0304T — Icar Ischm Mntrng Sys Device
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). Icar ischm mntrng sys device (OTHER 0304T) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/0304T?code_type=OTHER
MLA (9th ed.)
“Icar ischm mntrng sys device (OTHER 0304T) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/0304T?code_type=OTHER. Accessed .
Chicago (notes-bibliography)
“Icar ischm mntrng sys device (OTHER 0304T) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/0304T?code_type=OTHER.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $5,063–$11,643 (25th–75th percentile) across 109 hospitals · 87 payers.
“Negotiated” is the hospital’s negotiated facility rate for this OTHER 0304T — 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 |
|---|---|---|---|---|---|---|---|
| NATIONWIDE CHILDREN'S HOSPITAL OutpatientFacility | Anthem BCBS | All Products | $686.85 | — | — | 2026-04-01 | MRF ↗ |
| PALESTINE REGIONAL MEDICAL CENTER OutpatientFacility | BCBS | All Commercial Plans | $1,013.00 | — | — | 2026-04-01 | MRF ↗ |
| PALESTINE REGIONAL WEST CAMPUS OutpatientFacility | BCBS | All Commercial Plans | $1,013.00 | — | — | 2026-04-01 | MRF ↗ |
| NORTHBAY MEDICAL CENTER OutpatientFacility | Blue Cross - Asc | All Commercial Plans | $1,340.00 | — | — | 2026-04-01 | MRF ↗ |
| GRIFFIN HOSPITAL OutpatientFacility | Connecticare (CCI) | All Products | $2,969.00 | — | — | 2025-11-26 | MRF ↗ |
| GRIFFIN HOSPITAL OutpatientFacility | Connecticare (CBI) | Exchange | $2,969.00 | — | — | 2025-11-26 | MRF ↗ |
| DEKALB COMMUNITY HOSPITAL Outpatient | COMMUNITY PLAN | 2495_SDTN MEDICAID REPLACEMENT UNITED HEALTH CARE COMMUNITY PLAN 20191001 | $3,272.67 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION SAINT THOMAS THREE RIVERS Outpatient | COMMUNITY PLAN | 2494_RHTN MEDICAID REPLACEMENT UNITED HEALTH CARE COMMUNITY PLAN 20191001 | $3,272.67 | — | — | 2026-01-01 | MRF ↗ |
| SAINT THOMAS RIVER PARK HOSPITAL Outpatient | COMMUNITY PLAN | 1351_RPTN MEDICAID REPLACEMENT UNITED HEALTH CARE COMMUNITY PLAN 20191001 | $3,272.67 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Saint Thomas Hickman Outpatient | COMMUNITY PLAN | 2496_THTN MEDICAID REPLACEMENT UNITED HEALTH CARE COMMUNITY PLAN 20191001 | $3,272.67 | — | — | 2026-01-01 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Group Health of South Central | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Iowa Total Care | Medicaid | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | UHC | Medicaid | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | ICare | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Group Health Eau Claire | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN PALMER LUTHERAN HOSPITAL AND CLINICS OutpatientFacility | Molina Health | Managed Medicaid | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS OutpatientFacility | Amerigroup | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Molina Health | Managed Medicaid | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN BOSCOBEL AREA HOSPITAL AND CLINICS OutpatientFacility | Amerigroup | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Group Health of South Central | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN PALMER LUTHERAN HOSPITAL AND CLINICS OutpatientFacility | Amerigroup | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Managed Health Service | Managed Medicaid | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Managed Health Service | Managed Medicaid | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Amerigroup | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN TRI-COUNTY HOSPITAL & CLINICS OutpatientFacility | Amerigroup | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Iowa Total Care | Medicaid | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Molina Health | Managed Medicaid | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Group Health Eau Claire | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN ST JOSEPHS HOSPITAL AND CLINICS OutpatientFacility | Amerigroup | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Anthem | Medicaid | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Amerigroup | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN MOUNDVIEW HOSPITAL AND CLINICS OutpatientFacility | Amerigroup | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | ICare | Medicaid HMO | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | Anthem | Medicaid | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| GUNDERSEN LUTHERAN MEDICAL CENTER OutpatientFacility | UHC | Medicaid | $3,406.96 | — | — | 2025-06-27 | MRF ↗ |
| ASCENSION PROVIDENCE HOSPITAL, SOUTHFIELD AND NOVI Both | MOLINA HEALTH | 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT 20211001 | $3,522.54 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE HOSPITAL, SOUTHFIELD AND NOVI Both | JVHL - MEDICAID REPLACEMENT | 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001 | $3,522.54 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE HOSPITAL, SOUTHFIELD AND NOVI Both | HEALTH PLAN OF MI MEDICAID HMO | 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001 | $3,522.54 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE HOSPITAL, SOUTHFIELD AND NOVI Both | JVHL - MEDICAID REPLACEMENT | 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 20250101 | $3,522.54 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE HOSPITAL, SOUTHFIELD AND NOVI Both | JVHL - MEDICAID REPLACEMENT | 1245_SJPK,SJPR MEDICAID REPLACEMENT HMO JVHL OUTPATIENT 20250101 | $3,522.54 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE HOSPITAL, SOUTHFIELD AND NOVI Both | JVHL - MEDICAID REPLACEMENT | 1079_SJPK,SJPR MEDICAID HMO JVHL INPATIENT 20211001 | $3,522.54 | — | — | 2026-01-01 | MRF ↗ |
| HENRY FORD HEALTH ST JOHN HOSPITAL Both | MERIDIAN HEALTH PLAN | 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 20220101 | $3,522.54 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION RIVER DISTRICT HOSPITAL Both | MERIDIAN HEALTH PLAN | 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 20220101 | $3,522.54 | — | — | 2026-01-01 | MRF ↗ |
| Henry Ford Health Warren Hospital Both | MERIDIAN HEALTH PLAN | 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 20220101 | $3,522.54 | — | — | 2026-01-01 | MRF ↗ |
| Henry Ford Health Warren Hospital Outpatient | PPOM | 934_PPOM 20191001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE HOSPITAL, SOUTHFIELD AND NOVI Both | MOLINA HEALTH | 1081_SJPK,SJPR MEDICAID REPLACEMENT MOLINA HEALTH INPATIENT 20211001 | $3,522.54 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Macomb-Oakland Hospital Madison Heights Campus Outpatient | PPOM | 934_PPOM 20191001 | — | — | — | 2026-01-01 | MRF ↗ |
| Ascension Macomb-Oakland Hospital Madison Heights Campus Both | MERIDIAN HEALTH PLAN | 1945_MEDICAID REPLACEMENT MERIDIAN HEALTH OUTPATIENT 20220101 | $3,522.54 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION RIVER DISTRICT HOSPITAL Outpatient | PPOM | 934_PPOM 20191001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION PROVIDENCE HOSPITAL, SOUTHFIELD AND NOVI Both | HEALTH PLAN OF MI MEDICAID HMO | 1083_SJPK,SJPR MERIDIAN HEALTH INPATIENT 20211001 | $3,522.54 | — | — | 2026-01-01 | MRF ↗ |
| HENRY FORD HEALTH ST JOHN HOSPITAL Outpatient | PPOM | 934_PPOM 20191001 | — | — | — | 2026-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Law Enforcement Franklin Co. | Medicaid | $4,122.24 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Law Enforcement Franklin Co. | Medicaid | $4,122.24 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | UHC | Medicaid | $4,287.13 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | UHC | Medicaid | $4,287.13 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Anthem | Medicaid | $4,328.35 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Molina | Medicaid | $4,328.35 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Anthem | Medicaid | $4,328.35 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Molina | Medicaid | $4,328.35 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Humana | Medicaid | $4,369.57 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Humana | Medicaid | $4,369.57 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Buckeye (Centene) | Medicaid | $4,410.80 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Buckeye Community Health | Medicaid | $4,410.80 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | AmeriHealth Caritas | Medicaid | $4,410.80 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Buckeye (Centene) | Medicaid | $4,410.80 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Caresource | Medicaid | $4,410.80 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Buckeye Community Health | Medicaid | $4,410.80 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Caresource | Medicaid | $4,410.80 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | AmeriHealth Caritas | Medicaid | $4,410.80 | — | — | 2025-01-01 | MRF ↗ |
| BELLEVUE HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| North Central Bronx Hospital OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| JACOBI MEDICAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| WOODHULL MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| METROPOLITAN HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| JACOBI MEDICAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| QUEENS HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| KINGS COUNTY HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| ELMHURST HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| QUEENS HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| North Central Bronx Hospital OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| METROPOLITAN HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| WOODHULL MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| LINCOLN MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| KINGS COUNTY HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $4,450.83 | — | — | 2025-09-05 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Safe Program | Medicaid | $4,493.24 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | PARAMOUNT | Medicaid | $4,493.24 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | Safe Program | Medicaid | $4,493.24 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL OutpatientFacility | PARAMOUNT | Medicaid | $4,493.24 | — | — | 2025-01-01 | MRF ↗ |
| PROVIDENCE HOLY CROSS MEDICAL CENTER OutpatientFacility | Blue Cross | All Commercial Plans | $4,619.00 | — | — | 2026-04-01 | MRF ↗ |
| PROVIDENCE LITTLE CO OF MARY MED CTR SAN PEDRO OutpatientFacility | Blue Cross | All Commercial Plans | $4,712.00 | — | — | 2026-04-01 | MRF ↗ |
| QUEENS HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| BELLEVUE HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| WOODHULL MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| ELMHURST HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| METROPOLITAN HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| METROPOLITAN HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| QUEENS HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| North Central Bronx Hospital OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| North Central Bronx Hospital OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| KINGS COUNTY HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| WOODHULL MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| LINCOLN MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| JACOBI MEDICAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| JACOBI MEDICAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| KINGS COUNTY HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $4,762.39 | — | — | 2025-09-05 | MRF ↗ |
| STAMFORD HOSPITAL OutpatientFacility | Connecticare | All Commercial Plans | $4,802.00 | — | — | 2026-04-01 | MRF ↗ |
| STAMFORD HOSPITAL OutpatientFacility | Connecticare | Exchange | $4,802.00 | — | — | 2026-04-01 | MRF ↗ |
| PROVIDENCE LITTLE COMPANY OF MARY MED CTR TORRANCE OutpatientFacility | Blue Cross | All Commercial Plans | $4,818.00 | — | — | 2026-04-01 | MRF ↗ |
| PROVIDENCE LITTLE COMPANY OF MARY MED CTR TORRANCE OutpatientFacility | Blue Cross | All Commercial Plans | $4,818.00 | — | — | 2026-04-01 | MRF ↗ |
| ASCENSION BORGESS ALLEGAN HOSPITAL Both | BLUE CAID | 3807_BOAH MEDICAID REPLACEMENT BLUE CROSS COMPLETE OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Both | BLUE CAID | 3807_BOAH MEDICAID REPLACEMENT BLUE CROSS COMPLETE OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Both | MOLINA MEDICAID | 3810_BOAH MOLINA MEDICAID OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Both | BOAH MEDICAID REPLACEMENT MERIDIAN OUTPATIENT 20250701 | 3808_BOAH MEDICAID REPLACEMENT MERIDIAN OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | MI CHILD | 3257_BPHC MEDICAID REPLACEMENT MICHIGAN CHILD OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | MEDICAID REPLACEMENT | 3256_BPHC MEDICAID REPLACEMENT MERIDIAN OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | AETNA MEDICAID | 3255_BPHC MEDICAID REPLACEMENT AETNA BETTER HEALTH OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | MEDICAID HMO | 3261_BPHC MEDICAID REPLACEMENT HMO OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | MOLINA MEDICAID | 3260_BPHC MEDICAID REPLACEMENT MOLINA OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| BORGESS MEDICAL CENTER Outpatient | MI CHILD | 3793_BOMC MEDICAID REPLACEMENT MICHIGAN CHILD OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | BLUE CAID | 3262_BPHC MEDICAID REPLACEMENT BLUE CROSS COMPLETE OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| BORGESS MEDICAL CENTER Outpatient | UHC MCD | 3796_BOMC MEDICAID REPLACEMENT UNITED HEALTH CARE COMMUNITY PLAN OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | MI CHILD | 3257_BPHC MEDICAID REPLACEMENT MICHIGAN CHILD OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| BORGESS MEDICAL CENTER Outpatient | COVENTRY CARES | 3790_BOMC MEDICAID REPLACEMENT COVENTRY CARES OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | UHC MCD | 3258_BPHC MEDICAID REPLACEMENT UNITED HEALTH CARE COMMUNITY PLAN OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| BORGESS MEDICAL CENTER Outpatient | BLUE CAID | 3789_BOMC MEDICAID REPLACEMENT BLUE CAID COMPLETE OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| BORGESS MEDICAL CENTER Outpatient | PRIORITY MCD | 3795_BOMC MEDICAID REPLACEMENT PRIORITY HEALTH OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | UHC MCD | 3804_BPHC MEDICAID REPLACEMENT UNITED HEALTH CARE COMMUNITY PLAN OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | MI CHILD | 3802_BPHC MEDICAID REPLACEMENT MICHIGAN CHILD OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | BPHC MEDICAID REPLACEMENT MERIDIAN OUTPATIENT 20250701 | 3821_BPHC MEDICAID REPLACEMENT MERIDIAN OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | BLUE CAID | 3800_BPHC MEDICAID REPLACEMENT BLUE CROSS COMPLETE OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| BORGESS MEDICAL CENTER Outpatient | MOLINA MEDICAID | 3794_BOMC MEDICAID REPLACEMENT MOLINA OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| BORGESS MEDICAL CENTER Outpatient | MERIDIAN MEDICAID | 3792_BOMC MEDICAID REPLACEMENT MERIDIAN OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | MOLINA MEDICAID | 3803_BPHC MEDICAID REPLACEMENT MOLINA OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Outpatient | UHC MCD | 3817_BOLE MEDICAID REPLACEMENT UNITED HEALTH CARE COMMUNITY PLAN OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | MEDICAID HMO | 3801_BPHC MEDICAID REPLACEMENT HMO OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Both | AETNA MEDICAID | 3806_BOAH MEDICAID REPLACEMENT AETNA BETTER HEALTH OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Outpatient | BLUE CAID | 3813_BOLE MEDICAID REPLACEMENT BLUE CROSS COMPLETE OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Outpatient | MI CHILD | 3815_BOLE MEDICAID REPLACEMENT MICHIGAN CHILD OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | AETNA MEDICAID | 3799_BPHC MEDICAID REPLACEMENT AETNA BETTER HEALTH OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Both | MOLINA MEDICAID | 3810_BOAH MOLINA MEDICAID OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Outpatient | MOLINA MEDICAID | 3816_BOLE MEDICAID REPLACEMENT MOLINA OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Both | UHC MCD | 3809_BOAH MEDICAID REPLACEMENT UNITED HEALTH CARE COMMUNITY PLAN OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Outpatient | MEDICAID HMO | 3814_BOLE MEDICAID REPLACEMENT HMO OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Outpatient | AETNA MEDICAID | 3812_BOLE MEDICAID REPLACEMENT AETNA BETTER HEALTH OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| BORGESS MEDICAL CENTER Outpatient | MEDICAID HMO | 3791_BOMC MEDICAID REPLACEMENT HMO OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | BLUE CAID | 3262_BPHC MEDICAID REPLACEMENT BLUE CROSS COMPLETE OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| THREE RIVERS HEALTH Both | BLUE CAID | 3661_BOLE MEDICAID REPLACEMENT BLUE CROSS COMPLETE INPATIENT 20241001 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Both | UHC MCD | 3809_BOAH MEDICAID REPLACEMENT UNITED HEALTH CARE COMMUNITY PLAN OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Both | BOAH MEDICAID REPLACEMENT MERIDIAN OUTPATIENT 20250701 | 3808_BOAH MEDICAID REPLACEMENT MERIDIAN OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| THREE RIVERS HEALTH Both | BLUE CAID | 3807_BOAH MEDICAID REPLACEMENT BLUE CROSS COMPLETE OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | UHC MCD | 3258_BPHC MEDICAID REPLACEMENT UNITED HEALTH CARE COMMUNITY PLAN OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| BORGESS MEDICAL CENTER Outpatient | AETNA MEDICAID | 3788_BOMC MEDICAID REPLACEMENT AETNA BETTER HEALTH OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION BORGESS ALLEGAN HOSPITAL Both | AETNA MEDICAID | 3806_BOAH MEDICAID REPLACEMENT AETNA BETTER HEALTH OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | MEDICAID HMO | 3261_BPHC MEDICAID REPLACEMENT HMO OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| THREE RIVERS HEALTH Both | AETNA MEDICAID | 3806_BOAH MEDICAID REPLACEMENT AETNA BETTER HEALTH OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | AETNA MEDICAID | 3255_BPHC MEDICAID REPLACEMENT AETNA BETTER HEALTH OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | MEDICAID REPLACEMENT | 3256_BPHC MEDICAID REPLACEMENT MERIDIAN OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| Ascension Borgess Pipp Hospital Outpatient | MOLINA MEDICAID | 3260_BPHC MEDICAID REPLACEMENT MOLINA OUTPATIENT 20240701 | $4,889.64 | — | — | 2024-12-17 | MRF ↗ |
| ASCENSION BORGESS ALLEGAN HOSPITAL Both | MOLINA MEDICAID | 3810_BOAH MOLINA MEDICAID OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION BORGESS ALLEGAN HOSPITAL Both | UHC MCD | 3809_BOAH MEDICAID REPLACEMENT UNITED HEALTH CARE COMMUNITY PLAN OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION BORGESS ALLEGAN HOSPITAL Both | BOAH MEDICAID REPLACEMENT MERIDIAN OUTPATIENT 20250701 | 3808_BOAH MEDICAID REPLACEMENT MERIDIAN OUTPATIENT 20250701 | $4,889.64 | — | — | 2026-01-01 | MRF ↗ |
| UF HEALTH LEESBURG HOSPITAL OutpatientFacility | Simply Healthcare | MANAGED MEDICAID | $4,953.93 | — | — | 2026-03-31 | MRF ↗ |
| UF HEALTH LEESBURG HOSPITAL OutpatientFacility | Humana | MANAGED MEDICAID | $4,953.93 | — | — | 2026-03-31 | MRF ↗ |
| VILLAGES REGIONAL HOSPITAL, THE OutpatientFacility | Humana | MANAGED MEDICAID | $4,953.93 | — | — | 2026-03-31 | MRF ↗ |
| VILLAGES REGIONAL HOSPITAL, THE OutpatientFacility | Simply Healthcare | MANAGED MEDICAID | $4,953.93 | — | — | 2026-03-31 | MRF ↗ |
| ADVENTHEALTH REDMOND OutpatientFacility | Alliant Health Plans | Ppo | $5,063.00 | — | — | 2026-04-01 | MRF ↗ |
| ADVENTHEALTH MURRAY OutpatientFacility | Alliant Health Plans | Ppo | $5,063.00 | — | — | 2026-04-01 | MRF ↗ |
| ADVENTHEALTH GORDON OutpatientFacility | Alliant Health Plans | Ppo | $5,063.00 | — | — | 2026-04-01 | MRF ↗ |
| BAPTIST HOSPITAL OutpatientFacility | UHC COMMUNITY | MCAID HMO | $5,079.13 | — | — | 2025-12-23 | MRF ↗ |
| GULF BREEZE HOSPITAL OutpatientFacility | UHC COMMUNITY | MCAID HMO | $5,079.13 | — | — | 2025-12-23 | MRF ↗ |
| HALIFAX HEALTH /UF HEALTH MEDICAL CENTER OF DELTON OutpatientFacility | UHC AMERICHOICE | MANAGED MEDICAID | $5,079.14 | — | — | 2025-07-23 | MRF ↗ |
| HALIFAX HEALTH /UF HEALTH MEDICAL CENTER OF DELTON OutpatientFacility | HUMANA | MANAGED MEDICAID | $5,079.14 | — | — | 2025-07-23 | MRF ↗ |
| HALIFAX HEALTH /UF HEALTH MEDICAL CENTER OF DELTON OutpatientFacility | COVENTRY | MANAGED MEDICAID | $5,079.14 | — | — | 2025-07-23 | MRF ↗ |
| JAY HOSPITAL OutpatientFacility | AETNA | BETTER HLTHY KIDS | $5,079.14 | — | — | 2025-12-23 | MRF ↗ |
| GULF BREEZE HOSPITAL OutpatientFacility | AETNA | BETTER HLTHY KIDS | $5,079.14 | — | — | 2025-12-23 | MRF ↗ |
| JAY HOSPITAL OutpatientFacility | CHA HEALTH PLAN | HMO | $5,079.14 | — | — | 2025-12-23 | MRF ↗ |
| JAY HOSPITAL OutpatientFacility | SIMPLY HEALTHCARE HEALTHY KIDS | ALL PRODUCTS | $5,079.14 | — | — | 2025-12-23 | MRF ↗ |
| MEMORIAL HOSPITAL WEST OutpatientFacility | Community Care Plan | Healthy Kids | $5,079.14 | — | — | 2025-07-30 | MRF ↗ |
| Memorial Regional Hospital South OutpatientFacility | Community Care Plan | Healthy Kids | $5,079.14 | — | — | 2025-07-30 | MRF ↗ |
| GULF BREEZE HOSPITAL OutpatientFacility | CHA HEALTH PLAN | HMO | $5,079.14 | — | — | 2025-12-23 | MRF ↗ |
| HALIFAX HEALTH /UF HEALTH MEDICAL CENTER OF DELTON OutpatientFacility | FLORIDA MEDICAID | MANAGED MEDICAID | $5,079.14 | — | — | 2025-07-23 | MRF ↗ |
| HALIFAX HEALTH /UF HEALTH MEDICAL CENTER OF DELTON OutpatientFacility | HCRA | MANAGED MEDICAID | $5,079.14 | — | — | 2025-07-23 | MRF ↗ |
| BAPTIST HOSPITAL OutpatientFacility | AETNA | BETTER HLTHY KIDS | $5,079.14 | — | — | 2025-12-23 | MRF ↗ |
| HALIFAX HEALTH /UF HEALTH MEDICAL CENTER OF DELTON OutpatientFacility | WEST VOLUSIA | MANAGED MEDICAID | $5,079.14 | — | — | 2025-07-23 | MRF ↗ |
| BAPTIST HOSPITAL OutpatientFacility | CHA HEALTH PLAN | HMO | $5,079.14 | — | — | 2025-12-23 | MRF ↗ |
| HALIFAX HEALTH /UF HEALTH MEDICAL CENTER OF DELTON OutpatientFacility | MOLINA | MANAGED MEDICAID | $5,079.14 | — | — | 2025-07-23 | MRF ↗ |
| MEMORIAL HOSPITAL PEMBROKE OutpatientFacility | Community Care Plan | Healthy Kids | $5,079.14 | — | — | 2025-07-30 | MRF ↗ |
| MEMORIAL HOSPITAL MIRAMAR OutpatientFacility | Community Care Plan | Healthy Kids | $5,079.14 | — | — | 2025-07-30 | MRF ↗ |
| MEMORIAL HOSPITAL WEST OutpatientFacility | Community Care Plan | Healthy Kids | $5,079.14 | — | — | 2025-07-30 | MRF ↗ |
| NEW YORK COMMUNITY HOSPITAL OF BROOKLYN, INC. OutpatientFacility | Magnacare | Commercial PPO | $5,100.00 | — | — | 2026-04-01 | MRF ↗ |
| NEW YORK COMMUNITY HOSPITAL OF BROOKLYN, INC. OutpatientFacility | Magnacare | Commercial HMO | $5,100.00 | — | — | 2026-04-01 | MRF ↗ |
| MOUNT CARMEL ST ANN'S OutpatientFacility | Law Enforcement Franklin Co. | Medicaid | $5,276.17 | — | — | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL ST ANN'S OutpatientFacility | Law Enforcement Franklin Co. | Medicaid | $5,276.17 | — | — | 2025-01-01 | MRF ↗ |
| MEMORIAL HOSPITAL WEST OutpatientFacility | Sunshine | Child Welfare Program | $5,282.31 | — | — | 2025-07-30 | MRF ↗ |
| MEMORIAL HOSPITAL WEST OutpatientFacility | Sunshine | MEDICAID | $5,282.31 | — | — | 2025-07-30 | MRF ↗ |
| MEMORIAL HOSPITAL MIRAMAR OutpatientFacility | Sunshine | Child Welfare Program | $5,282.31 | — | — | 2025-07-30 | MRF ↗ |
| MEMORIAL HOSPITAL PEMBROKE OutpatientFacility | Sunshine | Child Welfare Program | $5,282.31 | — | — | 2025-07-30 | MRF ↗ |
| MEMORIAL HOSPITAL WEST OutpatientFacility | Sunshine | MEDICAID | $5,282.31 | — | — | 2025-07-30 | MRF ↗ |
| MEMORIAL HOSPITAL MIRAMAR OutpatientFacility | Sunshine | MEDICAID | $5,282.31 | — | — | 2025-07-30 | MRF ↗ |
| MEMORIAL HOSPITAL PEMBROKE OutpatientFacility | Sunshine | MEDICAID | $5,282.31 | — | — | 2025-07-30 | 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.