23405 — Incision Of Tendon & Muscle
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). INCISION OF TENDON & MUSCLE (HCPCS 23405) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/23405?code_type=HCPCS
MLA (9th ed.)
“INCISION OF TENDON & MUSCLE (HCPCS 23405) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/23405?code_type=HCPCS. Accessed .
Chicago (notes-bibliography)
“INCISION OF TENDON & MUSCLE (HCPCS 23405) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/23405?code_type=HCPCS.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $2,761–$8,540 (25th–75th percentile) across 1,767 hospitals · 4,278 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CPT/HCPCS 23405 — the consumer-grade median across the country. It covers the facility charge only; the surgeon’s and anesthesiologist’s fees are billed separately.
Estimated complete episode
What the whole episode might cost
Your hospital facility price plus the separately-billed professional fees a complete episode adds. The facility figure is an actual negotiated rate from our data; the surgeon and anesthesia figures are estimates from the Medicare fee schedule scaled to commercial rates — not facility-specific quotes.
What hospitals actually negotiate
Measured
$2,761
$6,437 typical
$8,540
The middle 50% of negotiated facility rates for this procedure, measured across 1,767 hospitals. Surgeon & anesthesia fees are modeled estimates added on top.
What you’ll likely be billed
| Hospital facility Actual median across hospitals The hospital’s negotiated facility rate — from our MRF data. | $6,437 |
| Surgeon (professional fee) Estimate national typical Medicare PFS $574 × 1.22 commercial. | $701 |
| Likely subtotal | $7,138 |
Surgical episode (typical)
~$7,138
Your recovery plan — adjust to what your surgeon told you
After surgery, recovery care is billed separately. We pre-fill the typical plan; change it to your situation.
Recovery cost modeled
~$3,785
With your recovery plan (typical)
~$10,923
How each figure is sourced
- Hospital facility (actual)
- source: Hospital MRF (45 CFR 180)
- Surgeon (professional fee) (estimate)
- rvu_version: RVU26A (updated 2025-12-29) · gpci: National (unadjusted, GPCI = 1.000) · cf_rule: CMS-1832-F ($33.40) · multiplier_source: HCCI 2017 national
Estimates use CMS Medicare Physician Fee Schedule reference data (RVU × GPCI × conversion factor; anesthesia base+time × CF) scaled by a sourced commercial multiplier, weighted by how often each component is billed. See the methodology. Your real total appears on your insurer’s Explanation of Benefits (EOB).
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 |
|---|---|---|---|---|---|---|---|
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Superior HealthPlan | Commercial | $2.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Amerigroup | Children's Health Insurance Program | $2.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| PACIFICA HOSPITAL OF THE VALLEY Outpatient | Aetna | Commercial | $2.00 | $4.00 | $4.00 | 2025-11-19 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Amerigroup | Medicare Advantage | $2.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | ChoiceCare Network | Commercial | $2.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Wellpoint | Commercial | $3.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| WILSON MEMORIAL HOSPITAL Both | Anthem | Ppo Hmo | — | $10.50 | $5.25 | 2026-05-13 | MRF ↗ |
| WILSON MEMORIAL HOSPITAL Both | Med Mutual | Ppo Hmo | — | $10.50 | $5.25 | 2026-05-13 | MRF ↗ |
| WILSON MEMORIAL HOSPITAL Both | Aetna | Hmo Ppo | — | $10.50 | $5.25 | 2026-05-13 | MRF ↗ |
| WILSON MEMORIAL HOSPITAL Both | Cigna | Cigna | — | $10.50 | $5.25 | 2026-05-13 | MRF ↗ |
| WILSON MEMORIAL HOSPITAL Both | Anthem | Traditional | — | $10.50 | $5.25 | 2026-05-13 | MRF ↗ |
| WILSON MEMORIAL HOSPITAL Both | Molina | Marketplace | — | $10.50 | $5.25 | 2026-05-13 | MRF ↗ |
| PACIFICA HOSPITAL OF THE VALLEY Outpatient | Blue Cross Blue Shield - CA | Medi-Cal | $4.00 | $4.00 | $4.00 | 2025-11-19 | MRF ↗ |
| PACIFICA HOSPITAL OF THE VALLEY Outpatient | Heritage Provider Network | Medi-Cal | $4.00 | $4.00 | $4.00 | 2025-11-19 | MRF ↗ |
| PACIFICA HOSPITAL OF THE VALLEY Outpatient | Altamed | Commercial | $4.00 | $4.00 | $4.00 | 2025-11-19 | MRF ↗ |
| PACIFICA HOSPITAL OF THE VALLEY Outpatient | Molina | Medi-Cal | $4.00 | $4.00 | $4.00 | 2025-11-19 | MRF ↗ |
| KNOX COUNTY HOSPITAL Outpatient | Blue Cross Blue Shield of Texas | Blue Advantage HMO | $5.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| MULESHOE AREA MEDICAL CENTER Outpatient | Aetna | Commercial | $5.00 | $12.00 | $7.00 | 2026-05-22 | MRF ↗ |
| CRESCENT MEDICAL CENTER LANCASTER Outpatient | Oscar | Commercial | $6.00 | $30.00 | $20.00 | 2026-05-27 | MRF ↗ |
| KNOX COUNTY HOSPITAL Outpatient | Superior Health Plan | Commercial | $6.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| KNOX COUNTY HOSPITAL Outpatient | WellMed | Commercial | $6.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| KNOX COUNTY HOSPITAL Outpatient | MultiPlan | Commercial | $6.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| KNOX COUNTY HOSPITAL Outpatient | Humana | Commercial | $6.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Blue Cross Blue Shield | Blue Essentials | $7.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | Wellpoint | Medicare Advantage | $7.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Aetna | Commercial | $7.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Blue Cross Blue Shield | Blue Advantage | $7.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| KNOX COUNTY HOSPITAL Outpatient | Blue Cross Blue Shield of Texas | Blue Essentials | $7.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| KNOX COUNTY HOSPITAL Outpatient | Blue Cross Blue Shield of Texas | PPO | $7.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| MULESHOE AREA MEDICAL CENTER Outpatient | Superior Health Plan | HMO | $7.00 | $12.00 | $7.00 | 2026-05-22 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | Blue Cross Blue Shield - Tx | Blue Advantage HMO | $7.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| JACKSON HEALTHCARE CENTER Outpatient | Blue Cross Blue Shield | Traditional HMO | $7.00 | $11.00 | $9.00 | 2026-03-25 | MRF ↗ |
| MULESHOE AREA MEDICAL CENTER Outpatient | Superior Health Plan | PPO | $7.00 | $12.00 | $7.00 | 2026-05-22 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Cigna | Commercial | $7.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Blue Cross Blue Shield | PPO | $8.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| KNOX COUNTY HOSPITAL Outpatient | Aetna | Commercial | $8.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| JACKSON HEALTHCARE CENTER Outpatient | Blue Cross Blue Shield | Traditional PPO | $8.00 | $11.00 | $9.00 | 2026-03-25 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Blue Cross Blue Shield | Commercial | $8.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| JACKSON HEALTHCARE CENTER Outpatient | Humana | Commercial | $8.00 | $11.00 | $9.00 | 2026-03-25 | MRF ↗ |
| JACKSON HEALTHCARE CENTER Outpatient | Aetna | Commercial | $8.00 | $11.00 | $9.00 | 2026-03-25 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | Superior Health Plan | Medicare Advantage | $8.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | Blue Cross Blue Shield - Tx | Blue Essentials | $9.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| KNOX COUNTY HOSPITAL Outpatient | FirstCare | Commercial | $9.00 | $10.00 | $10.00 | 2025-11-06 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Three Rivers Provider Network | Commercial | $9.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | Aetna | Commercial | $9.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | Cigna | Commercial | $9.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | Aetna | Medicare Advantage | $9.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| JACKSON HEALTHCARE CENTER Outpatient | United Healthcare | Commercial | $9.00 | $11.00 | $9.00 | 2026-03-25 | MRF ↗ |
| JACKSON HEALTHCARE CENTER Outpatient | Cigna | Commercial | $9.00 | $11.00 | $9.00 | 2026-03-25 | MRF ↗ |
| St Lawrence Rehabilitation Center Outpatient | Independence Keystone Health Plan | Commercial | $9.00 | $11.00 | $11.00 | 2026-03-31 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | HealthSmart Preferred Care | Commercial | $9.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| GRAHAM REGIONAL MEDICAL CENTER Outpatient | Health Advantage Network | Commercial | $9.00 | $10.00 | $10.00 | 2025-07-03 | MRF ↗ |
| St Lawrence Rehabilitation Center Outpatient | Amerihealth | HMO | $9.00 | $11.00 | $11.00 | 2026-03-31 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | ChoiceCare | Commercial | $9.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | Three Rivers Provider Network | Commercial | $9.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | HealthSmart Preferred Network | Commercial | $10.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | Galaxy Health Network | Commercial | $10.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | Private Health Care Systems (PHCS) | Commercial | $10.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | FirstCare | Commercial | $10.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | Blue Cross Blue Shield - Tx | Commercial | $10.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MULESHOE AREA MEDICAL CENTER Outpatient | Blue Cross Blue Shield of Texas | Commercial | $10.00 | $12.00 | $7.00 | 2026-05-22 | MRF ↗ |
| MULESHOE AREA MEDICAL CENTER Outpatient | Blue Cross Blue Shield of Texas | Blue Essentials | $10.00 | $12.00 | $7.00 | 2026-05-22 | MRF ↗ |
| MULESHOE AREA MEDICAL CENTER Outpatient | Blue Cross Blue Shield of Texas | HMO | $10.00 | $12.00 | $7.00 | 2026-05-22 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | Scott and White Health Plan | Commercial | $10.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MULESHOE AREA MEDICAL CENTER Outpatient | United Healthcare of Texas | Commercial | $10.00 | $12.00 | $7.00 | 2026-05-22 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | Superior Health Plan | Commercial - Exchange | $11.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | CapStar | PPO | $11.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MORRILL COUNTY COMMUNITY HOSPITAL Outpatient | Department of Health and Human Services | Medicaid Membership | $11.00 | $26.00 | $24.00 | 2025-07-24 | MRF ↗ |
| MC CAMEY HOSPITAL Outpatient | MultiPlan | Commercial | $11.00 | $11.00 | $11.00 | 2026-03-24 | MRF ↗ |
| MORRILL COUNTY COMMUNITY HOSPITAL Outpatient | Department of Health and Human Services | Medicaid Membership | $11.00 | $26.00 | $24.00 | 2025-07-24 | MRF ↗ |
| St Lawrence Rehabilitation Center Outpatient | Aetna | Commercial | $11.00 | $11.00 | $11.00 | 2026-03-31 | MRF ↗ |
| CRESCENT MEDICAL CENTER LANCASTER Outpatient | Blue Cross of Blue Shield of Texas | HMO | $12.00 | $30.00 | $20.00 | 2026-05-27 | MRF ↗ |
| MULESHOE AREA MEDICAL CENTER Outpatient | Superior Health Plan | Commercial | $12.00 | $12.00 | $7.00 | 2026-05-22 | MRF ↗ |
| MORRILL COUNTY COMMUNITY HOSPITAL Outpatient | United Healthcare | Medicare Advantage | $13.00 | $26.00 | $24.00 | 2025-07-24 | MRF ↗ |
| MORRILL COUNTY COMMUNITY HOSPITAL Outpatient | United Healthcare | Medicare Advantage | $13.00 | $26.00 | $24.00 | 2025-07-24 | MRF ↗ |
| CRESCENT MEDICAL CENTER LANCASTER Outpatient | Blue Cross of Blue Shield of Texas | Blue Essentials Network Participation | $14.00 | $30.00 | $20.00 | 2026-05-27 | MRF ↗ |
| CRESCENT MEDICAL CENTER LANCASTER Outpatient | Blue Cross of Blue Shield of Texas | Traditional Immidiate Bussiness | $15.00 | $30.00 | $20.00 | 2026-05-27 | MRF ↗ |
| NMC HEALTH Outpatient | WPPA | Commercial | $17.00 | $31.00 | $22.00 | 2025-06-30 | MRF ↗ |
| LAKEVIEW HOSPITAL BothFacility | HP MEDICAID REPLACEMENT [950307] | HP CARE PMAP [50327] | $17.85 | $8,752.00 | $3,238.24 | 2026-03-31 | MRF ↗ |
| NMC HEALTH Outpatient | Occunet | Commercial | $19.00 | $31.00 | $22.00 | 2025-06-30 | MRF ↗ |
| CRESCENT MEDICAL CENTER LANCASTER Outpatient | Prime Health Services | Commercial | $20.00 | $30.00 | $20.00 | 2026-05-27 | MRF ↗ |
| NMC HEALTH Outpatient | Samaritan Ministries International | Commercial | $20.00 | $31.00 | $22.00 | 2025-06-30 | MRF ↗ |
| NMC HEALTH Outpatient | MediNcrease Health Plan | Commercial | $20.00 | $31.00 | $22.00 | 2025-06-30 | MRF ↗ |
| MONMOUTH MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $20.41 | $11,337.00 | $7,262.33 | 2024-12-31 | MRF ↗ |
| NMC HEALTH Outpatient | Prime Health Services | Commercial | $23.00 | $31.00 | $22.00 | 2025-06-30 | MRF ↗ |
| MORRILL COUNTY COMMUNITY HOSPITAL Outpatient | Blue Cross Blue Shield | Commercial | $25.00 | $26.00 | $24.00 | 2025-07-24 | MRF ↗ |
| MORRILL COUNTY COMMUNITY HOSPITAL Outpatient | Blue Cross Blue Shield | Commercial | $25.00 | $26.00 | $24.00 | 2025-07-24 | MRF ↗ |
| BEATRICE COMMUNITY HOSPITAL & HEALTH CENTER, INC Outpatient | Tricare | Commercial | $28.00 | $175.00 | $175.00 | 2025-11-07 | MRF ↗ |
| NMC HEALTH Outpatient | United Healthcare | Commercial | $28.00 | $31.00 | $22.00 | 2025-06-30 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | BCBS-SC | BCBSSCBlueChoice | $28.70 | — | — | 2024-12-08 | MRF ↗ |
| NMC HEALTH Outpatient | Cigna | Commercial | $29.00 | $31.00 | $22.00 | 2025-06-30 | MRF ↗ |
| CRESCENT MEDICAL CENTER LANCASTER Outpatient | Cigna Health Springs | Commercial | $30.00 | $30.00 | $20.00 | 2026-05-27 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | BCBS-SC | BCBSSCPreferredBlue | $30.90 | — | — | 2024-12-08 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCBlueChoice | $33.10 | — | — | 2024-12-08 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCPreferredBlue | $33.10 | — | — | 2024-12-08 | MRF ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCPreferredBlue | $34.60 | — | — | 2024-12-08 | MRF ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCBlueChoice | $34.60 | — | — | 2024-12-08 | MRF ↗ |
| CRESCENT MEDICAL CENTER LANCASTER Outpatient | Friday Health Insurance Company | Commercial | $39.00 | $30.00 | $20.00 | 2026-05-27 | MRF ↗ |
| SALINA REGIONAL HEALTH CENTER Outpatient | BCBS BLUE CHOICE/SELECT - ALL OTHER PLANS | BCBS BLUE CHOICE/SELECT - ALL OTHER PLANS | $40.16 | $7,293.20 | $5,105.24 | 2026-01-12 | MRF ↗ |
| SALINA REGIONAL HEALTH CENTER Outpatient | BCBS CAP | BCBS CAP | $42.28 | $7,293.20 | $5,105.24 | 2026-01-12 | MRF ↗ |
| S E LACKEY MEMORIAL HOSPITAL Outpatient | CIGNA COMM - ALL PLANS | CIGNA COMM - ALL PLANS | $50.00 | $1,267.00 | $1,267.00 | 2026-02-10 | MRF ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCState | $50.00 | — | — | 2024-12-08 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCState | $50.00 | — | — | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | BCBS-SC | BCBSSCState | $50.00 | — | — | 2024-12-08 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Essential Plan | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Essential Plan | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Healthy New York | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Essential Plan | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Healthy New York | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Healthy New York | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Essential Plan | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Essential Plan | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Healthy New York | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Essential Plan | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Healthy New York | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Essential Plan | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Healthy New York | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Healthy New York | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Healthy New York | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Essential Plan | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Healthy New York | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Essential Plan | $50.52 | — | — | 2026-04-14 | MRF ↗ |
| GEISINGER SOUTH WILKES-BARRE Outpatient | Medicaid | Medicaid | $56.32 | $13,377.00 | $8,293.74 | 2026-04-01 | MRF ↗ |
| GEISINGER MEDICAL CENTER Outpatient | Medicaid | Medicaid | $56.32 | $13,135.00 | $8,143.70 | 2025-07-01 | MRF ↗ |
| GEISINGER MEDICAL CENTER Outpatient | Geisinger Family Plan | Geisinger Family Plan - Managed Medicaid | $58.01 | $13,135.00 | $8,143.70 | 2025-07-01 | MRF ↗ |
| GEISINGER SOUTH WILKES-BARRE Outpatient | Geisinger Family Plan | Geisinger Family Plan - Managed Medicaid | $58.01 | $13,377.00 | $8,293.74 | 2026-04-01 | MRF ↗ |
| AHN WEXFORD HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| AHN WEXFORD HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $59.14 | — | — | 2026-04-14 | MRF ↗ |
| TAHOE FOREST HOSPITAL Outpatient | MEDI-CAL | MEDI-CAL | $64.04 | $2,629.00 | $2,629.00 | 2025-10-04 | MRF ↗ |
| TAHOE FOREST HOSPITAL Outpatient | MEDI-CAL | MEDI-CAL | $64.04 | $2,629.00 | $2,629.00 | 2025-10-04 | MRF ↗ |
| GEISINGER MEDICAL CENTER Outpatient | AmeriHealth | AmeriHealth Cartias - Managed Medicaid | $64.77 | $13,135.00 | $8,143.70 | 2025-07-01 | MRF ↗ |
| GEISINGER SOUTH WILKES-BARRE Outpatient | AmeriHealth | AmeriHealth Cartias - Managed Medicaid | $64.77 | $13,377.00 | $8,293.74 | 2026-04-01 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Medicare | $66.16 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Medicare | $66.16 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Medicare | $66.16 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Medicare | $66.16 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Medicare | $66.16 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Medicare | $66.16 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Medicare | $66.16 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Medicare | $66.16 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Medicare | $66.16 | — | — | 2026-04-14 | MRF ↗ |
| GEISINGER MEDICAL CENTER Outpatient | UPMC For You | UPMC For You - Managed Medicaid | $66.18 | $13,135.00 | $8,143.70 | 2025-07-01 | MRF ↗ |
| GEISINGER SOUTH WILKES-BARRE Outpatient | UPMC For You | UPMC For You - Managed Medicaid | $66.18 | $13,377.00 | $8,293.74 | 2026-04-01 | MRF ↗ |
| BROOKS-TLC HOSPITAL SYSTEM, INC OutpatientFacility | Univera | Medicare Managed Care Plan | $66.29 | — | — | 2026-04-01 | MRF ↗ |
| OLEAN GENERAL HOSPITAL OutpatientFacility | Univera | Medicare Managed Care Plan | $66.29 | — | — | 2026-04-01 | MRF ↗ |
| GEISINGER MEDICAL CENTER Outpatient | Health Partners | Health Partners - Managed Medicaid | $67.58 | $13,135.00 | $8,143.70 | 2025-07-01 | MRF ↗ |
| GEISINGER SOUTH WILKES-BARRE Outpatient | Health Partners | Health Partners - Managed Medicaid | $67.58 | $13,377.00 | $8,293.74 | 2026-04-01 | MRF ↗ |
| GEISINGER MEDICAL CENTER Outpatient | UPMC CHIP | UPMC CHIP - Managed Medicaid | $70.40 | $13,135.00 | $8,143.70 | 2025-07-01 | MRF ↗ |
| GEISINGER SOUTH WILKES-BARRE Outpatient | UPMC CHIP | UPMC CHIP - Managed Medicaid | $70.40 | $13,377.00 | $8,293.74 | 2026-04-01 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Commercial | $74.29 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Commercial | $74.29 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Commercial | $74.29 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Commercial | $74.29 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Commercial | $74.29 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Commercial | $74.29 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Commercial | $74.29 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Commercial | $74.29 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Commercial | $74.29 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $74.34 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $74.34 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $74.34 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $74.34 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $74.34 | — | — | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $74.34 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $74.34 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $74.34 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $74.34 | — | — | 2026-04-14 | MRF ↗ |
| AHN WEXFORD HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $74.34 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $74.34 | — | — | 2026-04-14 | MRF ↗ |
| St Anthony Regional Hospital & Nursing Home Outpatient | MIDLANDS CHOICE - ALL PLANS | MIDLANDS CHOICE - ALL PLANS | $76.98 | $1,728.00 | $1,728.00 | 2026-02-09 | MRF ↗ |
| CHRIST HOSPITAL Inpatient | UHC COMMUNITY HEALTH DUAL [2197] | UHC DUAL [219701] | $77.65 | $1,554.00 | $932.40 | 2025-12-19 | MRF ↗ |
| CHRIST HOSPITAL Inpatient | CARESOURCE [2031] | CARESOURCE OH MEDICAID [203102] | $77.65 | $1,554.00 | $932.40 | 2025-12-19 | MRF ↗ |
| CHRIST HOSPITAL Inpatient | AETNA BETTER HEALTH DUAL [2182] | AETNA BETTER HEALTH DUAL (MYCARE) [218201] | $77.65 | $1,554.00 | $932.40 | 2025-12-19 | MRF ↗ |
| CHRIST HOSPITAL Inpatient | UHC COMMUNITY HEALTH DUAL [2197] | UHC DUAL [219701] | $77.65 | $1,554.00 | $932.40 | 2025-12-19 | MRF ↗ |
| CHRIST HOSPITAL Inpatient | UHC COMMUNITY MEDICAID [2175] | UHC COMMUNITY OH MEDICAID [217501] | $77.65 | $1,554.00 | $932.40 | 2025-12-19 | MRF ↗ |
| CHRIST HOSPITAL Inpatient | UHC COMMUNITY MEDICAID [2175] | UHC COMMUNITY OH MEDICAID [217501] | $77.65 | $1,554.00 | $932.40 | 2025-12-19 | MRF ↗ |
| CHRIST HOSPITAL Inpatient | AETNA BETTER HEALTH DUAL [2182] | AETNA BETTER HEALTH DUAL (MYCARE) [218201] | $77.65 | $1,554.00 | $932.40 | 2025-12-19 | MRF ↗ |
| CHRIST HOSPITAL Inpatient | ANTHEM MEDICARE [1002] | ANTHEM MEDIBLUE MEDICARE [100205] | $77.65 | $1,554.00 | $932.40 | 2025-12-19 | MRF ↗ |
| CHRIST HOSPITAL Inpatient | ANTHEM [2024] | OH ANTHEM EXCHANGE [202434] | $77.65 | $1,554.00 | $932.40 | 2025-12-19 | MRF ↗ |
| CHRIST HOSPITAL Inpatient | AETNA [2000] | AETNA HMO/PPO [200018] | $77.65 | $1,554.00 | $932.40 | 2025-12-19 | 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.