22851 — Pr Application Intervertebral Biomechanical Device
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). PR APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE (CPT 22851) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/22851?code_type=CPT
MLA (9th ed.)
“PR APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE (CPT 22851) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/22851?code_type=CPT. Accessed .
Chicago (notes-bibliography)
“PR APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE (CPT 22851) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/22851?code_type=CPT.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $1,376–$7,920 (25th–75th percentile) across 394 hospitals · 243 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CPT/HCPCS 22851 — 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 |
|---|---|---|---|---|---|---|---|
| Tyler Memorial Hospital OutpatientFacility | None | — | — | — | — | 2026-01-01 | MRF ↗ |
| LOGAN REGIONAL HOSPITAL OutpatientFacility | None | — | — | — | — | 2026-03-23 | MRF ↗ |
| EAST CARROLL PARISH HOSPITAL Outpatient | UNITED CHICAGO TEACHER FUND-ALL PLANS | UNITED CHICAGO TEACHER FUND-ALL PLANS | $55.62 | $412.00 | $309.00 | 2026-01-16 | MRF ↗ |
| EAST CARROLL PARISH HOSPITAL Outpatient | UNITED AT&T-ALL PLANS | UNITED AT&T-ALL PLANS | $85.49 | $412.00 | $309.00 | 2026-01-16 | MRF ↗ |
| ST MARYS MEDICAL CENTER Outpatient | Caresource | Wv Marketplace | — | — | — | 2026-05-06 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | United Healthcare | Commercial | $100.00 | — | — | 2025-01-28 | MRF ↗ |
| MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC Outpatient | Medicaid Hmo Apr Drg | Medicaid Hmo Apr Drg | $129.72 | $29.26 | $29.26 | 2026-05-22 | MRF ↗ |
| MOUNT SINAI MEDICAL CENTER OF FLORIDA, INC Outpatient | Magellan Complete Care | Magellan Complete Care | $138.80 | $29.26 | $29.26 | 2026-05-22 | MRF ↗ |
| EAST CARROLL PARISH HOSPITAL Outpatient | CIGNA-ALL PLANS | CIGNA-ALL PLANS | $185.40 | $412.00 | $309.00 | 2026-01-16 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Amerigroup | Medicare Advantage | $187.00 | $780.00 | $780.00 | 2025-07-03 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Amerigroup | Children's Health Insurance Program | $187.00 | $780.00 | $780.00 | 2025-07-03 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | ChoiceCare Network | Commercial | $187.00 | $780.00 | $780.00 | 2025-07-03 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Superior HealthPlan | Commercial | $187.00 | $780.00 | $780.00 | 2025-07-03 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Curative | Commercial | $250.00 | $780.00 | $780.00 | 2025-07-03 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Wellpoint | Commercial | $253.00 | $780.00 | $780.00 | 2025-07-03 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM HEALTHSYNC HMO | 9227_ANTHEM HEALTHSYNC HMO VCIN 20250101 | — | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | MEDICAID ADVANTAGE | 8723_MEDICAID REPLACEMENT OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | MHS CARE CONNECT | 8257_MHS CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | MDWISE HOOSIER ALLIANCE MEDICAID | 9347_MDWISE MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | MHS CARE CONNECT | 8877_MHS CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM MEDICAID | 7373_ANTHEM MEDICAID REPLACEMENT OUTPATIENT 20230101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | ANTHEM CARE CONNECT | 8879_ANTHEM CONNECT MEDICAID REPLACEMENT ASC OUTPATIENT 20240401 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | MDWISE HOOSIER ALLIANCE MEDICAID | 8256_MDWISE MEDICAID REPLACEMENT OUTPATIENT 20240101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | 9365_MEDICAID REPLACEMENT ASC OUTPATIENT 20250101 | $281.47 | — | — | 2026-01-01 | MRF ↗ |
| METROPOLITAN HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| QUEENS HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| ELMHURST HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| KINGS COUNTY HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| JACOBI MEDICAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| LINCOLN MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| JACOBI MEDICAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| WOODHULL MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| North Central Bronx Hospital OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| METROPOLITAN HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| WOODHULL MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| QUEENS HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| North Central Bronx Hospital OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| HARLEM HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| KINGS COUNTY HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| SOUTH BROOKLYN HEALTH OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| BELLEVUE HOSPITAL CENTER OutpatientFacility | UNITED | Managed Medicaid | $292.73 | — | — | 2025-09-05 | MRF ↗ |
| METROPOLITAN HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| JACOBI MEDICAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| LINCOLN MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| ELMHURST HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| QUEENS HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| WOODHULL MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| WOODHULL MEDICAL & MENTAL HEALTH CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| METROPOLITAN HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| QUEENS HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| North Central Bronx Hospital OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| KINGS COUNTY HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| HARLEM HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| North Central Bronx Hospital OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| KINGS COUNTY HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| JACOBI MEDICAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| SOUTH BROOKLYN HEALTH OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | MRF ↗ |
| BELLEVUE HOSPITAL CENTER OutpatientFacility | UNITED | Essential Plan 1-4_200-250 | $313.22 | — | — | 2025-09-05 | 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.