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
CLTX CARPL SCPHD FX W/O MNPJ
Austin, TX
See all hospitals reporting CPT 25622 →Price type
Ascension Seton’s median price of $232 is 40% below the median hospital's median price ($390), higher than 7% of the 1,824 hospitals reporting CPT 25622. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 35 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 4127_blue cross blue shield bav exchange 20250101 fee schedule · outpatient | $78 | $78 | — | — | — | $78 – $78 |
| 2 | Blue Cross Blue Shield 4166_blue cross chip (aus) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 3 | Blue Cross Blue Shield 4166_blue cross chip/star kids (aus) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 4 | Blue Cross Blue Shield 4168_blue cross chip (chi,dcn) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 5 | Blue Cross Blue Shield 4168_blue cross chip/star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 6 | Blue Cross Blue Shield 4217_chirp blue cross star (aus) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 7 | Blue Cross Blue Shield 4219_chirp blue cross star (chi,dcn) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 8 | Blue Cross Blue Shield 4999_blue cross star kids (aus) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 9 | Blue Cross Blue Shield 5003_blue cross star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 10 | UnitedHealthcare 4251_chirp uhc star (aus) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 11 | UnitedHealthcare 4253_chirp uhc star (chi,dcn) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 12 | UnitedHealthcare 4262_chirp uhc star plus (aus) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 13 | UnitedHealthcare 4264_chirp uhc star plus (chi,dcn) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 14 | UnitedHealthcare 4309_uhc star kids (aus) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 15 | UnitedHealthcare 4311_uhc star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $85 | $85 | — | — | — | $85 – $85 |
| 16 | Blue Cross Blue Shield 4440_blue cross blue shield hpn 20250501 fee schedule · outpatient | $105 | $105 | — | — | — | $105 – $105 |
| 17 | Blue Cross Blue Shield 4497_blue cross blue shield hpn (dell, williamson,hays) 20250501 fee schedule · outpatient | $105 | $105 | — | — | — | $105 – $105 |
| 18 | Blue Cross Blue Shield 4095_blue cross blue shield hmo essentials 20250101 fee schedule · outpatient | $112 | $112 | — | — | — | $112 – $112 |
| 19 | Blue Cross Blue Shield 4094_blue cross blue shield ppo 20250101 fee schedule · outpatient | $127 | $127 | — | — | — | $127 – $127 |
| 20 | Tricare 1229_tricare cah outpatient 20170101 fee schedule · outpatient | $167 | $167 | — | — | — | $167 – $167 |
| 21 | Aetna 4659_medicare advantage aetna inpatient 20251001 other · inpatient | $232 | $232 | — | — | — | $232 – $232 |
| 22 | Aetna 4749_medicare advantage aetna outpatient 20250811 other · outpatient | $232 | $232 | — | — | — | $232 – $232 |
| 23 | Devoted 4684_medicare advantage devoted health inpatient 20251001 other · inpatient | $232 | $232 | — | — | — | $232 – $232 |
| 24 | Devoted 4918_medicare advantage devoted health outpatient 20250811 other · outpatient | $232 | $232 | — | — | — | $232 – $232 |
| 25 | Humana 4661_medicare advantage humana inpatient (aus,hay,nw,sw) 20251001 other · inpatient | $232 | $232 | — | — | — | $232 – $232 |
Last updated: Jan 1, 2026
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