21044 — Leuprolide Acetate 11.25mg Syringe Kit 4
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). LEUPROLIDE ACETATE 11.25MG SYRINGE KIT 4 (CDM 21044) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/21044?code_type=CDM
MLA (9th ed.)
“LEUPROLIDE ACETATE 11.25MG SYRINGE KIT 4 (CDM 21044) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/21044?code_type=CDM. Accessed .
Chicago (notes-bibliography)
“LEUPROLIDE ACETATE 11.25MG SYRINGE KIT 4 (CDM 21044) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/21044?code_type=CDM.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $3,289–$13,528 (25th–75th percentile) across 20 hospitals · 124 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CDM 21044 — 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 |
|---|---|---|---|---|---|---|---|
| ARKANSAS HEART HOSPITAL, LLC Outpatient | UHC MCAID | UHC MCAID | $1.08 | $4.30 | $2.71 | 2026-03-25 | MRF ↗ |
| ARKANSAS HEART HOSPITAL, LLC Outpatient | AETNA COMM - ALL OTHER PLANS | AETNA COMM - ALL OTHER PLANS | $1.51 | $4.30 | $2.71 | 2026-03-25 | MRF ↗ |
| ARKANSAS HEART HOSPITAL, LLC Outpatient | AETNA MCR ADV | AETNA MCR ADV | $1.51 | $4.30 | $2.71 | 2026-03-25 | MRF ↗ |
| KANSAS HEART HOSPITAL Both | WPPA | COMMERCIAL | $1.72 | $4.30 | — | 2024-07-10 | MRF ↗ |
| ARKANSAS HEART HOSPITAL, LLC Outpatient | WPPA - ALL PLANS | WPPA - ALL PLANS | $1.72 | $4.30 | $2.71 | 2026-03-25 | MRF ↗ |
| ARKANSAS HEART HOSPITAL, LLC Outpatient | MULTIPLAN - ALL PLANS | MULTIPLAN - ALL PLANS | $3.87 | $4.30 | $2.71 | 2026-03-25 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Both | SMARTHEALTH | 794_MHKS SMARTHEALTH INPATIENT 20241001 | $18.72 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Both | SMARTHEALTH | 655_MHKS SMARTHEALTH OUTPATIENT 20230101 | $18.72 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Outpatient | AETNA | 780_MHKS AETNA 20240701 | $25.92 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Outpatient | CORE SOURCE | 283_CORE SOURCE 20180101 | $26.40 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Outpatient | COVENTRY | 669_MHKS COVENTRY 20170101 | $26.40 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Outpatient | FIRST HEALTH | 115_FIRST HEALTH 20130101 | $26.40 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Outpatient | MEDICA | 799_MEDICA HEALTHIER YOU 20241001 | $30.72 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Outpatient | PROVIDRS CARE | 867_MHKS PROVIDRS CARE 20250701 | $32.64 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Outpatient | UHC | 844_MHKS UNITED HEALTH CARE 20250101 | $35.04 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Outpatient | MULTIPLAN | 106_MULTIPLAN PHCS MHKS 20180601 | $38.40 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Outpatient | CENTURY | 668_CENTURY 20130101 | $42.24 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Outpatient | CIGNA | 778_MHKS CIGNA 20240701 | $42.72 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Outpatient | BCBS CAP | 842_BLUE CROSS BLUE SHIELD CAP MHKS 20250101 | $43.20 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Outpatient | BCBS CHOICE | 843_BLUE CROSS BLUE SHIELD CHOICE MHKS 20250101 | $43.20 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Both | HUMANA | 870_HUMANA 20250101 | $43.20 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Outpatient | NON-CONTRACTED | 275_NON-CONTRACTED 20170101 | $48.00 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ASCENSION VIA CHRISTI HOSPITAL MANHATTAN, INC Both | CDM DEFAULT - NON-NEGOTIATED RATE | CDM DEFAULT - NON-NEGOTIATED RATE | $48.00 | $48.00 | $19.20 | 2026-01-01 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | BCBS - MN | Medicaid|All Plans | $243.64 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | BCBS - MN | Medicaid|All Plans | $243.64 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Health Partners | Medicare|All Plans | $268.00 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Health Partners | Medicare|All Plans | $268.00 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Medica | Medicare|All Plans | $281.40 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Medica | Medicare|All Plans | $281.40 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | BCBS - MN | Medicare|All Plans | $292.37 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Humana | Medicare|All Plans | $292.37 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | BCBS - MN | Medicare|All Plans | $292.37 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Humana | Medicare|All Plans | $292.37 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Health Partners | Medicaid|All Plans | $300.49 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Medica | Medicaid|All Plans | $300.49 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Health Partners | Medicaid|All Plans | $300.49 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Medica | Medicaid|All Plans | $300.49 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Ucare | Medicare|All Plans | $306.99 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Ucare | Medicare|All Plans | $306.99 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Ucare | Medicaid|All Plans | $330.54 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Outpatient | Ucare | Medicaid|All Plans | $330.54 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ASCENSION SAINT THOMAS THREE RIVERS Both | CIGNA OAP | 4_CIGNA OAP | $378.99 | $618.25 | $185.48 | 2026-01-01 | MRF ↗ |
| ASCENSION SAINT THOMAS THREE RIVERS Both | CIGNA LOCAL PLUS | 3_CIGNA LOCAL PLUS | $382.70 | $618.25 | $185.48 | 2026-01-01 | MRF ↗ |
| ASCENSION SAINT THOMAS THREE RIVERS Both | CIGNA PPO | 5_CIGNA PPO | $382.70 | $618.25 | $185.48 | 2026-01-01 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | BCBS - MN | Commercial|Federal Plans | $454.79 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | BCBS - MN | Commercial|Federal Plans | $454.79 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | BCBS - MN | Commercial|All Other Plans | $462.91 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | BCBS - MN | Commercial|All Other Plans | $462.91 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ASCENSION SAINT THOMAS THREE RIVERS Both | AETNA COMMERCIAL | 2_AETNA COMMERCIAL | $482.24 | $618.25 | $185.48 | 2026-01-01 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | Health Partners | Commercial|All Plans | $487.28 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | Health Partners | Commercial|All Plans | $487.28 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| Memorial Regional Hospital South OutpatientFacility | Aetna | Gatekeeper | — | $40,995.14 | $28,696.60 | 2026-09-29 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | United | Commercial|New Business | $592.85 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | United | Commercial|New Business | $592.85 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ASCENSION SAINT THOMAS THREE RIVERS Both | CDM DEFAULT - NON-NEGOTIATED RATE | CDM DEFAULT - NON-NEGOTIATED RATE | $618.25 | $618.25 | $185.48 | 2026-01-01 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | United | Commercial|All Other Plans | $649.70 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | United | Commercial|All Other Plans | $649.70 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | Ucare | Commercial|All Plans | $714.67 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | Ucare | Commercial|All Plans | $714.67 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| BRIDGEPORT HOSPITAL Both | Medicaid Managed UHC | All Plans | $765.52 | $23,841.75 | $12,159.29 | 2025-01-10 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | MultiPlan | Commercial|All Plans | $771.52 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | Sanford Health Plan | Commercial|All Plans | $771.52 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | Sanford Health Plan | Commercial|All Plans | $771.52 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| ST GABRIELS HOSPITAL Inpatient | MultiPlan | Commercial|All Plans | $771.52 | $812.12 | $471.03 | 2026-02-28 | MRF ↗ |
| RIVERSIDE COMMUNITY HOSPITAL Outpatient | Aetna | MCRPOS | $940.10 | $9,401.00 | $9,401.00 | 2024-10-01 | MRF ↗ |
| RIVERSIDE COMMUNITY HOSPITAL Outpatient | Aetna | MCRPPO | $940.10 | $9,401.00 | $9,401.00 | 2024-10-01 | MRF ↗ |
| RIVERSIDE COMMUNITY HOSPITAL Outpatient | Aetna | MCRHMO | $940.10 | $9,401.00 | $9,401.00 | 2024-10-01 | MRF ↗ |
| Riverside Community Hospital Outpatient | Aetna | MCRHMO | $1,000.30 | $10,003.00 | $10,003.00 | 2026-03-01 | MRF ↗ |
| Riverside Community Hospital Outpatient | Aetna | MCRPPO | $1,000.30 | $10,003.00 | $10,003.00 | 2026-03-01 | MRF ↗ |
| Riverside Community Hospital Outpatient | Aetna | MCRPOS | $1,000.30 | $10,003.00 | $10,003.00 | 2026-03-01 | MRF ↗ |
| ASCENSION SE WISCONSIN HOSPITAL Outpatient | UNITED HEALTH CARE | 1282_UNITED HEALTH CARE 20250701 | $1,537.71 | $3,075.42 | $1,629.97 | 2026-01-01 | MRF ↗ |
| ASCENSION SE WISCONSIN HOSPITAL Outpatient | WEA TRUST SELECT POS | 431_WEA TRUST SELECT POS MIL 20180201 | $1,629.97 | $3,075.42 | $1,629.97 | 2026-01-01 | MRF ↗ |
| ASCENSION SE WISCONSIN HOSPITAL Outpatient | WEA TRUST PPO | 1164_WEA TRUST PPO MIL 20241001 | $1,629.97 | $3,075.42 | $1,629.97 | 2026-01-01 | MRF ↗ |
| MEMORIAL HOSPITAL MIRAMAR OutpatientFacility | Aetna | Gatekeeper | — | $40,995.14 | $28,696.60 | 2026-09-29 | MRF ↗ |
| ASCENSION SE WISCONSIN HOSPITAL Outpatient | MOLINA MARKETPLACE | 1162_MOLINA MARKETPLACE MIL 20241001 | $1,814.50 | $3,075.42 | $1,629.97 | 2026-01-01 | MRF ↗ |
| BEATRICE COMMUNITY HOSPITAL & HEALTH CENTER, INC OutpatientFacility | Tricare | Commercial | $1,824.00 | $11,130.00 | $11,130.00 | 2026-11-06 | MRF ↗ |
| ASCENSION COLUMBIA ST MARYS HOSPITAL MILWAUKEE Outpatient | SMARTHEALTH | 1129_SMARTHEALTH EMPLOYEES 20221001 | $1,905.33 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION SE WISCONSIN HOSPITAL Outpatient | TRILOGY | 1271_TRILOGY 20250701 | $2,122.04 | $3,075.42 | $1,629.97 | 2026-01-01 | MRF ↗ |
| Riverside Community Hospital Outpatient | Cigna | HMO | $2,240.67 | $10,003.00 | $10,003.00 | 2026-03-01 | MRF ↗ |
| Riverside Community Hospital Outpatient | Cigna | PPO | $2,240.67 | $10,003.00 | $10,003.00 | 2026-03-01 | MRF ↗ |
| BRIDGEPORT HOSPITAL Both | Medicare Adv Aetna | All Plans | $2,300.74 | $23,841.75 | $12,159.29 | 2025-01-10 | MRF ↗ |
| ASCENSION SE WISCONSIN HOSPITAL Outpatient | FIRST HEALTH NETWORK | 1290_FIRST HEALTH 20240101 SJWI FNWI MWWI | $2,306.57 | $3,075.42 | $1,629.97 | 2026-01-01 | MRF ↗ |
| MEMORIAL HOSPITAL PEMBROKE OutpatientFacility | Aetna | Gatekeeper | — | $40,995.14 | $28,696.60 | 2026-09-29 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | ANTHEM PATHWAYS | 946_ANTHEM PATHWAYS MEWI SEWI 20230101 | $2,375.32 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | ANTHEM PATHWAYS | 946_ANTHEM PATHWAYS MEWI SEWI 20230101 | $2,375.32 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| BRIDGEPORT HOSPITAL Both | TRPN | All Plans | $2,384.18 | $23,841.75 | $12,159.29 | 2025-01-10 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | UNITED HEALTH CARE | 1282_UNITED HEALTH CARE 20250701 | $2,442.73 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | UNITED HEALTH CARE | 1282_UNITED HEALTH CARE 20250701 | $2,442.73 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | SEHN | 1171_SEHN 20241001 | $2,442.73 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | SEHN | 1171_SEHN 20241001 | $2,442.73 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION COLUMBIA ST MARYS HOSPITAL MILWAUKEE Both | NETWORK HEALTH PLAN | 1136_NETWORK HEALTH PLAN 20221001 | $2,442.73 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION SE WISCONSIN HOSPITAL Outpatient | SEHN | 1171_SEHN 20241001 | $2,442.73 | $4,885.46 | $2,589.30 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | MEDICARE REPLACEMENT | 929_CRITICAL ACCESS HOSPITAL MEDICARE REPLACEMENT OUTPATIENT CAWI 20220701 | $2,488.43 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | SMARTHEALTH | 977_SMARTHEALTH OUTPATIENT CAWI 20230101 | $2,488.43 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | MEDICARE REPLACEMENT | 929_CRITICAL ACCESS HOSPITAL MEDICARE REPLACEMENT OUTPATIENT CAWI 20220701 | $2,488.43 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | WELLCARE | 984_MEDICARE ADVANTAGE WELLCARE OUTPATIENT CAWI 20220701 | $2,488.43 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | WELLCARE | 984_MEDICARE ADVANTAGE WELLCARE OUTPATIENT CAWI 20220701 | $2,488.43 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | SMARTHEALTH | 977_SMARTHEALTH OUTPATIENT CAWI 20230101 | $2,488.43 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION COLUMBIA ST MARYS HOSPITAL MILWAUKEE Outpatient | HUMANA WVN | 1135_HUMANA WVN 20221001 | $2,540.44 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| YALE-NEW HAVEN HOSPITAL Both | Medicare Adv Aetna | All Plans | $2,550.50 | $23,841.75 | $14,066.63 | 2025-01-10 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | WEA TRUST SELECT POS | 431_WEA TRUST SELECT POS MIL 20180201 | $2,589.29 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | WEA TRUST SELECT POS | 431_WEA TRUST SELECT POS MIL 20180201 | $2,589.29 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | WEA TRUST PPO | 1164_WEA TRUST PPO MIL 20241001 | $2,589.29 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION COLUMBIA ST MARYS HOSPITAL MILWAUKEE Outpatient | SEHN C89 | 1128_SEHN 20221001 | $2,589.29 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | WEA TRUST PPO | 1164_WEA TRUST PPO MIL 20241001 | $2,589.29 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | VETERANS ADMINISTRATION | 611_VETERANS ADMINISTRATION OUTPATIENT CAWI 20200201 | $2,601.54 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Both | MEDICARE RAILROAD | 923_CRITICAL ACCESS HOSPITAL MEDICARE RAILROAD INPATIENT CAWI 20220701 | $2,601.54 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Both | VETERANS ADMINISTRATION | 617_VETERANS ADMINISTRATION INPATIENT CAWI 20200201 | $2,601.54 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | TRICARE | 619_TRICARE OUTPATIENT CAWI 20200201 | $2,601.54 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Both | TRICARE | 623_TRICARE INPATIENT CAWI 20200201 | $2,601.54 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | VETERANS ADMINISTRATION | 611_VETERANS ADMINISTRATION OUTPATIENT CAWI 20200201 | $2,601.54 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Both | VETERANS ADMINISTRATION | 617_VETERANS ADMINISTRATION INPATIENT CAWI 20200201 | $2,601.54 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Both | TRICARE | 623_TRICARE INPATIENT CAWI 20200201 | $2,601.54 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | MEDICARE RAILROAD | 925_CRITICAL ACCESS HOSPITAL MEDICARE RAILROAD OUTPATIENT CAWI 20220701 | $2,601.54 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Both | MEDICARE RAILROAD | 923_CRITICAL ACCESS HOSPITAL MEDICARE RAILROAD INPATIENT CAWI 20220701 | $2,601.54 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | MEDICARE RAILROAD | 925_CRITICAL ACCESS HOSPITAL MEDICARE RAILROAD OUTPATIENT CAWI 20220701 | $2,601.54 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | TRICARE | 619_TRICARE OUTPATIENT CAWI 20200201 | $2,601.54 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| Riverside Community Hospital Outpatient | United | OptionsPPO | $2,630.79 | $10,003.00 | $10,003.00 | 2026-03-01 | MRF ↗ |
| OGDEN REGIONAL MEDICAL CENTER Outpatient | University of Utah | HIXIndividual | $2,685.19 | $8,444.00 | $8,444.00 | 2024-10-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | MOLINA MARKETPLACE | 521_MOLINA MARKETPLACE CAWI 20190615 | $2,714.65 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | MOLINA MARKETPLACE | 521_MOLINA MARKETPLACE CAWI 20190615 | $2,714.65 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| RIVERSIDE COMMUNITY HOSPITAL Outpatient | United | OptionsPPO | $2,716.89 | $9,401.00 | $9,401.00 | 2024-10-01 | MRF ↗ |
| ASCENSION SE WISCONSIN HOSPITAL Outpatient | NEHA PPO ON/NEAR SITE | 390_NEHA PPO ON/NEAR SITE 20180701 | $2,737.12 | $3,075.42 | $1,629.97 | 2026-01-01 | MRF ↗ |
| ASCENSION SE WISCONSIN HOSPITAL Outpatient | NEHA PPO BROAD | 388_NEHA PPO BROAD 20180701 | $2,737.12 | $3,075.42 | $1,629.97 | 2026-01-01 | MRF ↗ |
| Ascension SE Wisconsin Hospital - Elmbrook Campus Outpatient | SEHN | 1171_SEHN 20241001 | $2,827.76 | $5,655.53 | $2,997.43 | 2026-01-01 | MRF ↗ |
| Ascension SE Wisconsin Hospital - Elmbrook Campus Outpatient | UNITED HEALTH CARE | 1282_UNITED HEALTH CARE 20250701 | $2,827.76 | $5,655.53 | $2,997.43 | 2026-01-01 | MRF ↗ |
| ASCENSION COLUMBIA ST MARYS HOSPITAL MILWAUKEE Outpatient | ANTHEM HMO POS | 1120_ANTHEM HMO POS 20221001 | $2,833.57 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | MOLINA MARKETPLACE | 1162_MOLINA MARKETPLACE MIL 20241001 | $2,882.42 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION COLUMBIA ST MARYS HOSPITAL MILWAUKEE Outpatient | WEA PPP | 204_WEA PPP 20160101 | $2,882.42 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | MOLINA MARKETPLACE | 1161_MOLINA MARKETPLACE ASWI 20241001 | $2,882.42 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | MOLINA MARKETPLACE | 1161_MOLINA MARKETPLACE ASWI 20241001 | $2,882.42 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | MOLINA MARKETPLACE | 1162_MOLINA MARKETPLACE MIL 20241001 | $2,882.42 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| Ascension SE Wisconsin Hospital - Elmbrook Campus Outpatient | WEA TRUST SELECT POS | 431_WEA TRUST SELECT POS MIL 20180201 | $2,997.43 | $5,655.53 | $2,997.43 | 2026-01-01 | MRF ↗ |
| Ascension SE Wisconsin Hospital - Elmbrook Campus Outpatient | WEA TRUST PPO | 1164_WEA TRUST PPO MIL 20241001 | $2,997.43 | $5,655.53 | $2,997.43 | 2026-01-01 | MRF ↗ |
| OGDEN REGIONAL MEDICAL CENTER Outpatient | University of Utah | HealthyPreferred | $3,090.50 | $8,444.00 | $8,444.00 | 2024-10-01 | MRF ↗ |
| OGDEN REGIONAL MEDICAL CENTER Outpatient | University of Utah | HealthyPremierSSG | $3,090.50 | $8,444.00 | $8,444.00 | 2024-10-01 | MRF ↗ |
| RIVERSIDE COMMUNITY HOSPITAL Outpatient | Blue Shield | EPN | $3,096.69 | $9,401.00 | $9,401.00 | 2024-10-01 | MRF ↗ |
| BRIDGEPORT HOSPITAL Both | Medicare Adv Anthem | All Plans | $3,167.34 | $23,841.75 | $12,159.29 | 2025-01-10 | MRF ↗ |
| OGDEN REGIONAL MEDICAL CENTER Outpatient | DMBA (Deseret Mutual Benefit Admin) | PPO | $3,184.23 | $8,444.00 | $8,444.00 | 2024-10-01 | MRF ↗ |
| BRIDGEPORT HOSPITAL Both | Medicare Adv UHC | All Plans | $3,193.08 | $23,841.75 | $12,159.29 | 2025-01-10 | MRF ↗ |
| Riverside Community Hospital Outpatient | Blue Shield | EPN | $3,210.96 | $10,003.00 | $10,003.00 | 2026-03-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | NETWORK HEALTH PLAN | 938_NETWORK HEALTH PLAN MEWI SEWI 20230101 | $3,223.65 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | NETWORK HEALTH PLAN | 938_NETWORK HEALTH PLAN MEWI SEWI 20230101 | $3,223.65 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION COLUMBIA ST MARYS HOSPITAL MILWAUKEE Outpatient | CENTIVO | 1125_CENTIVO 20221001 | $3,273.26 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | ALLIANCE | 885_ALLIANCE MEWI SEWI 20221001 | $3,336.76 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| Ascension SE Wisconsin Hospital - Elmbrook Campus Outpatient | MOLINA MARKETPLACE | 1162_MOLINA MARKETPLACE MIL 20241001 | $3,336.76 | $5,655.53 | $2,997.43 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | ALLIANCE | 885_ALLIANCE MEWI SEWI 20221001 | $3,336.76 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| OGDEN REGIONAL MEDICAL CENTER Outpatient | University of Utah | HealthyPremier | $3,369.16 | $8,444.00 | $8,444.00 | 2024-10-01 | MRF ↗ |
| ASCENSION COLUMBIA ST MARYS HOSPITAL MILWAUKEE Outpatient | WPS | 1132_WISCONSIN PHYSICIAN SERVICES MCWI OCWI 20221001 | $3,370.97 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | TRILOGY | 1271_TRILOGY 20250701 | $3,370.97 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | TRILOGY | 1271_TRILOGY 20250701 | $3,370.97 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| OGDEN REGIONAL MEDICAL CENTER Outpatient | Cigna UT Overstock | COMM | $3,377.60 | $8,444.00 | $8,444.00 | 2024-10-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | NEHA LIMITED | 821_NEHA LIMITED 20220101 | $3,419.82 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION COLUMBIA ST MARYS HOSPITAL MILWAUKEE Outpatient | AETNA | 567_AETNA 20190701 | $3,419.82 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION COLUMBIA ST MARYS HOSPITAL MILWAUKEE Outpatient | ARISE | 1123_ARISE PREMIER MCWI OCWI 20221001 | $3,419.82 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | NEHA ASCENSION ONLY | 820_NEHA ASCENSION ONLY 20220101 | $3,419.82 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | NEHA LIMITED | 821_NEHA LIMITED 20220101 | $3,419.82 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | NEHA ASCENSION ONLY | 820_NEHA ASCENSION ONLY 20220101 | $3,419.82 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION SE WISCONSIN HOSPITAL Outpatient | NEHA ASCENSION ONLY | 820_NEHA ASCENSION ONLY 20220101 | $3,419.82 | $4,885.46 | $2,589.30 | 2026-01-01 | MRF ↗ |
| ASCENSION SE WISCONSIN HOSPITAL Outpatient | NEHA LIMITED | 821_NEHA LIMITED 20220101 | $3,419.82 | $4,885.46 | $2,589.30 | 2026-01-01 | MRF ↗ |
| BRIDGEPORT HOSPITAL Both | Medicare Adv CtCare | All Plans | $3,446.06 | $23,841.75 | $12,159.29 | 2025-01-10 | MRF ↗ |
| BRIDGEPORT HOSPITAL Both | Medicare Adv Wellcare | All Plans | $3,448.11 | $23,841.75 | $12,159.29 | 2025-01-10 | MRF ↗ |
| YALE-NEW HAVEN HOSPITAL Both | Medicare Adv UHC | All Plans | $3,559.33 | $23,841.75 | $14,066.63 | 2025-01-10 | MRF ↗ |
| YALE-NEW HAVEN HOSPITAL Both | Medicare Adv Anthem | All Plans | $3,573.68 | $23,841.75 | $14,066.63 | 2025-01-10 | MRF ↗ |
| BRIDGEPORT HOSPITAL Both | First Health | All Plans | $3,576.26 | $23,841.75 | $12,159.29 | 2025-01-10 | MRF ↗ |
| YALE-NEW HAVEN HOSPITAL Both | Medicare Adv Wellcare | All Plans | $3,610.21 | $23,841.75 | $14,066.63 | 2025-01-10 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | FIRST HEALTH NETWORK | 1290_FIRST HEALTH 20240101 SJWI FNWI MWWI | $3,664.09 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | WEA TRUST PPO | 1163_WEA TRUST PPO ASWI 20241001 | $3,664.09 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | WEA TRUST SELECT POS | 432_WEA TRUST SELECT POS ASWI 20180201 | $3,664.09 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | WEA TRUST PPO | 1163_WEA TRUST PPO ASWI 20241001 | $3,664.09 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | WEA TRUST SELECT POS | 432_WEA TRUST SELECT POS ASWI 20180201 | $3,664.09 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | FIRST HEALTH NETWORK | 1290_FIRST HEALTH 20240101 SJWI FNWI MWWI | $3,664.09 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION COLUMBIA ST MARYS HOSPITAL MILWAUKEE Outpatient | HEALTH PAYMENT SYSTEMS | 1126_HEALTH PAYMENT SYSTEMS 20221001 | $3,712.95 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| OGDEN REGIONAL MEDICAL CENTER Outpatient | Cigna | NBNPPO | $3,715.36 | $8,444.00 | $8,444.00 | 2024-10-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | AETNA | 1279_AETNA MIL 20250701 | $3,761.80 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION SE WISCONSIN HOSPITAL Outpatient | AETNA | 1279_AETNA MIL 20250701 | $3,761.80 | $4,885.46 | $2,589.30 | 2026-01-01 | MRF ↗ |
| ASCENSION ALL SAINTS HOSPITAL Outpatient | AETNA | 1279_AETNA MIL 20250701 | $3,761.80 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | CCHP | 931_CCHP MEWI SEWI 20230101 | $3,789.21 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | CCHP | 931_CCHP MEWI SEWI 20230101 | $3,789.21 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | PREVEA COMMERCIAL AND EXCHANGE | 1005_PREVEA COMMERCIAL AND EXCHANGE 20230701 | $3,845.76 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | PREVEA COMMERCIAL AND EXCHANGE | 1005_PREVEA COMMERCIAL AND EXCHANGE 20230701 | $3,845.76 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| YALE-NEW HAVEN HOSPITAL Both | Medicare Adv CTCare | All Plans | $3,862.74 | $23,841.75 | $14,066.63 | 2025-01-10 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | ACA | 908_NETWORK HEALTH PLAN ACA CAWI 20220101 | $3,902.32 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | ACA | 908_NETWORK HEALTH PLAN ACA CAWI 20220101 | $3,902.32 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | NETWORK HEALTH PLAN | 937_NETWORK HEALTH PLAN CAWI 20230101 | $3,902.32 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | NETWORK HEALTH PLAN | 937_NETWORK HEALTH PLAN CAWI 20230101 | $3,902.32 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| Ascension SE Wisconsin Hospital - Elmbrook Campus Outpatient | TRILOGY | 1271_TRILOGY 20250701 | $3,902.32 | $5,655.53 | $2,997.43 | 2026-01-01 | MRF ↗ |
| OGDEN REGIONAL MEDICAL CENTER Outpatient | Imagine Health Wise | PPO | $3,923.93 | $8,444.00 | $8,444.00 | 2024-10-01 | MRF ↗ |
| ASCENSION COLUMBIA ST MARYS HOSPITAL MILWAUKEE Outpatient | ANTHEM PPO | 1122_ANTHEM PPO 20221001 | $3,957.22 | $4,885.46 | $2,589.29 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | HUMANA PPO | 961_HUMANA PPO MEWI SEWI 20230301 | $3,958.87 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | HUMANA PPO | 961_HUMANA PPO MEWI SEWI 20230301 | $3,958.87 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | HUMANA HMO POS | 936_HUMANA HMO POS MEWI SEWI 20230301 | $3,958.87 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | HUMANA WVN | 962_HUMANA WVN MEWI SEWI 20230301 | $3,958.87 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | HUMANA WVN | 962_HUMANA WVN MEWI SEWI 20230301 | $3,958.87 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | HUMANA HMO POS | 936_HUMANA HMO POS MEWI SEWI 20230301 | $3,958.87 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | SEHN | 268_SEHN CAWI 20160101 | $3,958.87 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | NEHA LIMITED | 838_NEHA LIMITED CAWI 20220101 | $3,958.87 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | DEAN HEALTH PLAN | 942_DEAN HEALTH PLAN 20210901 | $3,958.87 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| ASCENSION CALUMET HOSPITAL Outpatient | DEAN HEALTH PLAN | 942_DEAN HEALTH PLAN 20210901 | $3,958.87 | $5,655.53 | $3,223.65 | 2026-01-01 | MRF ↗ |
| Ascension SE Wisconsin Hospital - Elmbrook Campus Outpatient | NEHA LIMITED | 821_NEHA LIMITED 20220101 | $3,958.87 | $5,655.53 | $2,997.43 | 2026-01-01 | MRF ↗ |
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