▸ Hospital · TX · CCN 451362
Clay County Memorial Hospital
310 WEST SOUTH STREET, HENRIETTA, TX, 451362
Compliance grade
A
97/100
Procedures tracked
109
of 209 target codes
Payers
5
with negotiated rates
Rates published
1,728
last crawl 2026-05-22
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychotherapy 30 minutes | CPT | 90832 | 5 | $610 | $427 | $122 | $153 | $195 |
| Psychotherapy 45 minutes | CPT | 90834 | 5 | $755 | $529 | $151 | $189 | $242 |
| Psychotherapy 60 minutes | CPT | 90837 | 5 | $770 | $539 | $154 | $193 | $246 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 5 | $258 | $181 | $26 | $47 | $83 |
| ED visit level 2 | CPT | 99282 | 5 | $423 | $296 | $85 | $106 | $135 |
| ED visit level 3 | CPT | 99283 | 5 | $709 | $496 | $142 | $177 | $227 |
| ED visit level 4 | CPT | 99284 | 5 | $1,355 | $948 | $218 | $285 | $434 |
| ED visit level 5 | CPT | 99285 | 5 | $4,335 | $3,035 | $249 | $632.5 | $1,387 |
| Critical care, first hour | CPT | 99291 | 5 | $6,502 | $4,551 | $88 | $553 | $2,081 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 5 | $1,602 | $1,121 | $320 | $401 | $513 |
| CT head with contrast | CPT | 70460 | 5 | $1,968 | $1,378 | $394 | $492 | $630 |
| CT head with and without contrast | CPT | 70470 | 5 | $2,396 | $1,677 | $479 | $599 | $767 |
| CT neck with contrast | CPT | 70491 | 5 | $1,794 | $1,256 | $286 | $373.5 | $574 |
| MRI brain without contrast | CPT | 70551 | 5 | $2,257 | $1,580 | $451 | $564 | $722 |
| MRI brain with and without contrast | CPT | 70553 | 5 | $3,520 | $2,464 | $704 | $880 | $1,126 |
| Chest X-ray single view | CPT | 71045 | 5 | $207 | $145 | $30 | $41 | $66 |
| Chest X-ray 2 views | CPT | 71046 | 5 | $210 | $147 | $42 | $53 | $67 |
| Chest X-ray 3 views | CPT | 71047 | 5 | $348 | $244 | $70 | $87 | $111 |
| CT chest without contrast | CPT | 71250 | 5 | $1,609 | $1,126 | $322 | $402 | $515 |
| CT chest with contrast | CPT | 71260 | 5 | $2,383 | $1,668 | $477 | $596 | $763 |
| CT chest with and without contrast | CPT | 71270 | 5 | $2,901 | $2,031 | $580 | $725 | $928 |
| MRI chest without contrast | CPT | 71550 | 5 | $2,257 | $1,580 | $451 | $564 | $722 |
| MRI chest with contrast | CPT | 71551 | 5 | $3,520 | $2,464 | $704 | $880 | $1,126 |
| MRI chest with and without contrast | CPT | 71552 | 5 | $4,514 | $3,160 | $903 | $1,129 | $1,444 |
| Lumbosacral spine X-ray | CPT | 72100 | 5 | $322 | $225 | $54 | $71 | $103 |
| CT cervical spine without contrast | CPT | 72125 | 5 | $2,044 | $1,431 | $409 | $511 | $654 |
| CT thoracic spine without contrast | CPT | 72128 | 5 | $1,986 | $1,390 | $397 | $497 | $636 |
| CT lumbar spine without contrast | CPT | 72131 | 5 | $2,396 | $1,677 | $409 | $533.5 | $767 |
| MRI cervical spine without contrast | CPT | 72141 | 5 | $2,257 | $1,580 | $451 | $564 | $722 |
| MRI thoracic spine without contrast | CPT | 72146 | 5 | $2,257 | $1,580 | $451 | $564 | $722 |
| MRI lumbar spine without contrast | CPT | 72148 | 5 | $2,257 | $1,580 | $451 | $564 | $722 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 5 | $3,520 | $2,464 | $704 | $880 | $1,126 |
| MRI cervical spine with and without contrast | CPT | 72156 | 5 | $4,514 | $3,160 | $903 | $1,129 | $1,444 |
| MRI lumbar spine with contrast | CPT | 72158 | 5 | $4,514 | $3,160 | $903 | $1,129 | $1,444 |
| CT pelvis without contrast | CPT | 72192 | 5 | $2,011 | $1,408 | $402 | $503 | $644 |
| CT pelvis with contrast | CPT | 72193 | 5 | $2,286 | $1,600 | $457 | $572 | $732 |
| Shoulder X-ray | CPT | 73030 | 5 | $232 | $162 | $44 | $56.5 | $74 |
| Humerus X-ray | CPT | 73060 | 5 | $213 | $149 | $43 | $53 | $68 |
| Hand X-ray 3 views | CPT | 73130 | 5 | $230 | $161 | $46 | $58 | $74 |
| MRI upper extremity joint without contrast | CPT | 73221 | 5 | $2,257 | $1,580 | $451 | $564 | $722 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 5 | $4,514 | $3,160 | $903 | $1,129 | $1,444 |
| Knee X-ray 1-2 views | CPT | 73560 | 5 | $196 | $137 | $39 | $49 | $63 |
| Ankle X-ray 3 views | CPT | 73610 | 5 | $230 | $161 | $46 | $58 | $74 |
| MRI lower extremity joint without contrast | CPT | 73721 | 5 | $2,257 | $1,580 | $451 | $564 | $722 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 5 | $4,514 | $3,160 | $903 | $1,129 | $1,444 |
| CT abdomen without contrast | CPT | 74150 | 5 | $1,993 | $1,395 | $399 | $498 | $638 |
| CT abdomen with contrast | CPT | 74160 | 5 | $2,336 | $1,635 | $467 | $584 | $748 |
| CT abdomen with and without contrast | CPT | 74170 | 5 | $2,821 | $1,975 | $564 | $705 | $903 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 5 | $4,262 | $2,983 | $852 | $1,066 | $1,364 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 5 | $5,105 | $3,574 | $991 | $1,257.5 | $1,634 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 5 | $5,208 | $3,646 | $1,042 | $1,302 | $1,667 |
| MRI abdomen without contrast | CPT | 74181 | 5 | $2,257 | $1,580 | $451 | $564 | $722 |
| MRI abdomen with and without contrast | CPT | 74183 | 5 | $4,514 | $3,160 | $903 | $1,129 | $1,444 |
| Abdominal ultrasound complete | CPT | 76700 | 5 | $869 | $608 | $120 | $174 | $278 |
| Abdominal ultrasound limited | CPT | 76705 | 5 | $564 | $395 | $88 | $119 | $180 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 5 | $615 | $431 | $113 | $146 | $197 |
| Obstetric ultrasound first trimester | CPT | 76801 | 5 | $979 | $685 | $196 | $245 | $313 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 5 | $979 | $685 | $196 | $245 | $313 |
| Transvaginal ultrasound | CPT | 76830 | 5 | $509 | $356 | $102 | $127 | $163 |
| Pelvic ultrasound complete | CPT | 76856 | 5 | $564 | $395 | $113 | $141 | $180 |
| Scrotal ultrasound | CPT | 76870 | 5 | $619 | $433 | $124 | $155 | $198 |
| EKG complete | CPT | 93000 | 5 | $32 | $22 | $6 | $8 | $10 |
| EKG tracing only | CPT | 93005 | 5 | $191 | $134 | $38 | $48 | $61 |
| Transthoracic echocardiogram | CPT | 93307 | 5 | $2,058 | $1,441 | $412 | $515 | $659 |
| inpatient | ||||||||
| Initial hospital care, low complexity | CPT | 99221 | 5 | $198 | $139 | $40 | $50 | $63 |
| Initial hospital care, moderate complexity | CPT | 99222 | 5 | $268 | $188 | $54 | $67 | $86 |
| Initial hospital care, high complexity | CPT | 99223 | 5 | $397 | $278 | $79 | $99 | $127 |
| Hospital discharge, <30 min | CPT | 99238 | 5 | $157 | $110 | $31 | $39 | $50 |
| Hospital discharge, >30 min | CPT | 99239 | 5 | $209 | $146 | $42 | $52 | $67 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 5 | $140 | $98 | $28 | $35 | $45 |
| General health panel | CPT | 80050 | 5 | $478 | $335 | $96 | $120 | $153 |
| Electrolyte panel | CPT | 80051 | 5 | $71 | $50 | $14 | $18 | $23 |
| Comprehensive metabolic panel | CPT | 80053 | 5 | $304 | $213 | $51 | $66.5 | $97 |
| Lipid panel | CPT | 80061 | 5 | $94 | $66 | $5 | $13.5 | $30 |
| Renal function panel | CPT | 80069 | 5 | $214 | $150 | $43 | $54 | $68 |
| Hepatic function panel | CPT | 80076 | 5 | $123 | $86 | $25 | $31 | $39 |
| Urinalysis non-automated | CPT | 81002 | 5 | $7 | $5 | $1 | $2 | $2 |
| Urinalysis automated | CPT | 81003 | 5 | $50 | $35 | $5 | $9 | $16 |
| Glucose quantitative | CPT | 82947 | 5 | $70 | $49 | $3 | $7 | $22 |
| Hemoglobin A1c | CPT | 83036 | 5 | $231 | $162 | $5 | $33 | $74 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 5 | $102 | $71 | $9 | $17.5 | $33 |
| Complete blood count with automated differential | CPT | 85025 | 5 | $99 | $69 | $15 | $20 | $32 |
| Complete blood count without differential | CPT | 85027 | 5 | $70 | $49 | $14 | $18 | $22 |
| Urine culture bacterial | CPT | 87086 | 5 | $110 | $77 | $22 | $28 | $35 |
| Urine culture identification | CPT | 87088 | 5 | $78 | $55 | $16 | $20 | $25 |
| Tissue exam by pathologist level IV | CPT | 88305 | 5 | $249 | $174 | $50 | $62 | $80 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 5 | $202 | $141 | $29 | $40 | $65 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 5 | $269 | $188 | $42 | $55.5 | $86 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 5 | $336 | $235 | $64 | $82 | $108 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 5 | $403 | $282 | $80 | $100.5 | $129 |
| Office visit, established patient, 5 min | CPT | 99211 | 5 | $403 | $282 | $17 | $54 | $129 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 5 | $403 | $282 | $20 | $56.5 | $129 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 5 | $212 | $148 | $28 | $42 | $68 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 5 | $265 | $186 | $41 | $54.5 | $85 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 5 | $292 | $204 | $56 | $71.5 | $93 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 5 | $3,859 | $2,701 | $118 | $717 | $1,235 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 5 | $5,404 | $3,783 | $132 | $253 | $1,729 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 5 | $3,859 | $2,701 | $86 | $455 | $1,235 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 5 | $630 | $441 | $126 | $158 | $202 |
| Colonoscopy diagnostic | CPT | 45378 | 5 | $3,859 | $2,701 | $193 | $540 | $1,235 |
| Colonoscopy with biopsy | CPT | 45380 | 5 | $5,404 | $3,783 | $230 | $724.5 | $1,729 |
| Colonoscopy with polyp removal | CPT | 45385 | 5 | $6,313 | $4,419 | $273 | $850 | $2,020 |
| surgery | ||||||||
| Laparoscopic appendectomy | CPT | 44970 | 5 | $8,250 | $5,775 | $1,650 | $2,063 | $2,640 |
| Laparoscopic cholecystectomy | CPT | 47562 | 5 | $11,057 | $7,740 | $1,656 | $2,231.5 | $3,538 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 5 | $12,028 | $8,420 | $2,017 | $2,632.5 | $3,849 |
| Open umbilical hernia repair | CPT | 49560 | 5 | $9,843 | $6,890 | $1,969 | $2,461 | $3,150 |
| Umbilical hernia repair age 5+ | CPT | 49585 | 5 | $9,843 | $6,890 | $1,969 | $2,461 | $3,150 |
| Lap inguinal hernia repair | CPT | 49650 | 5 | $9,843 | $6,890 | $1,969 | $2,461 | $3,150 |
| Cataract surgery with lens implant | CPT | 66984 | 5 | $6,260 | $4,382 | $1,252 | $1,565 | $2,003 |
Payer mix (top 5)
| Payer | Codes covered | Median rate |
|---|---|---|
| Aetna | 109 | $148 |
| Blue Cross Blue Shield | 109 | $189 |
| Cigna | 109 | $160 |
| healthsmart | 109 | $118 |
| muti-plan | 109 | $118 |