0201T — Perq Sacral Augmt Bilat Inj
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). Perq sacral augmt bilat inj (OTHER 0201T) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/0201T?code_type=OTHER
MLA (9th ed.)
“Perq sacral augmt bilat inj (OTHER 0201T) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/0201T?code_type=OTHER. Accessed .
Chicago (notes-bibliography)
“Perq sacral augmt bilat inj (OTHER 0201T) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/0201T?code_type=OTHER.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $4,961–$10,991 (25th–75th percentile) across 707 hospitals · 1,379 payers.
“Negotiated” is the hospital’s negotiated facility rate for this OTHER 0201T — 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 |
|---|---|---|---|---|---|---|---|
| RUSH MEMORIAL HOSPITAL Outpatient | UHC COMM-ALL OTHER PLANS | UHC COMM-ALL OTHER PLANS | $20.20 | $101.00 | $75.75 | 2026-04-27 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | CIGNA COMM - ALL PLANS | CIGNA COMM - ALL PLANS | $24.00 | $5,066.00 | $5,066.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | AETNA COMM OP ONLY - ALL OTHER PLANS | AETNA COMM OP ONLY - ALL OTHER PLANS | $24.00 | $5,066.00 | $5,066.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | CIGNA COMM - ALL PLANS | CIGNA COMM - ALL PLANS | $24.00 | $5,066.00 | $5,066.00 | 2026-02-09 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | SOONERCARE MCAID - ALL PLANS | SOONERCARE MCAID - ALL PLANS | $25.60 | $5,066.00 | $5,066.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | CHILDRENS MED CENTER HP - ALL PLANS | CHILDRENS MED CENTER HP - ALL PLANS | $25.60 | $5,066.00 | $5,066.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | COMMUNITY FIRST HP - ALL PLANS | COMMUNITY FIRST HP - ALL PLANS | $25.60 | $5,066.00 | $5,066.00 | 2026-04-23 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | MOLINA MCAID - ALL PLANS | MOLINA MCAID - ALL PLANS | $25.60 | $5,066.00 | $5,066.00 | 2026-04-23 | MRF ↗ |
| RARITAN BAY MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $29.61 | $16,448.00 | $7,262.33 | 2024-12-31 | MRF ↗ |
| TEXAS SCOTTISH RITE HOSPITAL FOR CHILDREN Outpatient | UHC MCAID | UHC MCAID | $34.00 | $5,066.00 | $5,066.00 | 2026-04-23 | MRF ↗ |
| KEARNEY REGIONAL MEDICAL CENTER Outpatient | WELLCARE OF NEBRASKA MCAID-ALL PLANS | WELLCARE OF NEBRASKA MCAID-ALL PLANS | $40.10 | $9,885.00 | $6,919.50 | 2025-07-17 | MRF ↗ |
| KEARNEY REGIONAL MEDICAL CENTER Outpatient | ARBOR HEALTH PLAN MCAID-ALL PLANS | ARBOR HEALTH PLAN MCAID-ALL PLANS | $40.10 | $9,885.00 | $6,919.50 | 2025-07-17 | MRF ↗ |
| RUSH MEMORIAL HOSPITAL Outpatient | HEALTH NET | HEALTH NET | $50.50 | $101.00 | $75.75 | 2026-04-27 | MRF ↗ |
| RUSH MEMORIAL HOSPITAL Outpatient | CIGNA-ALL PLANS | CIGNA-ALL PLANS | $50.50 | $101.00 | $75.75 | 2026-04-27 | MRF ↗ |
| RUSH MEMORIAL HOSPITAL Outpatient | PHCS-ALL PLANS | PHCS-ALL PLANS | $63.00 | $101.00 | $75.75 | 2026-04-27 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | MIDLANDS CHOICE - ALL PLANS | MIDLANDS CHOICE - ALL PLANS | $63.50 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| RUSH MEMORIAL HOSPITAL Outpatient | COVENTRY/FIRST HEALTH-ALL PLANS | COVENTRY/FIRST HEALTH-ALL PLANS | $70.70 | $101.00 | $75.75 | 2026-04-27 | MRF ↗ |
| ADVENTIST HEALTH BAKERSFIELD Outpatient | BLUE CROSS MCS | BLUE CROSS MCS | $75.60 | $3,936.32 | $590.45 | 2026-10-05 | MRF ↗ |
| ADVENTIST HEALTH BAKERSFIELD Outpatient | BLUE CROSS NON-MCS - ALL OTHER PLANS | BLUE CROSS NON-MCS - ALL OTHER PLANS | $75.60 | $3,936.32 | $590.45 | 2026-10-05 | MRF ↗ |
| BELLEVUE MEDICAL CENTER Outpatient | AETNA COMM-ALL OTHER PLANS | AETNA COMM-ALL OTHER PLANS | $78.57 | $2,555.00 | $1,660.75 | 2026-08-10 | MRF ↗ |
| ST DOMINIC-JACKSON MEMORIAL HOSPITAL Outpatient | UHC NEXUS | UHC NEXUS | $160.00 | $25,584.00 | $12,792.00 | 2026-01-17 | MRF ↗ |
| ST DOMINIC-JACKSON MEMORIAL HOSPITAL Outpatient | UHC EXCHANGE | UHC EXCHANGE | $162.00 | $25,584.00 | $12,792.00 | 2026-01-17 | MRF ↗ |
| ST DOMINIC-JACKSON MEMORIAL HOSPITAL Outpatient | UHC - ALL OTHER PLANS | UHC - ALL OTHER PLANS | $178.00 | $25,584.00 | $12,792.00 | 2026-01-17 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | MADISON COUNTY SHERIFF-ALL PLANS | MADISON COUNTY SHERIFF-ALL PLANS | $221.50 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| Saint Francis Hospital Outpatient | Imagine Health Network, Inc. | Imagine Health Network Commercial | $232.00 | $10,890.00 | $7,737.00 | 2026-03-17 | MRF ↗ |
| Saint Francis Hospital Outpatient | Imagine Health Network, Inc. | Imagine Health Network Commercial | $232.00 | $10,890.00 | $7,737.00 | 2026-09-01 | MRF ↗ |
| CASS COUNTY MEMORIAL HOSPITAL Outpatient | MIDLANDS CHOICE MEDICA MCR | MIDLANDS CHOICE MEDICA MCR | $309.00 | $1,545.00 | $1,081.50 | 2026-06-01 | MRF ↗ |
| HOLY CROSS HOSPITAL OutpatientFacility | AvMed | All Products | $323.00 | $22,392.00 | $14,554.80 | 2025-01-01 | MRF ↗ |
| HOLY CROSS HOSPITAL OutpatientFacility | AvMed | All Products | $323.00 | $22,392.00 | $14,554.80 | 2025-01-01 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | CHOICECARE-ALL PLANS | CHOICECARE-ALL PLANS | $354.40 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | MEDIMORE EMPLOYEE HP - ALL PLANS | MEDIMORE EMPLOYEE HP - ALL PLANS | $354.40 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER OutpatientFacility | Blue Shield | Ucd Hb Blue Shield Referred | $361.76 | — | — | 2026-04-01 | MRF ↗ |
| UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER OutpatientFacility | Sheet Metal Workers Union(Smw) | Ucd Hb Blue Shield Referred | $361.76 | — | — | 2026-04-01 | MRF ↗ |
| UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER OutpatientFacility | Blue Shield | Ucd Hb Blue Shield Ifp | $361.76 | — | — | 2026-04-01 | MRF ↗ |
| UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER OutpatientFacility | Blue Shield | Ucd Hb Blue Shield Calpers | $361.76 | — | — | 2026-04-01 | MRF ↗ |
| UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER OutpatientFacility | Pipe Trades | Ucd Hb Blue Shield Referred | $361.76 | — | — | 2026-04-01 | MRF ↗ |
| UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER OutpatientFacility | Ufcw | Ucd Hb Blue Shield Referred | $361.76 | — | — | 2026-04-01 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | TRICARE/HNFS - ALL PLANS | TRICARE/HNFS - ALL PLANS | $367.22 | $854.00 | $683.20 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | AETNA MCR ADV | AETNA MCR ADV | $367.22 | $854.00 | $683.20 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | MEDIGOLD-ALL PLANS | MEDIGOLD-ALL PLANS | $367.22 | $854.00 | $683.20 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | UHC MCR ADV | UHC MCR ADV | $367.22 | $854.00 | $683.20 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | MEDICAL ASSOCIATES HP - ALL PLANS | MEDICAL ASSOCIATES HP - ALL PLANS | $367.22 | $854.00 | $683.20 | 2026-06-05 | MRF ↗ |
| RUSH MEMORIAL HOSPITAL Outpatient | HUMANA CHOICE CARE ONE | HUMANA CHOICE CARE ONE | $382.17 | $101.00 | $75.75 | 2026-04-27 | MRF ↗ |
| RUSH MEMORIAL HOSPITAL Outpatient | HUMANA CHOICE CARE-ALL OTHER PLANS | HUMANA CHOICE CARE-ALL OTHER PLANS | $382.17 | $101.00 | $75.75 | 2026-04-27 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | AMERICAN HP MCR ADV-ALL PLANS | AMERICAN HP MCR ADV-ALL PLANS | $385.58 | $854.00 | $683.20 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | CORVEL WC-ALL PLANS | CORVEL WC-ALL PLANS | $398.70 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | IOWA TOTAL CARE MCAID-ALL PLANS | IOWA TOTAL CARE MCAID-ALL PLANS | $401.38 | $854.00 | $683.20 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | UHC MCAID | UHC MCAID | $401.38 | $854.00 | $683.20 | 2026-06-05 | MRF ↗ |
| SAINT AGNES MEDICAL CENTER OutpatientFacility | BSCA | EPN | $415.30 | $7,807.00 | $5,464.90 | 2025-01-01 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | MOLINA MCAID/CHIP -ALL PLANS | MOLINA MCAID/CHIP -ALL PLANS | $415.47 | $854.00 | $683.20 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | FIRST CHOICE-ALL PLANS | FIRST CHOICE-ALL PLANS | $420.85 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | PREFERRED HLTH NTWORK-ALL PLANS | PREFERRED HLTH NTWORK-ALL PLANS | $420.85 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | PRINCIPAL HEALTHCARE-ALL PLANS | PRINCIPAL HEALTHCARE-ALL PLANS | $420.85 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | INTEGRATED HP-ALL PLANS | INTEGRATED HP-ALL PLANS | $420.85 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | USA MANAGED CARE-ALL PLANS | USA MANAGED CARE-ALL PLANS | $420.85 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | PLAINES HEALTH-ALL PLANS | PLAINES HEALTH-ALL PLANS | $420.85 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | FIRST HEALTH-ALL PLANS | FIRST HEALTH-ALL PLANS | $420.85 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | MUTUAL OF OMAHA-ALL PLANS | MUTUAL OF OMAHA-ALL PLANS | $420.85 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | AMERIGROUP MCAID-ALL PLANS | AMERIGROUP MCAID-ALL PLANS | $425.46 | $854.00 | $683.20 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | MADISON COUNTY SHERIFF-ALL PLANS | MADISON COUNTY SHERIFF-ALL PLANS | $427.00 | $854.00 | $683.20 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | IOWA TOTAL CARE MCAID-ALL PLANS | IOWA TOTAL CARE MCAID-ALL PLANS | $443.00 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | UHC MCAID | UHC MCAID | $443.00 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | BENEFIT ADMIN OF AMERICA-ALL PLANS | BENEFIT ADMIN OF AMERICA-ALL PLANS | $443.00 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| BROOKS-TLC HOSPITAL SYSTEM, INC OutpatientFacility | Bcbs | Bcwyn Medicare Managed Care Plan | $449.72 | — | — | 2026-04-01 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | MOLINA MCAID/CHIP -ALL PLANS | MOLINA MCAID/CHIP -ALL PLANS | $454.08 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| KUAKINI MEDICAL CENTER OutpatientFacility | UHC | QUEST INT | $456.03 | $2,823.00 | $2,540.70 | 2026-01-25 | MRF ↗ |
| MADISON COUNTY HEALTH CARE SYSTEM Outpatient | AMERIGROUP MCAID-ALL PLANS | AMERIGROUP MCAID-ALL PLANS | $469.58 | $443.00 | $354.40 | 2026-06-05 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | ANTHEM PPO PREFERRED | 9406_ANTHEM PREFERRED VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | ENCORE EXCLUSIVE | 9409_ENCORE EXCUSIVE VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | PATOKA VALLEY TIER 1 | 9412_PAKOTA VALLEY TIER 1 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | ENCORE EXCLUSIVE | 9409_ENCORE EXCUSIVE VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ST VINCENT HEART CENTER Outpatient | PATOKA VALLEY TIER 2 | 9413_PAKOTA VALLEY TIER 2 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | ANTHEM PATHWAY X | 9405_ANTHEM PATHWAY X VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ANTHEM HEALTHSYNC POS | 9401_ANTHEM HEALTHSYNC POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ST VINCENT HEART CENTER Outpatient | ANTHEM PPO PREFERRED | 9406_ANTHEM PREFERRED VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ST VINCENT HEART CENTER Outpatient | PATOKA VALLEY TIER 1 | 9410_PAKOTA VALLEY TIER 1 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | PATOKA VALLEY TIER 1 | 9412_PAKOTA VALLEY TIER 1 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Outpatient | ANTHEM PPO PREFERRED | 9406_ANTHEM PREFERRED VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ANTHEM SHORT TERM LIMITED DURATION | 9407_ANTHEM SHORT TERM LIMITED DURATION VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | PATOKA VALLEY TIER 1 | 9410_PAKOTA VALLEY TIER 1 VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | ANTHEM HMO/POS | 9403_ANTHEM HMO POS VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ANTHEM TRADITIONAL | 9408_ANTHEM TRADITIONAL VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | PATOKA VALLEY TIER 2 | 9415_PAKOTA VALLEY TIER 2 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | PATOKA VALLEY TIER 1 | 9410_PAKOTA VALLEY TIER 1 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ANTHEM SHORT TERM LIMITED DURATION | 9407_ANTHEM SHORT TERM LIMITED DURATION VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | PATOKA VALLEY TIER 2 | 9415_PAKOTA VALLEY TIER 2 VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | PATOKA VALLEY TIER 2 | 9413_PAKOTA VALLEY TIER 2 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | PATOKA VALLEY TIER 2 | 9415_PAKOTA VALLEY TIER 2 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ANTHEM PATHWAY X | 9405_ANTHEM PATHWAY X VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM PATHWAY | 9404_ANTHEM PATHWAY VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | PATOKA VALLEY TIER 1 | 9410_PAKOTA VALLEY TIER 1 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ANTHEM HMO/POS | 9403_ANTHEM HMO POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Outpatient | PATOKA VALLEY TIER 1 | 9410_PAKOTA VALLEY TIER 1 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | PATOKA VALLEY TIER 2 | 9413_PAKOTA VALLEY TIER 2 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | PATOKA VALLEY TIER 2 | 9413_PAKOTA VALLEY TIER 2 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | ANTHEM HEALTHSYNC POS | 9401_ANTHEM HEALTHSYNC POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | ANTHEM HEALTHSYNC HMO | 9399_ANTHEM HEALTHSYNC HMO VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | ANTHEM PATHWAY | 9404_ANTHEM PATHWAY VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | PATOKA VALLEY TIER 2 | 9415_PAKOTA VALLEY TIER 2 VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Outpatient | PATOKA VALLEY TIER 2 | 9415_PAKOTA VALLEY TIER 2 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ANTHEM HEALTHSYNC HMO | 9399_ANTHEM HEALTHSYNC HMO VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ANTHEM PATHWAY | 9404_ANTHEM PATHWAY VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Outpatient | ANTHEM HEALTHSYNC POS | 9401_ANTHEM HEALTHSYNC POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Outpatient | ANTHEM TRADITIONAL | 9408_ANTHEM TRADITIONAL VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Outpatient | ANTHEM HEALTHSYNC HMO | 9399_ANTHEM HEALTHSYNC HMO VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Outpatient | PATOKA VALLEY TIER 1 | 9412_PAKOTA VALLEY TIER 1 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | PATOKA VALLEY TIER 1 | 9410_PAKOTA VALLEY TIER 1 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ST VINCENT HEART CENTER Outpatient | ANTHEM TRADITIONAL | 9408_ANTHEM TRADITIONAL VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | PATOKA VALLEY TIER 1 | 9412_PAKOTA VALLEY TIER 1 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | ANTHEM HEALTHSYNC POS | 9401_ANTHEM HEALTHSYNC POS VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| RUSH MEMORIAL HOSPITAL Outpatient | ANTHEM HMO | ANTHEM HMO | $499.00 | $101.00 | $75.75 | 2026-04-27 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | PATOKA VALLEY TIER 1 | 9412_PAKOTA VALLEY TIER 1 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | PATOKA VALLEY TIER 2 | 9415_PAKOTA VALLEY TIER 2 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ANTHEM HEALTHSYNC HMO | 9399_ANTHEM HEALTHSYNC HMO VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | PATOKA VALLEY TIER 1 | 9410_PAKOTA VALLEY TIER 1 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | PATOKA VALLEY TIER 2 | 9415_PAKOTA VALLEY TIER 2 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | ANTHEM HEALTHSYNC HMO | 9399_ANTHEM HEALTHSYNC HMO VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM TRADITIONAL | 9408_ANTHEM TRADITIONAL VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ENCORE EXCLUSIVE | 9409_ENCORE EXCUSIVE VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM PATHWAY | 9404_ANTHEM PATHWAY VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ENCORE EXCLUSIVE | 9409_ENCORE EXCUSIVE VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM HEALTHSYNC POS | 9401_ANTHEM HEALTHSYNC POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM HMO/POS | 9403_ANTHEM HMO POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ANTHEM PPO PREFERRED | 9406_ANTHEM PREFERRED VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM HEALTHSYNC HMO | 9399_ANTHEM HEALTHSYNC HMO VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | ANTHEM SHORT TERM LIMITED DURATION | 9407_ANTHEM SHORT TERM LIMITED DURATION VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | PATOKA VALLEY TIER 2 | 9413_PAKOTA VALLEY TIER 2 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Outpatient | ANTHEM HEALTHSYNC POS | 9401_ANTHEM HEALTHSYNC POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| RUSH MEMORIAL HOSPITAL Outpatient | ANTHEM PATH X | ANTHEM PATH X | $499.00 | $101.00 | $75.75 | 2026-04-27 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | PATOKA VALLEY TIER 1 | 9412_PAKOTA VALLEY TIER 1 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ST VINCENT HEART CENTER Outpatient | ANTHEM HMO/POS | 9403_ANTHEM HMO POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Outpatient | PATOKA VALLEY TIER 2 | 9413_PAKOTA VALLEY TIER 2 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | ANTHEM PATHWAY | 9404_ANTHEM PATHWAY VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | ANTHEM SHORT TERM LIMITED DURATION | 9407_ANTHEM SHORT TERM LIMITED DURATION VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Outpatient | ANTHEM HMO/POS | 9403_ANTHEM HMO POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | PATOKA VALLEY TIER 2 | 9415_PAKOTA VALLEY TIER 2 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | PATOKA VALLEY TIER 1 | 9412_PAKOTA VALLEY TIER 1 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | PATOKA VALLEY TIER 2 | 9413_PAKOTA VALLEY TIER 2 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | ANTHEM HEALTHSYNC HMO | 9399_ANTHEM HEALTHSYNC HMO VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM PPO PREFERRED | 9406_ANTHEM PREFERRED VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ST VINCENT HEART CENTER Outpatient | ANTHEM HEALTHSYNC HMO | 9399_ANTHEM HEALTHSYNC HMO VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM SHORT TERM LIMITED DURATION | 9407_ANTHEM SHORT TERM LIMITED DURATION VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | ENCORE EXCLUSIVE | 9409_ENCORE EXCUSIVE VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | ANTHEM HMO/POS | 9403_ANTHEM HMO POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | ANTHEM HEALTHSYNC POS | 9401_ANTHEM HEALTHSYNC POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | PATOKA VALLEY TIER 1 | 9410_PAKOTA VALLEY TIER 1 VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ANTHEM PATHWAY X | 9405_ANTHEM PATHWAY X VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ST VINCENT HEART CENTER Outpatient | ANTHEM SHORT TERM LIMITED DURATION | 9407_ANTHEM SHORT TERM LIMITED DURATION VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Outpatient | ANTHEM PPO PREFERRED | 9406_ANTHEM PREFERRED VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | ANTHEM TRADITIONAL | 9408_ANTHEM TRADITIONAL VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | PATOKA VALLEY TIER 1 | 9412_PAKOTA VALLEY TIER 1 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | PATOKA VALLEY TIER 2 | 9413_PAKOTA VALLEY TIER 2 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | ANTHEM HEALTHSYNC POS | 9401_ANTHEM HEALTHSYNC POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | PATOKA VALLEY TIER 2 | 9415_PAKOTA VALLEY TIER 2 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | ANTHEM HEALTHSYNC HMO | 9399_ANTHEM HEALTHSYNC HMO VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM SHORT TERM LIMITED DURATION | 9407_ANTHEM SHORT TERM LIMITED DURATION VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | PATOKA VALLEY TIER 2 | 9413_PAKOTA VALLEY TIER 2 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | ANTHEM HMO/POS | 9403_ANTHEM HMO POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | ANTHEM TRADITIONAL | 9408_ANTHEM TRADITIONAL VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | ANTHEM PATHWAY | 9404_ANTHEM PATHWAY VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM PPO PREFERRED | 9406_ANTHEM PREFERRED VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| RUSH MEMORIAL HOSPITAL Outpatient | ANTHEM PATH | ANTHEM PATH | $499.00 | $101.00 | $75.75 | 2026-04-27 | MRF ↗ |
| ST VINCENT HEART CENTER Outpatient | ENCORE EXCLUSIVE | 9409_ENCORE EXCUSIVE VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | ANTHEM TRADITIONAL | 9408_ANTHEM TRADITIONAL VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | ANTHEM PATHWAY X | 9405_ANTHEM PATHWAY X VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Outpatient | ANTHEM TRADITIONAL | 9408_ANTHEM TRADITIONAL VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | ANTHEM PATHWAY X | 9405_ANTHEM PATHWAY X VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | ANTHEM HMO/POS | 9403_ANTHEM HMO POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM TRADITIONAL | 9408_ANTHEM TRADITIONAL VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | ANTHEM PATHWAY X | 9405_ANTHEM PATHWAY X VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | ANTHEM PPO PREFERRED | 9406_ANTHEM PREFERRED VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| RUSH MEMORIAL HOSPITAL Outpatient | ANTHEM PPO | ANTHEM PPO | $499.00 | $101.00 | $75.75 | 2026-04-27 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | ANTHEM PPO PREFERRED | 9406_ANTHEM PREFERRED VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | PATOKA VALLEY TIER 1 | 9410_PAKOTA VALLEY TIER 1 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Outpatient | ANTHEM HMO/POS | 9403_ANTHEM HMO POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | ANTHEM PPO PREFERRED | 9406_ANTHEM PREFERRED VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ENCORE EXCLUSIVE | 9409_ENCORE EXCUSIVE VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | ANTHEM SHORT TERM LIMITED DURATION | 9407_ANTHEM SHORT TERM LIMITED DURATION VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | PATOKA VALLEY TIER 1 | 9412_PAKOTA VALLEY TIER 1 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | ANTHEM TRADITIONAL | 9408_ANTHEM TRADITIONAL VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ANTHEM HMO/POS | 9403_ANTHEM HMO POS VEIN 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| RUSH MEMORIAL HOSPITAL Outpatient | ANTHEM PATH ESSENTIALS | ANTHEM PATH ESSENTIALS | $499.00 | $101.00 | $75.75 | 2026-04-27 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM HMO/POS | 9403_ANTHEM HMO POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Outpatient | ANTHEM SHORT TERM LIMITED DURATION | 9407_ANTHEM SHORT TERM LIMITED DURATION VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM PATHWAY X | 9405_ANTHEM PATHWAY X VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM HEALTHSYNC POS | 9401_ANTHEM HEALTHSYNC POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | ANTHEM PATHWAY | 9404_ANTHEM PATHWAY VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | ENCORE EXCLUSIVE | 9409_ENCORE EXCUSIVE VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ST VINCENT HEART CENTER Outpatient | ANTHEM PATHWAY X | 9405_ANTHEM PATHWAY X VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| RUSH MEMORIAL HOSPITAL Outpatient | ANTHEM TRAD - ALL OTHER PLANS | ANTHEM TRAD - ALL OTHER PLANS | $499.00 | $101.00 | $75.75 | 2026-04-27 | MRF ↗ |
| ST VINCENT HEART CENTER Outpatient | PATOKA VALLEY TIER 2 | 9415_PAKOTA VALLEY TIER 2 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Outpatient | ENCORE EXCLUSIVE | 9409_ENCORE EXCUSIVE VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | ENCORE EXCLUSIVE | 9409_ENCORE EXCUSIVE VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | PATOKA VALLEY TIER 2 | 9413_PAKOTA VALLEY TIER 2 20250101 | $499.00 | $16,789.00 | $10,073.40 | 2026-01-01 | MRF ↗ |
| ST VINCENT HEART CENTER Outpatient | ANTHEM HEALTHSYNC POS | 9401_ANTHEM HEALTHSYNC POS VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ST VINCENT HEART CENTER Outpatient | PATOKA VALLEY TIER 1 | 9412_PAKOTA VALLEY TIER 1 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | ANTHEM SHORT TERM LIMITED DURATION | 9407_ANTHEM SHORT TERM LIMITED DURATION VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | PATOKA VALLEY TIER 1 | 9410_PAKOTA VALLEY TIER 1 VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | ANTHEM PATHWAY X | 9405_ANTHEM PATHWAY X VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
| ST VINCENT HEART CENTER Outpatient | ANTHEM PATHWAY | 9404_ANTHEM PATHWAY VEIN 20250101 | $499.00 | — | — | 2026-01-01 | MRF ↗ |
Showing the first 200 rate rows. The CSV export above returns up to 1,000 rows — filter by state to narrow a code with more than that.