Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
REINFORCE/GRAFT EYE WALL
Arlington, TX
See all hospitals reporting CPT 67255 →Price type
AMH Cath Labs LLC’s median price of $4.3k is 4% above the median hospital's median price ($4.1k), higher than 57% of the 1,478 hospitals reporting CPT 67255. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 19 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Blue Cross Blue Shield managed medicaid fee schedule · outpatient | $850 | $850 | — | — | — | $850 – $850 |
| 2 | UnitedHealthcare managed medicaid fee schedule · outpatient | $850 | $850 | — | — | — | $850 – $850 |
| 3 | WellCare managed medicaid fee schedule · outpatient | $892 | $892 | — | — | — | $892 – $892 |
| 4 | Molina managed medicaid fee schedule · outpatient | $918 | $918 | — | — | — | $918 – $918 |
| 5 | Aetna managed medicaid fee schedule · outpatient | $935 | $935 | — | — | — | $935 – $935 |
| 6 | Blue Cross Blue Shield exchange case rate · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 7 | Blue Cross Blue Shield medicare advantage case rate · outpatient | $4.2k | $4.2k | — | — | — | $4.2k – $4.2k |
| 8 | Humana medicare advantage case rate · outpatient | $4.3k | $4.3k | — | — | — | $4.3k – $4.3k |
| 9 | Humana medicare advantage ppo case rate · outpatient | $4.3k | $4.3k | — | — | — | $4.3k – $4.3k |
| 10 | Molina medicare advantage case rate · outpatient | $4.4k | $4.4k | — | — | — | $4.4k – $4.4k |
| 11 | WellCare medicare advantage hmo case rate · outpatient | $4.4k | $4.4k | — | — | — | $4.4k – $4.4k |
| 12 | WellCare medicare advantage mmp case rate · outpatient | $4.6k | $4.6k | — | — | — | $4.6k – $4.6k |
| 13 | UnitedHealthcare medicare advantage ppo case rate · outpatient | $4.6k | $4.6k | — | — | — | $4.6k – $4.6k |
| 14 | UnitedHealthcare medicare advantage hmo case rate · outpatient | $4.7k | $4.7k | — | — | — | $4.7k – $4.7k |
| 15 | Blue Cross Blue Shield hmo case rate · outpatient | $4.8k | $4.8k | — | — | — | $4.8k – $4.8k |
| 16 | UnitedHealthcare all payer case rate · outpatient | $5.0k | $5.0k | — | — | — | $5.0k – $5.0k |
| 17 | Blue Cross Blue Shield ppo case rate · outpatient | $5.3k | $5.3k | — | — | — | $5.3k – $5.3k |
| 18 | UnitedHealthcare ppo case rate · outpatient | $6.5k | $6.5k | — | — | — | $6.5k – $6.5k |
| 19 | Blue Cross Blue Shield traditional case rate · outpatient | $16.9k | $16.9k | — | — | — | $16.9k – $16.9k |
Last updated: Apr 21, 2026
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