0191T — Insert Ant Segment Drain Int
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). Insert ant segment drain int (HCPCS 0191T) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/0191T?code_type=HCPCS
MLA (9th ed.)
“Insert ant segment drain int (HCPCS 0191T) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/0191T?code_type=HCPCS. Accessed .
Chicago (notes-bibliography)
“Insert ant segment drain int (HCPCS 0191T) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/0191T?code_type=HCPCS.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $2,182–$7,265 (25th–75th percentile) across 602 hospitals · 393 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CPT/HCPCS 0191T — the consumer-grade median across the country. It covers the facility charge only; the surgeon’s and anesthesiologist’s fees are billed separately.
Per-month price trends are temporarily unavailable while we rebuild them on quality-filtered rates. The medians, percentiles, and per-hospital rates on this page are the quality-filtered figures.
Hospital rates (per row)
Showing consumer-grade rates only. Flagged / outlier filings (excluded from the medians above) are hidden — tick “Show flagged / outlier rates” to include them.
| Hospital | Payer | Plan | Negotiated rate | Gross | Cash | Observed | Source |
|---|---|---|---|---|---|---|---|
| H Lee Moffitt Cancer Center & Research Institute I Outpatient | Health First | Commercial (MMG) | $31.79 | — | — | 2025-10-24 | MRF ↗ |
| Tyler Memorial Hospital OutpatientFacility | None | — | — | — | — | 2026-01-01 | MRF ↗ |
| H Lee Moffitt Cancer Center & Research Institute I Outpatient | BlueCross | BlueSelect (MMG) | $66.00 | — | — | 2025-10-24 | MRF ↗ |
| H Lee Moffitt Cancer Center & Research Institute I Outpatient | Cigna | Medicare Advantage | $68.00 | — | — | 2025-10-24 | MRF ↗ |
| H Lee Moffitt Cancer Center & Research Institute I Outpatient | BlueCross | HealthOptions (MMG) | $75.00 | — | — | 2025-10-24 | MRF ↗ |
| THE NEBRASKA MEDICAL CENTER Outpatient | AETNA-ALL PLANS | AETNA-ALL PLANS | $76.43 | $4,510.70 | $2,931.96 | 2026-01-05 | MRF ↗ |
| BELLEVUE MEDICAL CENTER Outpatient | AETNA-ALL PLANS | AETNA-ALL PLANS | $76.43 | $4,510.70 | $2,931.96 | 2025-12-29 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | VA Community Care Network VACCN Region 4 Triwest | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Blue Cross Blue Shield of AZ | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Tricare East Region DOS lt 01012025 | Federal | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | ASAGEHA | Federal | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Blue Cross Blue Shield of AZ | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Tricare West | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | United Healthcare | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Medicare A AZ JF | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Humana | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Humana | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | UMR Wausau/UHIS | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Health Choice Pathway MCR Adv | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Aetna | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Aetna | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Tricare West | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Great West Healthcare AZ | PPO | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Presbyterian Health Plan MCR Adv | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Cigna | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Health Choice Pathway MCR Adv | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Arizona Foundation for Medical Care (AFMC) | PPO | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Blue Cross Blue Shield of AZ | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Blue Cross Blue Shield of AZ | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Medicare A AZ JF | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Sierra Health and Life MCR Adv | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Aetna | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Tricare East Region DOS lt 01012025 | Federal | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | VA Community Care Network VACCN Region 4 Triwest | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | United Healthcare | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Presbyterian Health Plan MCR Adv | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | United Healthcare | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | UMR Wausau/UHIS | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | ASAGEHA | Federal | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Arizona Foundation for Medical Care (AFMC) | PPO | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Blue Cross Blue Shield of AZ | Federal | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Sierra Health and Life MCR Adv | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Cigna | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Great West Healthcare AZ | PPO | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Aetna | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Blue Cross Blue Shield of AZ | Federal | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Cigna | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | Cigna | Medicare Advantage | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| WHITE MOUNTAIN REGIONAL MEDICAL CENTER Both | United Healthcare | Default | — | $3,376.53 | $1,924.62 | 2026-03-16 | MRF ↗ |
| BELLEVUE MEDICAL CENTER Outpatient | MIDLANDS CHOICE-ALL PLANS | MIDLANDS CHOICE-ALL PLANS | $80.09 | $4,510.70 | $2,931.96 | 2025-12-29 | MRF ↗ |
| THE NEBRASKA MEDICAL CENTER Outpatient | MIDLANDS CHOICE-ALL PLANS | MIDLANDS CHOICE-ALL PLANS | $80.09 | $4,510.70 | $2,931.96 | 2026-01-05 | MRF ↗ |
| ST MARYS MEDICAL CENTER Outpatient | Caresource | Wv Marketplace | — | — | — | 2026-05-06 | MRF ↗ |
| MONTEFIORE MEDICAL CENTER Both | BCBS Empire Healthplus | Essential 1 & 2 | $177.85 | $4,115.00 | $2,691.21 | 2026-04-01 | MRF ↗ |
| MONTEFIORE MEDICAL CENTER Both | BCBC Empre Healthplus | Medicaid & HARP | $177.85 | $4,115.00 | $2,691.21 | 2026-04-01 | MRF ↗ |
| MONTEFIORE MEDICAL CENTER Both | BCBS Empire Healthplus | Essential 3 & 4 | $177.85 | $4,115.00 | $2,691.21 | 2026-04-01 | MRF ↗ |
| UCHEALTH BROOMFIELD HOSPITAL OutpatientFacility | Denver Health Medical Plan | Medicaid Choice | $186.59 | — | — | 2025-11-01 | MRF ↗ |
| BOULDER COMMUNITY HEALTH OutpatientFacility | Rocky Mountain Health Maintenance Organization | Managed Medicaid | $219.35 | — | — | 2025-12-23 | MRF ↗ |
| FORT MEMORIAL HOSPITAL OutpatientFacility | Molina | Managed Medicaid | $245.00 | — | — | 2025-07-22 | MRF ↗ |
| SAINT THOMAS RUTHERFORD HOSPITAL Outpatient | BCBS TENNCARE SELECT | 2414_BCBS BLUE CARE TENNCARE (RUTHERFORD) 20221001 | $267.12 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Saint Thomas Hospital Midtown Outpatient | BCBS BLUE CARE | 1015_BCBS BLUE CARE TENNCARE SELECT 20221001 | $267.12 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION SAINT THOMAS HOSPITAL Outpatient | BCBS TENNCARE SELECT | 2423_BCBS BLUE CARE TENNCARE (WEST) 20221001 | $267.12 | — | — | 2026-01-01 | MRF ↗ |
| OLEAN GENERAL HOSPITAL OutpatientFacility | Bcbs - Western Ny | Medicaid Managed Care Plan | $278.58 | — | — | 2026-04-01 | MRF ↗ |
| ST MARYS MEDICAL CENTER Outpatient | Unicare | Wv Medicaid | $283.94 | — | — | 2026-05-06 | MRF ↗ |
| ST MARYS MEDICAL CENTER Outpatient | The Healthplan | Wv Medicaid | $283.94 | — | — | 2026-05-06 | MRF ↗ |
| MEEKER MEMORIAL HOSPITAL OutpatientFacility | HEALTH PARTNERS | HPI | $323.08 | — | — | 2025-12-28 | MRF ↗ |
| MEEKER MEMORIAL HOSPITAL OutpatientFacility | HEALTH PARTNERS | HEALTH PARTNERS | $323.08 | — | — | 2025-12-28 | MRF ↗ |
| Mount Sinai Behavioral Health Center OutpatientFacility | Metroplus | Metroplus Ep 1-2 - Brook | $338.03 | — | — | 2026-04-01 | MRF ↗ |
| Mount Sinai Behavioral Health Center OutpatientFacility | Metroplus | Metroplus Ep 3-4 - Brook | $338.03 | — | — | 2026-04-01 | MRF ↗ |
| Mount Sinai Behavioral Health Center OutpatientFacility | Metroplus | Metroplus Medicaid - Brook | $338.03 | — | — | 2026-04-01 | MRF ↗ |
| Mount Sinai Behavioral Health Center OutpatientFacility | Metroplus | Metroplus Medicare Adv - Brook | $338.03 | — | — | 2026-04-01 | MRF ↗ |
| Mount Sinai Behavioral Health Center OutpatientFacility | Metroplus | Metroplus Exchange - Brook | $338.03 | — | — | 2026-04-01 | MRF ↗ |
| Shepherd Center Outpatient | Bcbs | Hmo | $338.98 | — | — | 2026-05-06 | MRF ↗ |
| Shepherd Center Outpatient | Bcbs | Ppo | $338.98 | — | — | 2026-05-06 | MRF ↗ |
| H Lee Moffitt Cancer Center & Research Institute I Outpatient | Humana | HMO/PPO | $345.51 | — | — | 2025-10-24 | MRF ↗ |
| MONTEFIORE MEDICAL CENTER Both | Humana | Medicare Midlevels | $345.92 | $4,115.00 | $2,691.21 | 2026-04-01 | MRF ↗ |
| ST JAMES PARISH HOSPITAL OutpatientFacility | Aetna | All Commercial Plans | $384.61 | — | — | 2026-04-01 | MRF ↗ |
| MONTEFIORE MEDICAL CENTER Both | Aetna | Medicare | $389.13 | $4,115.00 | $2,691.21 | 2026-04-01 | MRF ↗ |
| MONTEFIORE MEDICAL CENTER Outpatient | SEIU1199 | Local 1199 | $390.00 | — | — | 2026-04-01 | MRF ↗ |
| SAINT THOMAS RIVER PARK HOSPITAL Outpatient | BCBS BLUE CARE (REGIONALS ONLY) | 2430_BCBS BLUE CARE (RIVER PARK) 20221001 | $399.10 | — | — | 2026-01-01 | MRF ↗ |
| MONTEFIORE MEDICAL CENTER Both | Humana | Medicare | $415.11 | $4,115.00 | $2,691.21 | 2026-04-01 | MRF ↗ |
| Shepherd Center Outpatient | Aetna | Commercial | $456.42 | — | — | 2026-05-06 | MRF ↗ |
| SAINT THOMAS RIVER PARK HOSPITAL Outpatient | BCBS TENNCARE SELECT | 2426_BCBS TENNCARE SELECT (RIVER PARK) 20221001 | $507.53 | — | — | 2026-01-01 | MRF ↗ |
| METROPOLITAN HOSPITAL CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| North Central Bronx Hospital OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| JACOBI MEDICAL CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| LINCOLN MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| METROPOLITAN HOSPITAL CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| WOODHULL MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| RICHMOND UNIVERSITY MEDICAL CENTER OutpatientFacility | Local 1199 | Local 1199 | $520.00 | — | $2,835.08 | 2025-08-06 | MRF ↗ |
| HARLEM HOSPITAL CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| MONTEFIORE MEDICAL CENTER Both | 1199 | 1199 | $520.00 | $4,115.00 | $2,691.21 | 2026-04-01 | MRF ↗ |
| NY EYE AND EAR INFIRMARY OF MOUNT SINAI OutpatientFacility | 1199 Seiu | 1199 Seiu - Nyeei | $520.00 | — | — | 2026-04-01 | MRF ↗ |
| QUEENS HOSPITAL CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| North Central Bronx Hospital OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| MOUNT SINAI HOSPITAL OutpatientFacility | Local 1199 | 1199 Seiu - Tmsh | $520.00 | — | — | 2026-04-01 | MRF ↗ |
| ELMHURST HOSPITAL CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| WOODHULL MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| QUEENS HOSPITAL CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| KINGS COUNTY HOSPITAL CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| MAIMONIDES MEDICAL CENTER OutpatientFacility | Local 1199 | Commercial PPO | $520.00 | — | — | 2026-04-01 | MRF ↗ |
| NYACK HOSPITAL Outpatient | SEIU1199 | SEIU1199 | $520.00 | — | — | 2026-04-01 | MRF ↗ |
| Mount Sinai Behavioral Health Center OutpatientFacility | Local 1199 | 1199 Seiu - Brook | $520.00 | — | — | 2026-04-01 | MRF ↗ |
| BELLEVUE HOSPITAL CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| Mount Sinai Behavioral Health Center OutpatientFacility | Local 1199 | 1199 Seiu - Msq | $520.00 | — | — | 2026-04-01 | MRF ↗ |
| MOUNT SINAI WEST OutpatientFacility | Local 1199 | 1199 Seiu - Bi | $520.00 | — | — | 2026-04-01 | MRF ↗ |
| MOUNT SINAI WEST OutpatientFacility | Local 1199 | 1199 Seiu - Slw | $520.00 | — | — | 2026-04-01 | MRF ↗ |
| SOUTH BROOKLYN HEALTH OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| JACOBI MEDICAL CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| NEW YORK COMMUNITY HOSPITAL OF BROOKLYN, INC. OutpatientFacility | Local 1199 | Commercial PPO | $520.00 | — | — | 2026-04-01 | MRF ↗ |
| KINGS COUNTY HOSPITAL CENTER OutpatientFacility | Local 1199 | ALL PRODUCTS | $520.00 | — | — | 2025-09-05 | MRF ↗ |
| MEDINA REGIONAL HOSPITAL OutpatientFacility | United Healthcare | Medicare Advantage | $525.00 | — | — | 2025-06-26 | MRF ↗ |
| OSF SAINT ANTHONY'S HEALTH CENTER OutpatientFacility | Humana | All Commercial Plans | $536.86 | — | — | 2026-03-31 | MRF ↗ |
| SAINT FRANCIS MEDICAL CENTER OutpatientFacility | Humana | Ppo | $536.86 | — | — | 2026-03-31 | MRF ↗ |
| SAINT FRANCIS MEDICAL CENTER OutpatientFacility | Humana | Hmo/Pos | $536.86 | — | — | 2026-03-31 | MRF ↗ |
| SAINT FRANCIS MEDICAL CENTER OutpatientFacility | Humana | Ppo | $536.86 | — | — | 2026-03-31 | MRF ↗ |
| SAINT FRANCIS MEDICAL CENTER OutpatientFacility | Humana | Hmo/Pos | $536.86 | — | — | 2026-03-31 | MRF ↗ |
| OSF SAINT ANTHONY'S HEALTH CENTER OutpatientFacility | Humana | All Commercial Plans | $536.86 | — | — | 2026-03-31 | MRF ↗ |
| KONA COMMUNITY HOSPITAL Outpatient | HMSA | Mcd_ABD | $547.00 | — | — | 2025-07-28 | MRF ↗ |
| KAUAI VETERANS MEMORIAL HOSPITAL Outpatient | HMSA | Mcd_ABD | $547.00 | — | — | 2025-08-07 | MRF ↗ |
| KONA COMMUNITY HOSPITAL Outpatient | HMSA | Mcd_ABD | $547.00 | — | — | 2025-07-28 | MRF ↗ |
| ASCENSION COLUMBIA ST MARYS HOSPITAL MILWAUKEE Both | NETWORK HEALTH PLAN | 1136_NETWORK HEALTH PLAN 20221001 | $569.62 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Sacred Heart Rehabilitation Hospital Both | NETWORK HEALTH PLAN | 1136_NETWORK HEALTH PLAN 20221001 | $569.62 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Columbia St. Mary's Hospital Ozaukee Both | NETWORK HEALTH PLAN | 1136_NETWORK HEALTH PLAN 20221001 | $569.62 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION SETON NORTHWEST Outpatient | HUMANA HMO | 2668_HUMANA HMO 20230701 | $579.51 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION SETON EDGAR B DAVIS Outpatient | HUMANA HMO | 2668_HUMANA HMO 20230701 | $579.51 | — | — | 2026-01-01 | MRF ↗ |
| DELL SETON MED CENTER AT THE UNIVERSITY OF TX Outpatient | HUMANA HMO | 2668_HUMANA HMO 20230701 | $579.51 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION SETON SMITHVILLE Outpatient | HUMANA HMO | 2668_HUMANA HMO 20230701 | $579.51 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION SETON MEDICAL CENTER AUSTIN Outpatient | HUMANA HMO | 2668_HUMANA HMO 20230701 | $579.51 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION SETON HIGHLAND LAKES Outpatient | HUMANA HMO | 2668_HUMANA HMO 20230701 | $579.51 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION SETON HAYS Outpatient | HUMANA HMO | 2668_HUMANA HMO 20230701 | $579.51 | — | — | 2026-01-01 | MRF ↗ |
| OSS ORTHOPAEDIC HOSPITAL OutpatientFacility | Aetna | F8101_Aetna - Medicare Advantage | $604.90 | — | — | 2026-04-01 | MRF ↗ |
| OSS ORTHOPAEDIC HOSPITAL OutpatientFacility | Aetna | F8101_Aetna - Medicare Advantage | $604.90 | — | — | 2026-04-01 | MRF ↗ |
| Roswell Park Cancer Institute OutpatientFacility | Bcbs | Medicare Managed Care - Ppo | $624.34 | — | — | 2026-04-01 | MRF ↗ |
| Roswell Park Cancer Institute OutpatientFacility | Bcbs | Zero Premium Medicare Managed Care - Hmo | $624.34 | — | — | 2026-04-01 | MRF ↗ |
| KAHUKU MEDICAL CENTER Outpatient | HMSA | Mcd_ABD | $654.22 | — | — | 2024-06-28 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $659.86 | — | — | 2026-01-01 | MRF ↗ |
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