116047 — Revas/lito/stent/tib/per
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). REVAS/LITO/STENT/TIB/PER (CDM 116047) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/116047?code_type=CDM
MLA (9th ed.)
“REVAS/LITO/STENT/TIB/PER (CDM 116047) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/116047?code_type=CDM. Accessed .
Chicago (notes-bibliography)
“REVAS/LITO/STENT/TIB/PER (CDM 116047) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/116047?code_type=CDM.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $342–$49,259 (25th–75th percentile) across 8 hospitals · 65 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CDM 116047 — 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 |
|---|---|---|---|---|---|---|---|
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Superior Health Plan | CHPFC | $29.64 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Superior Health Plan | CHIP | $29.64 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Superior Health Plan | STARKids | $29.64 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Superior Health Plan | STAR | $29.64 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Superior Health Plan | STARPLUS | $29.64 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | MCR | $32.75 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Community Health Choice MCD | STAR | $64.22 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Community Health Choice MCD | CHIP | $64.22 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Community Health Choice MCD | STAR+PLUS | $64.22 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Community Health Choice MCD | CHIPPerinatal | $64.22 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Amerigroup | MGMCD | $69.16 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Amerigroup | MCDCHIPBH | $69.16 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Cigna | CSN | $73.11 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Cigna | OpenAccessPlus | $79.04 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | BCBS | MyBlueHealth | $80.52 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Superior | HMO | $86.45 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Superior | EPO | $86.45 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | United | OptionsPPO | $86.94 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | BCBS | BAV | $88.92 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Cigna | PPO | $93.86 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Oscar | HIX | $96.33 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Superior | ValueHMO | $97.81 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Texas Childrens Health Plans | CHIP | $100.78 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | BCBS | HMO | $111.15 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | BCBS | EPOSOA | $113.62 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | BCBS | PPO | $115.60 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Texas Childrens Health Plans | STAR | $117.08 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Texas Childrens Health Plans | STARKIDS | $117.08 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | TX Workforce Commission | GVT | $118.56 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Healthcare Highways | NarrowNetwork | $125.97 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | QHPExchange | $130.91 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Molina Healthcare | HIX | $133.38 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Evry Health | BroadNetwork | $134.86 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Humana | PPO | $157.64 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Humana | HMO | $157.64 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | NBPPO | $158.57 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | NBHMO | $158.57 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | NBPOS | $158.57 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | COMMHMO | $168.95 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | COMMPOS | $168.95 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | COMMPPO | $168.95 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | BCBS | Traditional | $172.90 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Imagine Health | PPO | $172.90 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Christus (USFHP) | TRICARE | $197.60 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Curative Administrators | COMM | $197.60 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | OONHMO | $198.09 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | OONPOS | $198.09 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | OONPPO | $198.09 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | HealthSmart Preferred Care | ACCEL | $212.42 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | ASAPPO | $213.90 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | ASAPOS | $213.90 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Aetna | ASAHMO | $213.90 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Fidelis SecureCare of TX | MGMCR | $222.30 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | United | GlobalAppendix | $222.30 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Averde Health | Commercial | $222.30 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Multiplan | SAVILITYNETWORK | $247.00 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Coventry National First Health | COMM | $263.30 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Rockport Workers Comp | COMM | $271.70 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Physicians Cooperative of Texas | WC | $271.70 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Beech Street | WCOMP | $296.40 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | SouthWest Medical | WORKERSCOMP | $296.40 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | National Healthcare Solutions | COMM | $296.40 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Independent Medical System | COMM | $296.40 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Texas Athletic Network | Premier | $300.00 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Coastal Comp | COMM | $321.10 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | HealthSmart Preferred Care | PPO | $405.08 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | HealthSmart Preferred Care | ACCOUNTABLEPPO | $419.90 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Physicians, INC | COMM | $419.90 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Affiliated PPO | COMM | $444.60 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Multiplan | COMPLEMENTARYPPO | $444.60 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Beech Street | COMMPPO | $454.48 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Texas Athletic Network | PremierPlus | $500.00 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CONROE Outpatient | Texas Athletic Network | TexasCustomUC | $600.00 | $494.00 | $494.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | AmeriHealth Caritas | MCD | $3,078.42 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | AmeriHealth Caritas | MCD | $3,078.42 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Well Sense Health Plan | MCD | $6,112.01 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Well Sense Health Plan | MCD | $6,112.01 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | United | OptionsPPO | $7,840.86 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | BCBS | BlueChoice | $7,854.48 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | BCBS | Cap | $7,854.48 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | United | OptionsPPO | $8,236.30 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | Health Partners of Kansas | CignaLocalPlusNetwork | $9,107.09 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | Aetna | LocalPreferred | $9,321.37 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Health Partners of Kansas | CignaLocalPlusNetwork | $9,436.28 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Aetna | LocalPreferred | $9,501.74 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Preferred Health Choices | COMM | $10,309.00 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Medical Associates Health Plan | COMM | $10,309.00 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Vail Health | COMM | $11,507.30 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | Health Partners of Kansas | Non-LocalPlusandNon-ConnectCare | $11,883.04 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | Aetna | LocalOpen | $12,545.38 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Aetna | LocalOpen | $12,785.35 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | Aetna | NationalOpen | $12,842.45 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Health Partners of Kansas | Non-LocalPlusandNon-ConnectCare | $12,872.62 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Aetna | NationalOpen | $13,090.80 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | Vail Health | COMM | $13,176.39 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Kaiser | HMO | $14,308.42 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | Aetna Better Health | MCD | $14,610.30 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Cigna | Connect-SBP | $14,611.24 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | United | OptionsPPO | $15,671.13 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Aetna Better Health | MCD | $16,363.50 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | Spirit Aerosystems | COMMOON | $16,460.94 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Spirit Aerosystems | COMMOON | $17,454.40 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | United | OptionsPPO | $17,944.16 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | United | FreedomBenefitPlans | $19,202.78 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | United | FreedomBenefitPlans | $19,202.78 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Cigna | SureFit | $19,229.30 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Aetna | Spirit | $19,472.57 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Cigna | Connect-NSBP | $19,607.83 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | Cigna | Connect-SBP | $20,544.76 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | United | GlobalBenefitPlan | $21,915.45 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | Cigna | SureFit | $22,018.44 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | Cigna | Connect-NSBP | $22,451.87 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Aetna | MCRADVPPO | $22,711.78 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Bright Health | OON | $22,711.78 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Aetna | MCRADVHMO | $22,711.78 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Maine Community Health | SmallGroup | $23,364.63 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Maine Community Health | SmallGroup | $23,364.63 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Maine Community Health | Individual | $23,364.63 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Maine Community Health | Individual | $23,364.63 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | First Health | PPO | $23,619.99 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | Health Partners of Kansas | Humana | $24,350.50 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | United | GlobalBenefitPlan | $24,545.25 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Aetna | NBR | $24,680.13 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | First Health | PPO | $25,145.24 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Cigna | IFP | $25,373.21 | $177,435.00 | $177,435.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Cigna | IFP | $25,387.22 | $177,533.00 | $177,533.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Colorado Program for Children with Special Needs | HCP | $25,740.01 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | Aetna | MCRADVHMO | $26,006.03 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | Bright Health | OON | $26,006.03 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | Aetna | MCRADVPPO | $26,006.03 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Aetna | MGMCR | $26,615.25 | $177,435.00 | $177,435.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Aetna | MGMCR | $26,629.95 | $177,533.00 | $177,533.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Cigna | Broad | $26,875.60 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Cigna | HMO | $27,197.72 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Cigna | HMO | $27,197.72 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Health Partners of Kansas | Humana | $27,272.50 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Tufts Health Plan | HMO | $28,094.34 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Tufts Health Plan | PPO | $28,094.34 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Tufts Health Plan | PPO | $28,094.34 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Tufts Health Plan | HMO | $28,094.34 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | Aetna | NBR | $28,259.89 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Aetna | ExistingBusiness | $30,055.25 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | Cigna | Broad | $30,773.80 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Cigna | PPO | $31,456.70 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Cigna | PPO | $31,456.70 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | Triwest Healthcare Alliance | Tricare | $31,655.65 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Anthem Maine | INDEMNITY | $33,100.52 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Anthem Maine | INDEMNITY | $33,100.52 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Anthem | INDEMNITY | $33,100.52 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Anthem | INDEMNITY | $33,100.52 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Lifeworks | MCR | $33,712.65 | $177,435.00 | $177,435.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Lifeworks | MCR | $33,731.27 | $177,533.00 | $177,533.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | United | GlobalBenefit | $34,067.66 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | Multiplan | COMMPPOPRIMARYNETWORK | $34,090.70 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | United | AllPayerAppendix | $34,221.30 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | United | AllPayerAppendix | $34,221.30 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | Aetna | ExistingBusiness | $34,414.65 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Triwest Healthcare Alliance | Tricare | $35,454.25 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Aetna | ASA | $36,111.72 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | United | OptionsPPO | $36,906.48 | $177,435.00 | $177,435.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | United | OptionsPPO | $36,926.86 | $177,533.00 | $177,533.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Cigna | HMO | $37,261.35 | $177,435.00 | $177,435.00 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Cigna | PPO | $37,261.35 | $177,435.00 | $177,435.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Cigna | HMO | $37,281.93 | $177,533.00 | $177,533.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Cigna | PPO | $37,281.93 | $177,533.00 | $177,533.00 | 2026-03-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | Colorado Program for Children with Special Needs | HCP | $38,142.18 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Multiplan | COMMPPOPRIMARYNETWORK | $38,181.50 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | United | GlobalBenefit | $39,009.05 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| HENRICO DOCTORS' HOSPITAL Outpatient | Universal Healthcare Group | MCR | $39,035.70 | $177,435.00 | $177,435.00 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Universal Healthcare Group | MCR | $39,057.26 | $177,533.00 | $177,533.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Maine Community Health | LargeGroup | $39,593.60 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Maine Community Health | LargeGroup | $39,593.60 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| HCA-HEALTHONE DBA SWEDISH MEDICAL CENTER Outpatient | Aetna | ASA | $41,349.59 | $86,686.77 | $86,686.77 | 2026-03-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | Multiplan | COMMPPOCOMPLEMENTARYNETWORK | $41,395.85 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | USA Managed Care | COMM | $41,395.85 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Tufts Health Plan | POS | $42,739.27 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Tufts Health Plan | POS | $42,739.27 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| WESLEY MEDICAL CENTER Outpatient | Multiplan | BeechStreetCOMMPPO | $43,830.90 | $48,701.00 | $48,701.00 | 2024-10-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | USA Managed Care | COMM | $46,363.25 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Multiplan | COMMPPOCOMPLEMENTARYNETWORK | $46,363.25 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Aetna | HMO | $47,297.13 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Aetna | PPO | $47,297.13 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Aetna | HMO | $47,297.13 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Aetna | PPO | $47,297.13 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Aetna | EPO | $47,297.13 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Aetna | POS | $47,297.13 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Aetna | EPO | $47,297.13 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | Aetna | POS | $47,297.13 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Cigna | Connect-SBPLeanBenefitPlans | $48,451.79 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Cigna | SureFitLeanBenefitPlans | $48,451.79 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Cigna | Connect-NSBPLeanBenefitPlans | $48,451.79 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Cigna | BroadLeanBenefitPlans | $48,451.79 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | Multiplan | BeechStreetCOMMPPO | $49,090.50 | $54,545.00 | $54,545.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | United | OptionsPPO | $49,314.54 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | United | OptionsPPO | $49,314.54 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | NorthCare | COMM | $52,994.14 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Multiplan | COMMPPOPRIMARYNETWORK | $52,994.14 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE MOUNTAIN RIDGE Outpatient | Physician Health Partners | MCR | $52,994.14 | $75,705.92 | $75,705.92 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | CorVel | WorkersComp | $53,797.68 | $74,719.00 | $74,719.00 | 2026-03-01 | MRF ↗ |
| PORTSMOUTH REGIONAL HOSPITAL Outpatient | CorVel | WorkersComp | $53,797.68 | $74,719.00 | $74,719.00 | 2026-03-01 | 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.