | $211.05 | $44.15 | $105.32 | $281.4 |
| Psychotherapy 60 minutes | CPT | 90837 | 8 | $152.25 | $91.35 | $44.15 | $94.09 | $121.8 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 8 | $152.25 | $91.35 | $44.15 | $94.09 | $121.8 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 8 | $330 | $198 | $68.66 | $185.54 | $270 |
| ED visit level 2 | CPT | 99282 | 8 | $645 | $387 | $124.65 | $259.95 | $516 |
| ED visit level 3 | CPT | 99283 | 8 | $855 | $513 | $62.42 | $247.95 | $684 |
| ED visit level 4 | CPT | 99284 | 8 | $1,590 | $954 | $243.6 | $480.06 | $1,272 |
| ED visit level 5 | CPT | 99285 | 8 | $1,890.25 | $1,134.15 | $163.82 | $486.39 | $1,512.2 |
| Critical care, first hour | CPT | 99291 | 8 | $2,205 | $1,323 | $270 | $665.69 | $1,764 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 8 | $2,144.1 | $1,286.46 | $114.46 | $634.22 | $1,715.28 |
| CT head with contrast | CPT | 70460 | 8 | $2,276.4 | $1,365.84 | $227.23 | $673.36 | $1,821.12 |
| CT head with and without contrast | CPT | 70470 | 8 | $2,859.15 | $1,715.49 | $227.23 | $845.74 | $2,287.32 |
| CT neck with contrast | CPT | 70491 | 8 | $2,487.45 | $1,492.47 | $227.23 | $735.79 | $1,989.96 |
| MRI brain without contrast | CPT | 70551 | 8 | $3,498.6 | $2,099.16 | $232.31 | $1,034.89 | $2,798.88 |
| MRI brain with contrast | CPT | 70552 | 8 | $4,342.8 | $2,605.68 | $252.74 | $1,284.6 | $3,474.24 |
| MRI brain with and without contrast | CPT | 70553 | 8 | $5,880 | $3,528 | $456.37 | $1,739.3 | $4,704 |
| Chest X-ray single view | CPT | 71045 | 8 | $290.85 | $174.51 | $62.12 | $109.47 | $232.68 |
| Chest X-ray 2 views | CPT | 71046 | 8 | $357 | $214.2 | $62.12 | $109.47 | $285.6 |
| Chest X-ray 3 views | CPT | 71047 | 8 | $382.2 | $229.32 | $62.12 | $113.05 | $305.76 |
| CT chest without contrast | CPT | 71250 | 8 | $2,384.55 | $1,430.73 | $114.46 | $1,254.32 | $1,907.64 |
| CT chest with contrast | CPT | 71260 | 8 | $2,419.2 | $1,451.52 | $227.23 | $715.6 | $1,935.36 |
| CT chest with and without contrast | CPT | 71270 | 8 | $2,711.1 | $1,626.66 | $227.23 | $801.94 | $2,168.88 |
| MRI chest without contrast | CPT | 71550 | 8 | $3,481.8 | $2,089.08 | $232.31 | $1,029.92 | $2,785.44 |
| MRI chest with contrast | CPT | 71551 | 8 | $4,082.4 | $2,449.44 | $681.88 | $1,207.57 | $3,265.92 |
| MRI chest with and without contrast | CPT | 71552 | 8 | $5,427.45 | $3,256.47 | $456.37 | $1,605.44 | $4,341.96 |
| Lumbosacral spine X-ray | CPT | 72100 | 8 | $387.45 | $232.47 | $112.36 | $134.67 | $309.96 |
| CT cervical spine without contrast | CPT | 72125 | 8 | $2,507.4 | $1,504.44 | $114.46 | $741.69 | $2,005.92 |
| CT thoracic spine without contrast | CPT | 72128 | 8 | $2,373 | $1,423.8 | $114.46 | $701.93 | $1,898.4 |
| CT lumbar spine without contrast | CPT | 72131 | 8 | $2,507.4 | $1,504.44 | $114.46 | $741.69 | $2,005.92 |
| MRI cervical spine without contrast | CPT | 72141 | 8 | $3,904.95 | $2,342.97 | $232.31 | $1,155.08 | $3,123.96 |
| MRI thoracic spine without contrast | CPT | 72146 | 8 | $3,581.55 | $2,148.93 | $232.31 | $1,059.42 | $2,865.24 |
| MRI lumbar spine without contrast | CPT | 72148 | 8 | $3,949.05 | $2,369.43 | $232.31 | $1,168.13 | $3,159.24 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 8 | $4,326 | $2,595.6 | $456.37 | $1,279.63 | $3,460.8 |
| MRI cervical spine with and without contrast | CPT | 72156 | 8 | $4,650.45 | $2,790.27 | $456.37 | $1,375.6 | $3,720.36 |
| MRI lumbar spine with contrast | CPT | 72158 | 8 | $5,880 | $3,528 | $456.37 | $1,739.3 | $4,704 |
| CT pelvis without contrast | CPT | 72192 | 8 | $1,855.35 | $1,113.21 | $114.46 | $548.81 | $1,484.28 |
| CT pelvis with contrast | CPT | 72193 | 8 | $2,051.7 | $1,231.02 | $227.23 | $606.89 | $1,641.36 |
| Shoulder X-ray | CPT | 73030 | 8 | $871.5 | $522.9 | $62.12 | $269.29 | $697.2 |
| Humerus X-ray | CPT | 73060 | 8 | $539.7 | $323.82 | $44.76 | $156.51 | $431.76 |
| Hand X-ray 3 views | CPT | 73130 | 8 | $617.4 | $370.44 | $62.12 | $192.07 | $493.92 |
| MRI upper extremity joint without contrast | CPT | 73221 | 8 | $7,025.55 | $4,215.33 | $232.31 | $2,172.52 | $5,620.44 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 8 | $11,397 | $6,838.02 | $456.37 | $3,521.58 | $9,117.36 |
| Knee X-ray 1-2 views | CPT | 73560 | 8 | $584.85 | $350.91 | $62.12 | $181.69 | $467.88 |
| Ankle X-ray 3 views | CPT | 73610 | 8 | $672 | $403.2 | $62.12 | $208.95 | $537.6 |
| MRI lower extremity joint without contrast | CPT | 73721 | 8 | $7,526.4 | $4,515.84 | $232.31 | $2,327.6 | $6,021.12 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 8 | $11,081 | $6,648.39 | $456.37 | $3,423.6 | $8,864.52 |
| CT abdomen without contrast | CPT | 74150 | 8 | $2,074.8 | $1,244.88 | $114.46 | $613.73 | $1,659.84 |
| CT abdomen with contrast | CPT | 74160 | 8 | $2,373 | $1,423.8 | $227.23 | $701.93 | $1,898.4 |
| CT abdomen with and without contrast | CPT | 74170 | 8 | $4,859.4 | $2,915.64 | $227.23 | $1,437.41 | $3,887.52 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 8 | $4,281.9 | $2,569.14 | $232.31 | $1,266.59 | $3,425.52 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 8 | $4,605.3 | $2,763.18 | $252.74 | $1,362.25 | $3,684.24 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 8 | $7,536.9 | $4,522.14 | $252.74 | $2,229.42 | $6,029.52 |
| MRI abdomen without contrast | CPT | 74181 | 8 | $3,481.8 | $2,089.08 | $232.31 | $1,029.92 | $2,785.44 |
| MRI abdomen with and without contrast | CPT | 74183 | 8 | $5,587.05 | $3,352.23 | $456.37 | $1,652.65 | $4,469.64 |
| Abdominal ultrasound complete | CPT | 76700 | 8 | $744.45 | $446.67 | $114.46 | $220.21 | $595.56 |
| Abdominal ultrasound limited | CPT | 76705 | 8 | $680.4 | $408.24 | $114.46 | $413.35 | $544.32 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 8 | $732.9 | $439.74 | $114.46 | $216.79 | $586.32 |
| Obstetric ultrasound first trimester | CPT | 76801 | 8 | $783.3 | $469.98 | $75.37 | $231.7 | $626.64 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 8 | $569.1 | $341.46 | $94.03 | $168.34 | $455.28 |
| Transvaginal ultrasound | CPT | 76830 | 8 | $721.35 | $432.81 | $89.36 | $213.38 | $577.08 |
| Pelvic ultrasound complete | CPT | 76856 | 8 | $621.6 | $372.96 | $114.46 | $183.87 | $497.28 |
| Scrotal ultrasound | CPT | 76870 | 8 | $621.6 | $372.96 | $114.46 | $183.87 | $497.28 |
| EKG tracing only | CPT | 93005 | 8 | $327.6 | $196.56 | $95 | $202.46 | $262.08 |
| EKG interpretation only | CPT | 93010 | 8 | $40.95 | $24.57 | $11.27 | $24.01 | $32.76 |
| Transthoracic echocardiogram complete | CPT | 93306 | 8 | $2,194.5 | $1,316.7 | $636.41 | $1,356.2 | $1,755.6 |
| Transthoracic echocardiogram | CPT | 93307 | 8 | $1,445.85 | $867.51 | $294.24 | $893.54 | $1,156.68 |
| inpatient | ||||||||
| Initial hospital care, low complexity | CPT | 99221 | 8 | $313.95 | $188.37 | $89.83 | $191.43 | $251.16 |
| Initial hospital care, moderate complexity | CPT | 99222 | 8 | $424.2 | $254.52 | $122.1 | $260.21 | $339.36 |
| Initial hospital care, high complexity | CPT | 99223 | 8 | $628.95 | $377.37 | $167.17 | $356.25 | $503.16 |
| Hospital discharge, <30 min | CPT | 99238 | 8 | $164.85 | $98.91 | $47.81 | $101.88 | $131.88 |
| Hospital discharge, >30 min | CPT | 99239 | 8 | $332.85 | $199.71 | $65.47 | $148.77 | $266.28 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 8 | $145.95 | $87.57 | $10.44 | $43.17 | $116.76 |
| General health panel | CPT | 80050 | 8 | $624.75 | $374.85 | $35.17 | $349.86 | $499.8 |
| Electrolyte panel | CPT | 80051 | 8 | $91.35 | $54.81 | $8.66 | $27.02 | $73.08 |
| Comprehensive metabolic panel | CPT | 80053 | 8 | $263.55 | $158.13 | $13.04 | $77.96 | $210.84 |
| Lipid panel | CPT | 80061 | 8 | $204.75 | $122.85 | $16.53 | $60.57 | $163.8 |
| Renal function panel | CPT | 80069 | 8 | $151.2 | $90.72 | $10.72 | $44.73 | $120.96 |
| Hepatic function panel | CPT | 80076 | 8 | $141.75 | $85.05 | $10.09 | $41.93 | $113.4 |
| Glucose quantitative | CPT | 82947 | 8 | $84 | $50.4 | $4.85 | $48.02 | $67.2 |
| Hemoglobin A1c | CPT | 83036 | 8 | $184.8 | $110.88 | $11.99 | $54.66 | $147.84 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 8 | $257.25 | $154.35 | $20.75 | $76.09 | $205.8 |
| Complete blood count with automated differential | CPT | 85025 | 8 | $101.85 | $61.11 | $9.59 | $30.13 | $81.48 |
| Urine culture bacterial | CPT | 87086 | 8 | $87.15 | $52.29 | $9.86 | $25.27 | $69.72 |
| maternity | ||||||||
| Vaginal delivery only | CPT | 59409 | 8 | $3,438.75 | $2,063.25 | $270 | $2,125.15 | $2,751 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 8 | $385.35 | $231.21 | $42.63 | $111.75 | $308.28 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 8 | $507.15 | $304.29 | $66.99 | $173.25 | $405.72 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 8 | $585.9 | $351.54 | $88.31 | $235.99 | $468.72 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 8 | $774.9 | $464.94 | $165.34 | $377.66 | $619.92 |
| Office visit, established patient, 5 min | CPT | 99211 | 8 | $297.15 | $178.29 | $8.53 | $48.67 | $237.72 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 8 | $385.35 | $231.21 | $15.23 | $67.12 | $308.28 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 8 | $318.15 | $190.89 | $23.94 | $104.37 | $254.52 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 8 | $453.6 | $272.16 | $47.68 | $135.98 | $362.88 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 8 | $519.75 | $311.85 | $130.02 | $284.07 | $415.8 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 7 | $2,104.2 | $1,262.52 | $315.16 | $743.49 | $1,683.36 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 7 | $2,156.7 | $1,294.02 | $405.59 | $864.33 | $1,725.36 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 7 | $1,521.45 | $912.87 | $138.6 | $445.63 | $1,217.16 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 7 | $1,437.45 | $862.47 | $310.59 | $709.98 | $1,149.96 |
| Colonoscopy diagnostic | CPT | 45378 | 7 | $1,950.9 | $1,170.54 | $359.31 | $765.7 | $1,560.72 |
| Colonoscopy with biopsy | CPT | 45380 | 7 | $2,451 | $1,470.6 | $443.41 | $944.92 | $1,960.8 |
| Colonoscopy with polyp removal | CPT | 45385 | 7 | $2,573.55 | $1,544.13 | $478.07 | $1,018.77 | $2,058.84 |
Payer mix (top 8)
| Payer | Codes covered | Median rate |
|---|---|---|
| Aetna | 103 | $497.28 |
| Blue Cross Blue Shield | 103 | $180.26 |
| Cigna | 103 | $399.11 |
| Humana | 103 | $380.36 |
| UnitedHealthcare | 103 | $313.42 |
| Medicare Advantage | 103 | $180.26 |
| pphp | 103 | $183.87 |
| Medicaid | 96 | $186.4 |