▸ Hospital · TX · CCN 451305
Burleson St Joseph Health Center
1101 WOODSON, CALDWELL, TX, 77836
15 bedsCritical Access Hospitals1
Compliance grade
A
100/100
Procedures tracked
197
of 209 target codes
Payers
11
with negotiated rates
Rates published
3,310
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 | 4 | $334 | $116.9 | $200.4 | $248.83 | $300.6 |
| Psychotherapy 30 minutes | CPT | 90832 | 4 | $229 | $80.15 | $137.4 | $170.61 | $206.1 |
| Psychotherapy 45 minutes | CPT | 90834 | 4 | $291 | $101.85 | $174.6 | $216.8 | $261.9 |
| Psychotherapy 60 minutes | CPT | 90837 | 4 | $291 | $101.85 | $174.6 | $216.8 | $261.9 |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 4 | $334 | $116.9 | $200.4 | $248.83 | $300.6 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 7 | $1,258 | $440.3 | $56.37 | $236 | $1,132.2 |
| ED visit level 2 | CPT | 99282 | 7 | $1,664 | $582.4 | $106.71 | $408 | $1,497.6 |
| ED visit level 3 | CPT | 99283 | 7 | $2,531 | $885.85 | $217.93 | $955.8 | $2,277.9 |
| ED visit level 4 | CPT | 99284 | 5 | $3,911 | $1,368.85 | $1,684.8 | $2,386.8 | $3,519.9 |
| ED visit level 5 | CPT | 99285 | 5 | $4,596 | $1,608.6 | $2,041.8 | $2,941.44 | $4,136.4 |
| Critical care, first hour | CPT | 99291 | 5 | $4,673 | $1,635.55 | $254.4 | $2,681.9 | $4,205.7 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 8 | $2,324 | $813.4 | $109.6 | $993.2 | $2,091.6 |
| CT head with contrast | CPT | 70460 | 8 | $4,225 | $1,478.75 | $154.36 | $1,623.02 | $3,802.5 |
| CT head with and without contrast | CPT | 70470 | 8 | $3,417 | $1,195.95 | $181.1 | $815.49 | $3,075.3 |
| CT neck with contrast | CPT | 70491 | 8 | $2,999 | $1,049.65 | $192.13 | $815.49 | $2,699.1 |
| MRI brain without contrast | CPT | 70551 | 8 | $4,297 | $1,503.95 | $218.85 | $758.5 | $3,867.3 |
| MRI brain with contrast | CPT | 70552 | 8 | $5,041 | $1,764.35 | $252.74 | $825.2 | $4,536.9 |
| MRI brain with and without contrast | CPT | 70553 | 8 | $5,649 | $1,977.15 | $357.85 | $1,430.09 | $5,084.1 |
| Chest X-ray single view | CPT | 71045 | 7 | $392 | $137.2 | $20.71 | $46.55 | $352.8 |
| Chest X-ray 2 views | CPT | 71046 | 7 | $601 | $210.35 | $28.74 | $145.99 | $540.9 |
| CT chest without contrast | CPT | 71250 | 8 | $3,082 | $1,078.7 | $114.46 | $373.71 | $2,773.8 |
| CT chest with contrast | CPT | 71260 | 8 | $3,386 | $1,185.1 | $185.78 | $815.49 | $3,047.4 |
| CT chest with and without contrast | CPT | 71270 | 8 | $4,521 | $1,582.35 | $222.54 | $815.49 | $4,068.9 |
| MRI chest without contrast | CPT | 71550 | 8 | $6,058 | $2,120.3 | $232.31 | $758.5 | $5,452.2 |
| MRI chest with contrast | CPT | 71551 | 8 | $4,590 | $1,606.5 | $432.7 | $1,936.54 | $4,131 |
| MRI chest with and without contrast | CPT | 71552 | 8 | $7,589 | $2,656.15 | $456.37 | $1,430.09 | $6,830.1 |
| Lumbosacral spine X-ray | CPT | 72100 | 7 | $805 | $281.75 | $31.8 | $50.35 | $724.5 |
| CT cervical spine without contrast | CPT | 72125 | 8 | $2,262 | $791.7 | $114.46 | $373.71 | $2,035.8 |
| CT thoracic spine without contrast | CPT | 72128 | 8 | $2,310 | $808.5 | $114.46 | $373.71 | $2,079 |
| CT lumbar spine without contrast | CPT | 72131 | 8 | $2,505 | $876.75 | $114.46 | $1,112.6 | $2,254.5 |
| MRI cervical spine without contrast | CPT | 72141 | 8 | $245 | $85.75 | $147 | $218.8 | $1,450 |
| MRI thoracic spine without contrast | CPT | 72146 | 8 | $4,548 | $1,591.8 | $213.18 | $758.5 | $4,093.2 |
| MRI lumbar spine without contrast | CPT | 72148 | 8 | $4,548 | $1,591.8 | $212.84 | $758.5 | $4,093.2 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 8 | $5,144 | $1,800.4 | $305.06 | $1,430.09 | $4,629.6 |
| MRI cervical spine with and without contrast | CPT | 72156 | 8 | $6,130 | $2,145.5 | $359.86 | $1,430.09 | $5,517 |
| MRI lumbar spine with contrast | CPT | 72158 | 8 | $6,130 | $2,145.5 | $359.19 | $1,430.09 | $5,517 |
| CT pelvis without contrast | CPT | 72192 | 8 | $2,059 | $720.65 | $114.46 | $373.71 | $1,853.1 |
| CT pelvis with contrast | CPT | 72193 | 8 | $2,637 | $922.95 | $213.51 | $815.49 | $2,373.3 |
| Shoulder X-ray | CPT | 73030 | 7 | $798 | $279.3 | $26.4 | $41.8 | $718.2 |
| Humerus X-ray | CPT | 73060 | 7 | $583 | $204.05 | $26.4 | $145.99 | $524.7 |
| Hand X-ray 3 views | CPT | 73130 | 7 | $671 | $234.85 | $28.2 | $44.65 | $603.9 |
| MRI upper extremity joint without contrast | CPT | 73221 | 8 | $4,781 | $1,673.35 | $224.88 | $758.5 | $4,302.9 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 8 | $6,643 | $2,325.05 | $445.4 | $2,701.96 | $5,978.7 |
| Knee X-ray 1-2 views | CPT | 73560 | 7 | $498 | $174.3 | $28.2 | $44.65 | $448.2 |
| Ankle X-ray 3 views | CPT | 73610 | 7 | $645 | $225.75 | $28.8 | $45.6 | $580.5 |
| MRI lower extremity joint without contrast | CPT | 73721 | 8 | $4,781 | $1,673.35 | $224.88 | $758.5 | $4,302.9 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 8 | $6,282 | $2,198.7 | $444.73 | $1,430.09 | $5,653.8 |
| CT abdomen without contrast | CPT | 74150 | 8 | $3,258 | $1,140.3 | $114.46 | $373.71 | $2,932.2 |
| CT abdomen with contrast | CPT | 74160 | 8 | $4,107 | $1,437.45 | $218.19 | $815.49 | $3,696.3 |
| CT abdomen with and without contrast | CPT | 74170 | 8 | $4,362 | $1,526.7 | $248.26 | $815.49 | $3,925.8 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 8 | $7,461 | $2,611.35 | $189.79 | $758.5 | $6,714.9 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 8 | $7,865 | $2,752.75 | $252.74 | $815.49 | $7,078.5 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 8 | $7,978 | $2,792.3 | $252.74 | $815.49 | $7,180.2 |
| MRI abdomen without contrast | CPT | 74181 | 8 | $4,440 | $1,554 | $232.31 | $758.5 | $3,996 |
| MRI abdomen with and without contrast | CPT | 74183 | 8 | $6,062 | $2,121.7 | $404.3 | $1,430.09 | $5,455.8 |
| Abdominal ultrasound complete | CPT | 76700 | 7 | $1,866 | $653.1 | $114.46 | $976.8 | $1,679.4 |
| Abdominal ultrasound limited | CPT | 76705 | 7 | $1,157 | $404.95 | $55.8 | $268.98 | $1,041.3 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 7 | $1,347 | $471.45 | $107.93 | $799.2 | $1,212.3 |
| Obstetric ultrasound first trimester | CPT | 76801 | 7 | $1,186 | $415.1 | $114.46 | $192.95 | $1,067.4 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 7 | $1,508 | $527.8 | $114.46 | $240.72 | $1,357.2 |
| Transvaginal ultrasound | CPT | 76830 | 7 | $981 | $343.35 | $114.46 | $579.6 | $882.9 |
| Pelvic ultrasound complete | CPT | 76856 | 7 | $1,475 | $516.25 | $96.28 | $876.6 | $1,327.5 |
| Scrotal ultrasound | CPT | 76870 | 7 | $105 | $36.75 | $63 | $67.71 | $105 |
| Diagnostic mammography unilateral | CPT | 77065 | 5 | $482 | $168.7 | $205.05 | $289.2 | $433.8 |
| Diagnostic mammography bilateral | CPT | 77066 | 5 | $497 | $173.95 | $69 | $280.05 | $447.3 |
| Screening mammography bilateral | CPT | 77067 | 5 | $482 | $168.7 | $136.2 | $243.05 | $433.8 |
| EKG tracing only | CPT | 93005 | 5 | $2,251 | $787.85 | $15.6 | $230.2 | $2,025.9 |
| EKG interpretation only | CPT | 93010 | 5 | $46 | $16.1 | $15.15 | $27.6 | $41.4 |
| Transthoracic echocardiogram complete | CPT | 93306 | 5 | $3,868 | $1,353.8 | $243.81 | $2,320.8 | $3,481.2 |
| Transthoracic echocardiogram | CPT | 93307 | 7 | $1,924 | $673.4 | $132.65 | $208.01 | $1,731.6 |
| Stress echocardiogram | CPT | 93350 | 7 | $4,068 | $1,423.8 | $177.43 | $291.67 | $3,661.2 |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 1 | — | — | $12,330 | $15,577 | $17,308 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 1 | — | — | $7,188.83 | $9,081.93 | $10,091 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 1 | — | — | $5,205.3 | $6,576.05 | $7,306.97 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 1 | — | — | $12,903 | $16,301 | $18,113 |
| COPD w MCC | MS-DRG | 190 | 1 | — | — | $8,035.93 | $10,152 | $11,281 |
| COPD w CC | MS-DRG | 191 | 1 | — | — | $6,397.51 | $8,082.22 | $8,980.55 |
| COPD w/o CC/MCC | MS-DRG | 192 | 1 | — | — | $5,065.16 | $6,399.01 | $7,110.26 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 1 | — | — | $6,506.27 | $8,219.63 | $9,133.23 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 1 | — | — | $4,949.42 | $6,252.8 | $6,947.79 |
| AMI discharged alive w MCC | MS-DRG | 280 | 1 | — | — | $11,557 | $14,601 | $16,224 |
| AMI discharged alive w CC | MS-DRG | 281 | 1 | — | — | $6,866.03 | $8,674.12 | $9,638.24 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 1 | — | — | $5,288.96 | $6,681.75 | $7,424.42 |
| Heart failure & shock w MCC | MS-DRG | 291 | 1 | — | — | $10,290 | $13,000 | $14,445 |
| Heart failure & shock w CC | MS-DRG | 292 | 1 | — | — | $6,684.75 | $8,445.11 | $9,383.78 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 1 | — | — | $4,696.34 | $5,933.07 | $6,592.52 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 1 | — | — | $8,286.22 | $10,468 | $11,632 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 1 | — | — | $5,382.38 | $6,799.78 | $7,555.56 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 1 | — | — | $3,921.75 | $4,954.5 | $5,505.19 |
| GI hemorrhage w CC | MS-DRG | 378 | 1 | — | — | $6,764.93 | $8,546.4 | $9,496.33 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 1 | — | — | $4,494.15 | $5,677.64 | $6,308.7 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 1 | — | — | $5,293.84 | $6,687.91 | $7,431.27 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 1 | — | — | $10,026 | $12,666 | $14,074 |
| Kidney/UTI w MCC | MS-DRG | 689 | 1 | — | — | $7,524.88 | $9,506.47 | $10,563 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 1 | — | — | $5,539.25 | $6,997.96 | $7,775.77 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 1 | — | — | $12,709 | $16,056 | $17,841 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 1 | — | — | $7,352.67 | $9,288.92 | $10,321 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 11 | $522 | $182.7 | $7.11 | $14.6 | $469.8 |
| General health panel | CPT | 80050 | 7 | $1,359 | $475.65 | $31.13 | $114.3 | $1,223.1 |
| Electrolyte panel | CPT | 80051 | 11 | $392 | $137.2 | $5.89 | $12.09 | $352.8 |
| Comprehensive metabolic panel | CPT | 80053 | 11 | $683 | $239.05 | $8.87 | $18.22 | $614.7 |
| Lipid panel | CPT | 80061 | 11 | $266 | $93.1 | $11.25 | $23.1 | $239.4 |
| Renal function panel | CPT | 80069 | 11 | $804 | $281.4 | $7.29 | $14.98 | $723.6 |
| Hepatic function panel | CPT | 80076 | 11 | $498 | $174.3 | $6.86 | $14.1 | $448.2 |
| Urinalysis non-automated | CPT | 81002 | 11 | $55 | $19.25 | $2.92 | $10.66 | $49.5 |
| Urinalysis automated | CPT | 81003 | 11 | $82 | $28.7 | $1.89 | $7.14 | $73.8 |
| Glucose quantitative | CPT | 82947 | 11 | $111 | $38.85 | $3.3 | $6.78 | $99.9 |
| Hemoglobin A1c | CPT | 83036 | 11 | $16 | $5.6 | $8.16 | $9.95 | $29.13 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 11 | $44 | $15.4 | $14.11 | $20.83 | $50.4 |
| Complete blood count with automated differential | CPT | 85025 | 11 | $192 | $67.2 | $6.53 | $13.41 | $172.8 |
| Complete blood count without differential | CPT | 85027 | 11 | $224 | $78.4 | $5.43 | $11.16 | $201.6 |
| Urine culture bacterial | CPT | 87086 | 11 | $150 | $52.5 | $6.78 | $16.14 | $135 |
| Urine culture identification | CPT | 87088 | 11 | $292 | $102.2 | $6.8 | $13.96 | $262.8 |
| Tissue exam by pathologist level IV | CPT | 88305 | 7 | $893 | $312.55 | $51 | $133.43 | $803.7 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 7 | $1,160 | $406 | $13.62 | $57.8 | $1,044 |
| Routine obstetric care including vaginal delivery | CPT | 59400 | 1 | — | — | $2,817.09 | $3,096.65 | $3,440.72 |
| Vaginal delivery only | CPT | 59409 | 5 | $3,533 | $1,236.55 | $2,119.8 | $3,003.05 | $3,636.43 |
| Vaginal delivery with postpartum | CPT | 59410 | 1 | — | — | $1,407.61 | $1,547.29 | $1,719.22 |
| Routine obstetric care with C-section | CPT | 59510 | 1 | — | — | $3,124.56 | $3,434.63 | $3,816.26 |
| C-section delivery only | CPT | 59514 | 1 | — | — | $1,240.7 | $1,363.82 | $1,515.36 |
| C-section with postpartum | CPT | 59515 | 1 | — | — | $1,709.9 | $1,879.59 | $2,088.43 |
| Cesarean section w CC/MCC | MS-DRG | 765 | 1 | — | — | $8,206.04 | $10,367 | $11,519 |
| Cesarean section w/o CC/MCC | MS-DRG | 766 | 1 | — | — | $5,836.26 | $7,373.18 | $8,192.7 |
| Vaginal delivery w complicating dx | MS-DRG | 774 | 1 | — | — | $5,789.55 | $7,314.16 | $8,127.12 |
| Vaginal delivery w/o complicating dx | MS-DRG | 775 | 1 | — | — | $4,499.73 | $5,684.68 | $6,316.53 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 6 | $686 | $240.1 | $37.2 | $92.86 | $617.4 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 5 | $153 | $53.55 | $91.8 | $133.56 | $153 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 5 | $233 | $81.55 | $139.8 | $203.88 | $233 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 5 | $293 | $102.55 | $175.8 | $249.05 | $293 |
| Office visit, established patient, 5 min | CPT | 99211 | 6 | $270 | $94.5 | $16.42 | $167.4 | $243 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 6 | $350 | $122.5 | $45 | $217 | $315 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 6 | $385 | $134.75 | $45 | $238.7 | $346.5 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 6 | $465 | $162.75 | $45 | $288.3 | $418.5 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 6 | $511 | $178.85 | $45 | $316.82 | $459.9 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 7 | $2,500 | $875 | $275.42 | $1,070.63 | $2,250 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 3 | — | — | $275.42 | $289.19 | $1,189.58 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 7 | $233 | $81.55 | $139.8 | $209.7 | $289.19 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 3 | — | — | $275.42 | $289.19 | $1,135.97 |
| Colonoscopy diagnostic | CPT | 45378 | 3 | — | — | $275.42 | $289.19 | $1,135.97 |
| Colonoscopy with biopsy | CPT | 45380 | 7 | $618 | $216.3 | $368.78 | $395.52 | $1,498.22 |
| Colonoscopy with polyp removal | CPT | 45385 | 3 | — | — | $368.78 | $387.22 | $1,498.22 |
| surgery | ||||||||
| Total shoulder arthroplasty | CPT | 23472 | 1 | — | — | $1,975.06 | $2,171.06 | $2,412.29 |
| PCI w drug-eluting stent w MCC | MS-DRG | 246 | 1 | — | — | $22,382 | $28,276 | $31,419 |
| PCI w drug-eluting stent w/o MCC | MS-DRG | 247 | 1 | — | — | $14,750 | $18,634 | $20,705 |
| Hip hemiarthroplasty | CPT | 27125 | 1 | — | — | $1,537.84 | $1,690.44 | $1,878.27 |
| Total hip replacement | CPT | 27130 | 1 | — | — | $1,841.07 | $2,023.78 | $2,248.64 |
| Total knee replacement | CPT | 27447 | 1 | — | — | $13,261 | $14,577 | $16,197 |
| Knee revision arthroplasty single component | CPT | 27486 | 1 | — | — | $1,908.77 | $2,098.2 | $2,331.33 |
| Knee revision arthroplasty all components | CPT | 27487 | 1 | — | — | $2,387.38 | $2,624.3 | $2,915.89 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 3 | — | — | $1,073.68 | $1,127.36 | $8,970.27 |
| Knee arthroscopy with meniscectomy | CPT | 29881 | 3 | — | — | $877.23 | $921.09 | $4,232.37 |
| ACL reconstruction | CPT | 29888 | 3 | — | — | $1,073.68 | $1,127.36 | $8,970.27 |
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 1 | — | — | $34,256 | $43,276 | $48,086 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 1 | — | — | $17,213 | $21,746 | $24,163 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 1 | — | — | $11,684 | $14,760 | $16,401 |
| CABG single arterial graft | CPT | 33533 | 1 | — | — | $2,541.58 | $2,793.8 | $3,104.22 |
| CABG 2 arterial grafts | CPT | 33534 | 1 | — | — | $2,990.1 | $3,286.83 | $3,652.03 |
| CABG 3 arterial grafts | CPT | 33535 | 1 | — | — | $3,331.42 | $3,662.02 | $4,068.91 |
| CABG 4+ arterial grafts | CPT | 33536 | 1 | — | — | $3,578.25 | $3,933.35 | $4,370.38 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 1 | — | — | $11,617 | $14,676 | $16,307 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 1 | — | — | $9,099.85 | $11,496 | $12,774 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 1 | — | — | $28,294 | $35,746 | $39,719 |
| Open appendectomy | CPT | 44950 | 1 | — | — | $3,813.62 | $4,192.07 | $4,657.86 |
| Laparoscopic appendectomy | CPT | 44970 | 1 | — | — | $5,880.17 | $6,463.7 | $7,181.89 |
| Spinal fusion (non-cervical) w MCC | MS-DRG | 459 | 1 | — | — | $42,098 | $53,184 | $59,095 |
| Spinal fusion (non-cervical) w/o MCC | MS-DRG | 460 | 1 | — | — | $27,992 | $35,363 | $39,294 |
| Major joint replacement w MCC | MS-DRG | 469 | 1 | — | — | $22,317 | $28,194 | $31,328 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 1 | — | — | $14,323 | $18,094 | $20,105 |
| Laparoscopic cholecystectomy | CPT | 47562 | 3 | — | — | $1,073.68 | $1,127.36 | $7,181.89 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 3 | — | — | $1,073.68 | $1,127.36 | $7,181.89 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 1 | — | — | $21,055 | $26,599 | $29,556 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 1 | — | — | $14,293 | $18,057 | $20,064 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 1 | — | — | $11,638 | $14,702 | $16,336 |
| Open umbilical hernia repair | CPT | 49560 | 3 | — | — | $877.23 | $921.09 | $4,657.86 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 7 | $672 | $235.2 | $403.2 | $894.77 | $4,657.86 |
| Lap inguinal hernia repair | CPT | 49650 | 3 | — | — | $1,073.68 | $1,127.36 | $7,181.89 |
| Lap incisional hernia repair | CPT | 49652 | 3 | — | — | $1,073.68 | $1,127.36 | $7,181.89 |
| Total abdominal hysterectomy | CPT | 58150 | 1 | — | — | $1,361.06 | $1,496.13 | $1,662.37 |
| Vaginal hysterectomy | CPT | 58260 | 3 | — | — | $1,073.68 | $1,127.36 | $6,578.9 |
| Lap-assisted vaginal hysterectomy | CPT | 58550 | 3 | — | — | $1,073.68 | $1,127.36 | $7,181.89 |
| Lap-assisted vaginal hysterectomy >250g | CPT | 58552 | 3 | — | — | $1,073.68 | $1,127.36 | $12,153 |
| Lap salpingo-oophorectomy | CPT | 58661 | 3 | — | — | $1,073.68 | $1,127.36 | $7,181.89 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 1 | — | — | $21,731 | $27,454 | $30,505 |
| OR procedure for obesity w CC | MS-DRG | 620 | 1 | — | — | $12,796 | $16,166 | $17,963 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 1 | — | — | $11,034 | $13,940 | $15,489 |
| Complex cataract surgery | CPT | 66982 | 3 | — | — | $755.85 | $793.64 | $3,073.74 |
| Cataract surgery with lens implant | CPT | 66984 | 3 | — | — | $755.85 | $793.64 | $3,073.74 |
| Intravitreal injection | CPT | 67028 | 3 | — | — | $63.67 | $275.42 | $289.19 |
| Vitrectomy mechanical | CPT | 67042 | 3 | — | — | $1,073.68 | $1,127.36 | $5,777.2 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 1 | — | — | $7,491.41 | $9,464.2 | $10,516 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 1 | — | — | $11,848 | $14,968 | $16,632 |
| PCI single major coronary artery | CPT | 92920 | 5 | $12,497 | $4,373.95 | $7,498.2 | $11,247 | $17,899 |
| PCI with drug-eluting stent | CPT | 92928 | 5 | $19,050 | $6,667.5 | $10,715 | $16,073 | $36,997 |
| PCI bypass graft | CPT | 92937 | 5 | $15,675 | $5,486.25 | $9,405 | $14,108 | $36,997 |
| Left heart catheterization | CPT | 93452 | 5 | $12,347 | $4,321.45 | $7,408.2 | $8,919.11 | $11,112 |
| Coronary angiography with cath | CPT | 93455 | 5 | $16,138 | $5,648.3 | $7,484.18 | $9,903.87 | $14,524 |
| Coronary angiography with bypass cath | CPT | 93458 | 5 | $19,639 | $6,873.65 | $7,484.18 | $11,783 | $17,675 |
Payer mix (top 11)
| Payer | Codes covered | Median rate |
|---|---|---|
| Blue Cross Blue Shield | 192 | $869.43 |
| Aetna | 109 | $439.04 |
| commercial | firstcare | all plans | 109 | $584.1 |
| commercial | phcs | all plans | 109 | $827.48 |
| Multiplan | 109 | $876.15 |
| UnitedHealthcare | 105 | $178.26 |
| Medicaid | 99 | $200.51 |
| Humana | 51 | $850 |
| Ambetter | 15 | $11.73 |
| commercial | ellwood | all plans | 15 | $24.27 |
| commercial | entrust | all plans | 15 | $16.18 |