23455 — Repair Shoulder Capsule
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). REPAIR SHOULDER CAPSULE (CPT 23455) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/23455?code_type=CPT
MLA (9th ed.)
“REPAIR SHOULDER CAPSULE (CPT 23455) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/23455?code_type=CPT. Accessed .
Chicago (notes-bibliography)
“REPAIR SHOULDER CAPSULE (CPT 23455) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/23455?code_type=CPT.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $3,421–$10,150 (25th–75th percentile) across 1,636 hospitals · 3,200 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CPT/HCPCS 23455 — 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 fees are estimated from the Medicare fee schedule scaled to commercial rates — not facility-specific quotes.
What hospitals actually negotiate
Measured
$3,421
$7,144 typical
$10,150
The middle 50% of negotiated facility rates for this procedure, measured across 1,636 hospitals. The surgeon and 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. | $7,144 |
| Surgeon (professional fee) Estimate national typical Medicare $880 × 1.22 commercial. | $1,074 |
| Anesthesia Estimate national typical Generic anesthesia (~90 min typical, median CMS base units). Medicare $225 × 3.14 commercial. Approximate — no procedure-specific anesthesia mapping for this code. | $708 |
| Likely subtotal | $8,926 |
Surgical episode (typical)
~$8,926
Your recovery plan — adjust to what your doctor told you
After your procedure, 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)
~$12,711
- The anesthesia component is a generic, approximate estimate — no procedure-specific anesthesia mapping exists for this code, so a typical anesthesia for this procedure type is shown.
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
- Anesthesia (estimate)
- base_units_version: CY2022 file (base units unchanged for CY2026 per CMS) · anesthesia_cf: $20.49754 (National) · cf_rule: CMS-1832-F · multiplier_source: AJMC/Duffy 2016-2017 (PMID 34156223) national · basis: generic surgical anesthesia — 5 base units (typical CMS value) × ~90 min; approximate, NOT a procedure-specific crosswalk
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 |
|---|---|---|---|---|---|---|---|
| NMC HEALTH Outpatient | Samaritan Ministries International | Commercial | $1.00 | $1.00 | $1.00 | 2025-06-30 | MRF ↗ |
| NMC HEALTH Outpatient | WPPA | Commercial | $1.00 | $1.00 | $1.00 | 2025-06-30 | MRF ↗ |
| NMC HEALTH Outpatient | United Healthcare | Commercial | $1.00 | $1.00 | $1.00 | 2025-06-30 | MRF ↗ |
| MCBRIDE ORTHOPEDIC HOSPITAL Outpatient | Cigna | Commercial | $1.00 | $1.00 | $1.00 | 2025-02-06 | MRF ↗ |
| NMC HEALTH Outpatient | Cigna | Commercial | $1.00 | $1.00 | $1.00 | 2025-06-30 | MRF ↗ |
| NMC HEALTH Outpatient | MediNcrease Health Plan | Commercial | $1.00 | $1.00 | $1.00 | 2025-06-30 | MRF ↗ |
| NMC HEALTH Outpatient | Prime Health Services | Commercial | $1.00 | $1.00 | $1.00 | 2025-06-30 | MRF ↗ |
| NMC HEALTH Outpatient | Occunet | Commercial | $1.00 | $1.00 | $1.00 | 2025-06-30 | MRF ↗ |
| NMC HEALTH Outpatient | Aetna | Commercial | $1.00 | $1.00 | $1.00 | 2025-06-30 | MRF ↗ |
| PRATT REGIONAL MEDICAL CENTER Outpatient | Christian Health Aid | Commercial | $2.00 | $2.00 | $1.00 | 2025-10-24 | MRF ↗ |
| PRATT REGIONAL MEDICAL CENTER Outpatient | United Healthcare | Commercial | $2.00 | $2.00 | $1.00 | 2025-10-24 | MRF ↗ |
| PRATT REGIONAL MEDICAL CENTER Outpatient | ChoiceCare | Commercial | $2.00 | $2.00 | $1.00 | 2025-10-24 | MRF ↗ |
| PRATT REGIONAL MEDICAL CENTER Outpatient | United Healthcare | Medicare Advantage | $2.00 | $2.00 | $1.00 | 2025-10-24 | MRF ↗ |
| PRATT REGIONAL MEDICAL CENTER Outpatient | Health Partners of Kansas | Commercial | $2.00 | $2.00 | $1.00 | 2025-10-24 | MRF ↗ |
| PRATT REGIONAL MEDICAL CENTER Outpatient | Aetna | Commercial | $2.00 | $2.00 | $1.00 | 2025-10-24 | MRF ↗ |
| St Lawrence Rehabilitation Center Outpatient | Amerihealth | HMO | $9.00 | $11.00 | $11.00 | 2026-03-31 | MRF ↗ |
| St Lawrence Rehabilitation Center Outpatient | Independence Keystone Health Plan | Commercial | $9.00 | $11.00 | $11.00 | 2026-03-31 | MRF ↗ |
| St Lawrence Rehabilitation Center Outpatient | Aetna | Commercial | $11.00 | $11.00 | $11.00 | 2026-03-31 | MRF ↗ |
| TYLER COUNTY HOSPITAL Outpatient | Blue Cross and Blue Shield | Blue Advantage HMO | $12.00 | $23.00 | $17.00 | 2025-04-15 | MRF ↗ |
| TYLER COUNTY HOSPITAL Outpatient | Blue Cross and Blue Shield | Blue Advantage HMO | $14.00 | $28.00 | $21.00 | 2025-04-15 | MRF ↗ |
| CITIZENS MEDICAL CENTER Outpatient | Wppa/Providrscare | Commercial | — | $3,143.00 | $2,357.25 | 2026-05-18 | MRF ↗ |
| CITIZENS MEDICAL CENTER Outpatient | Phcs/Multiplan | Commercial | — | $3,143.00 | $2,357.25 | 2026-05-18 | MRF ↗ |
| CITIZENS MEDICAL CENTER Outpatient | Hpk (Incl. Cigna) | Commercial | — | $3,143.00 | $2,357.25 | 2026-05-18 | MRF ↗ |
| CITIZENS MEDICAL CENTER Outpatient | Healthy Blue | Medicaid | — | $3,143.00 | $2,357.25 | 2026-05-18 | MRF ↗ |
| CITIZENS MEDICAL CENTER Outpatient | Blue Cross Blue Shield Of Ks | Commercial | $16.02 | $3,143.00 | $2,357.25 | 2026-05-18 | MRF ↗ |
| CITIZENS MEDICAL CENTER Outpatient | Sunflower | Medicaid | — | $3,143.00 | $2,357.25 | 2026-05-18 | MRF ↗ |
| CITIZENS MEDICAL CENTER Outpatient | Aetna | Commercial | — | $3,143.00 | $2,357.25 | 2026-05-18 | MRF ↗ |
| CITIZENS MEDICAL CENTER Outpatient | United Healthcare | Commercial | — | $3,143.00 | $2,357.25 | 2026-05-18 | MRF ↗ |
| TYLER COUNTY HOSPITAL Outpatient | Blue Cross and Blue Shield | Blue Essentials | $18.00 | $23.00 | $17.00 | 2025-04-15 | MRF ↗ |
| TYLER COUNTY HOSPITAL Outpatient | Blue Cross and Blue Shield | PPO/POS Network Participation | $18.00 | $23.00 | $17.00 | 2025-04-15 | MRF ↗ |
| TYLER COUNTY HOSPITAL Outpatient | Blue Cross and Blue Shield | Traditional Indemnity | $20.00 | $23.00 | $17.00 | 2025-04-15 | MRF ↗ |
| TYLER COUNTY HOSPITAL Outpatient | Blue Cross and Blue Shield | Blue Essentials | $22.00 | $28.00 | $21.00 | 2025-04-15 | MRF ↗ |
| TYLER COUNTY HOSPITAL Outpatient | Blue Cross and Blue Shield | PPO/POS Network Participation | $22.00 | $28.00 | $21.00 | 2025-04-15 | MRF ↗ |
| SAINT VINCENT HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | $2,747.00 | $494.46 | 2026-04-14 | MRF ↗ |
| AHN WEXFORD HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| AHN WEXFORD HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | $2,747.00 | $714.22 | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | $2,747.00 | $631.81 | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | $2,747.00 | $631.81 | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | $2,747.00 | $604.34 | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | $2,747.00 | $604.34 | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | $2,747.00 | $521.93 | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| AHN WEXFORD HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| AHN WEXFORD HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | $2,747.00 | $714.22 | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | $2,747.00 | $521.93 | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | $2,747.00 | $604.34 | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | $2,747.00 | $494.46 | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | $2,747.00 | $659.28 | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | $2,747.00 | $741.69 | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | $2,747.00 | $604.34 | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | $2,747.00 | $604.34 | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | $2,747.00 | $631.81 | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | $2,747.00 | $604.34 | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | $2,747.00 | $604.34 | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | $2,747.00 | $631.81 | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | $2,747.00 | $741.69 | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | $2,747.00 | $604.34 | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid HC | $23.76 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Outpatient | Amerihealth | Amerihealth Medicaid CHC | $23.76 | $2,747.00 | $659.28 | 2026-04-14 | MRF ↗ |
| TYLER COUNTY HOSPITAL Outpatient | Blue Cross and Blue Shield | Traditional Indemnity | $24.00 | $28.00 | $21.00 | 2025-04-15 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | BCBS-SC | BCBSSCBlueChoice | $28.70 | — | — | 2024-12-08 | MRF ↗ |
| MONMOUTH MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $28.76 | $15,980.00 | $7,262.33 | 2024-12-31 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | BCBS-SC | BCBSSCPreferredBlue | $30.90 | — | — | 2024-12-08 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCPreferredBlue | $33.10 | — | — | 2024-12-08 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCBlueChoice | $33.10 | — | — | 2024-12-08 | MRF ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCBlueChoice | $34.60 | — | — | 2024-12-08 | MRF ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCPreferredBlue | $34.60 | — | — | 2024-12-08 | MRF ↗ |
| Tyler Memorial Hospital OutpatientFacility | None | — | — | — | — | 2026-01-01 | MRF ↗ |
| EAST COOPER 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 ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCState | $50.00 | — | — | 2024-12-08 | MRF ↗ |
| St Anthony Regional Hospital & Nursing Home Outpatient | MIDLANDS CHOICE - ALL PLANS | MIDLANDS CHOICE - ALL PLANS | $76.98 | $2,263.00 | $2,263.00 | 2026-02-09 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Healthy New York | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Essential Plan | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Healthy New York | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Essential Plan | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Essential Plan | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Healthy New York | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Essential Plan | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Healthy New York | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Healthy New York | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Essential Plan | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Essential Plan | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Essential Plan | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Healthy New York | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Healthy New York | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Healthy New York | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Essential Plan | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Healthy New York | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Essential Plan | $80.36 | — | — | 2026-04-14 | MRF ↗ |
| MOUNT DESERT ISLAND HOSPITAL BothFacility | Martins Point | MCR Advantage | $90.45 | $201.00 | $180.90 | 2026-04-05 | MRF ↗ |
| MOUNT DESERT ISLAND HOSPITAL BothFacility | Cigna | MCR Advantage | $90.45 | $201.00 | $180.90 | 2026-04-05 | MRF ↗ |
| MOUNT DESERT ISLAND HOSPITAL BothFacility | Wellcare | MCR Advantage | $90.45 | $201.00 | $180.90 | 2026-04-05 | MRF ↗ |
| MOUNT DESERT ISLAND HOSPITAL BothFacility | Anthem | MCR Advantage | $90.45 | $201.00 | $180.90 | 2026-04-05 | MRF ↗ |
| MOUNT DESERT ISLAND HOSPITAL BothFacility | Aetna | MCR Advantage | $90.45 | $201.00 | $180.90 | 2026-04-05 | MRF ↗ |
| MOUNT DESERT ISLAND HOSPITAL BothFacility | United Healthcare | MCR Advantage | $90.45 | $201.00 | $180.90 | 2026-04-05 | MRF ↗ |
| Harper University Hospital Outpatient | Hap | HAPHMO | $93.00 | — | — | 2025-01-31 | MRF ↗ |
| HURON VALLEY-SINAI HOSPITAL Outpatient | Hap | HAPHMO | $93.00 | — | — | 2025-01-31 | MRF ↗ |
| Rehabilitation Institute Of Michigan Outpatient | Hap | HAPHMO | $104.79 | — | — | 2025-01-31 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Medicare | $105.24 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Medicare | $105.24 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Medicare | $105.24 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Medicare | $105.24 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Medicare | $105.24 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Medicare | $105.24 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Medicare | $105.24 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Medicare | $105.24 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Medicare | $105.24 | — | — | 2026-04-14 | MRF ↗ |
| OLEAN GENERAL HOSPITAL OutpatientFacility | Univera | Medicare Managed Care Plan | $105.69 | — | — | 2026-04-01 | MRF ↗ |
| BROOKS-TLC HOSPITAL SYSTEM, INC OutpatientFacility | Univera | Medicare Managed Care Plan | $105.69 | — | — | 2026-04-01 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $108.00 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Outpatient | Aetna | Aetna Better Health CHIP | $108.00 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $108.00 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| AHN WEXFORD HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| AHN WEXFORD HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $113.40 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Commercial | $118.18 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Commercial | $118.18 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Commercial | $118.18 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Commercial | $118.18 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Commercial | $118.18 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Commercial | $118.18 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Commercial | $118.18 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Commercial | $118.18 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Commercial | $118.18 | — | — | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid HC | $118.80 | — | — | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid CHC | $118.80 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $118.80 | — | — | 2026-04-14 | MRF ↗ |
| MOUNT DESERT ISLAND HOSPITAL BothFacility | United Healthcare | Commercial | $120.60 | $201.00 | $180.90 | 2026-04-05 | MRF ↗ |
| SAINT VINCENT HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid HC | $124.20 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for Kids | $124.20 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid HC | $124.20 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid CHC | $124.20 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid CHC | $124.20 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid CHC | $124.20 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for Kids | $124.20 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid HC | $124.20 | — | — | 2026-04-14 | MRF ↗ |
| SARASOTA MEMORIAL HOSPITAL Outpatient | Simply Healthcare Oncology | Healthy Kids | $126.88 | — | — | 2025-08-01 | MRF ↗ |
| SARASOTA MEMORIAL HOSPITAL Outpatient | Sunshine State Oncology | Medicaid HMO | $126.88 | — | — | 2025-08-01 | MRF ↗ |
| SARASOTA MEMORIAL HOSPITAL Outpatient | Simply Healthcare Oncology | Medicaid HMO | $126.88 | — | — | 2025-08-01 | MRF ↗ |
| FORBES HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $129.60 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $129.60 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $129.60 | — | — | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $129.60 | — | — | 2026-04-14 | MRF ↗ |
| SARASOTA MEMORIAL HOSPITAL Outpatient | Molina Oncology | Medicaid HMO | $130.51 | — | — | 2025-08-01 | MRF ↗ |
| SARASOTA MEMORIAL HOSPITAL Outpatient | Molina Oncology | Healthy Kids | $130.51 | — | — | 2025-08-01 | MRF ↗ |
| MOUNT DESERT ISLAND HOSPITAL BothFacility | HealthNet | Commercial | $130.65 | $201.00 | $180.90 | 2026-04-05 | MRF ↗ |
| SARASOTA MEMORIAL HOSPITAL Outpatient | Amerihealth Caritas Oncology | Medicaid HMO | $132.92 | — | — | 2025-08-01 | MRF ↗ |
| SARASOTA MEMORIAL HOSPITAL Outpatient | Community Care Plan Oncology | Medicaid HMO | $132.92 | — | — | 2025-08-01 | MRF ↗ |
| EAST CARROLL PARISH HOSPITAL Outpatient | UNITED CHICAGO TEACHER FUND-ALL PLANS | UNITED CHICAGO TEACHER FUND-ALL PLANS | $135.81 | $1,006.00 | $754.50 | 2026-01-16 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $142.56 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $142.56 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $142.56 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $142.56 | — | — | 2026-04-14 | MRF ↗ |
| AHN WEXFORD HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $142.56 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $142.56 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $142.56 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $142.56 | — | — | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $142.56 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $142.56 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $142.56 | — | — | 2026-04-14 | MRF ↗ |
| ADVENTIST HEALTH WHITE MEMORIAL Outpatient | PROSPECT MG MCR ADV PROFEE ONLY | PROSPECT MG MCR ADV PROFEE ONLY | $146.40 | $488.00 | $87.84 | 2026-01-30 | MRF ↗ |
| ADVENTIST HEALTH WHITE MEMORIAL Outpatient | PROSPECT MG COM/POS PROFEE ONLY-ALL OTHER PLAN | PROSPECT MG COM/POS PROFEE ONLY-ALL OTHER PLAN | $146.40 | $488.00 | $87.84 | 2026-01-30 | MRF ↗ |
Showing the first 200 rate rows. The CSV export above returns up to 1,000 rows — filter by state to narrow a code with more than that.