40820 — Treatment Of Mouth Lesion
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). TREATMENT OF MOUTH LESION (CPT 40820) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/40820?code_type=CPT
MLA (9th ed.)
“TREATMENT OF MOUTH LESION (CPT 40820) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/40820?code_type=CPT. Accessed .
Chicago (notes-bibliography)
“TREATMENT OF MOUTH LESION (CPT 40820) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/40820?code_type=CPT.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $711–$4,218 (25th–75th percentile) across 1,598 hospitals · 3,626 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CPT/HCPCS 40820 — 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 the surgeon's fee are estimated from the Medicare fee schedule scaled to commercial rates — not facility-specific quotes.
What hospitals actually negotiate
Measured
$711
$3,050 typical
$4,218
The middle 50% of negotiated facility rates for this procedure, measured across 1,598 hospitals. The the surgeon's fee 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. | $3,050 |
| Surgeon (professional fee) Estimate national typical Medicare $153 × 1.22 commercial. | $187 |
| Likely subtotal | $3,237 |
Surgical episode (typical)
~$3,237
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 |
|---|---|---|---|---|---|---|---|
| CHI Memorial Hospital - Hixson Outpatient | Alliant Health | Commercial|All Plans | $0.65 | — | — | 2026-02-28 | MRF ↗ |
| Mercy Orthopedic Hospital Springfield OutpatientFacility | BCBS MEDICAID CONTRACTED [320046] | HB SPRG KANCARE HEALTHY BLUE MEDICAID | $5.95 | $15,068.40 | $9,794.46 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL SPRINGFIELD OutpatientFacility | BCBS MEDICAID CONTRACTED [320046] | HB SPRG KANCARE HEALTHY BLUE MEDICAID | $5.95 | $15,068.40 | $9,794.46 | 2026-03-12 | MRF ↗ |
| HANCOCK COUNTY HEALTH SYSTEM Both | WELLMARK HMO-ALL OTHER PLANS | WELLMARK HMO-ALL OTHER PLANS | $7.62 | $325.00 | $243.75 | 2026-03-26 | MRF ↗ |
| COOSA VALLEY MEDICAL CENTER Outpatient | Health Spring | Commercial | $8.00 | $22.00 | $5.00 | 2026-01-28 | MRF ↗ |
| Crosbyton Clinic Hospital Outpatient | Aetna | Commercial | $9.00 | $48.00 | $48.00 | 2025-10-01 | MRF ↗ |
| COOSA VALLEY MEDICAL CENTER Outpatient | Aetna | Commercial | $10.00 | $22.00 | $5.00 | 2026-01-28 | MRF ↗ |
| MONMOUTH MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $12.93 | $7,186.00 | $3,123.62 | 2024-12-31 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Essential Plan | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Healthy New York | $13.56 | — | — | 2026-04-14 | MRF ↗ |
| BROOKS-TLC HOSPITAL SYSTEM, INC OutpatientFacility | Univera | Medicare Managed Care Plan | $16.99 | — | — | 2026-04-01 | MRF ↗ |
| OLEAN GENERAL HOSPITAL OutpatientFacility | Univera | Medicare Managed Care Plan | $16.99 | — | — | 2026-04-01 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Medicare | $17.02 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Univera | Univera Commercial | $19.94 | — | — | 2026-04-14 | MRF ↗ |
| SURGICAL INSTITUTE OF READING BothFacility | Unison | Med Plus | $20.00 | $671.00 | $4,783.07 | 2026-04-08 | MRF ↗ |
| ARNOT OGDEN MEDICAL CENTER OutpatientFacility | AmeriHealth | All Products | $20.00 | — | — | 2026-03-27 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $20.00 | $455.00 | $100.10 | 2026-04-14 | MRF ↗ |
| OSS ORTHOPAEDIC HOSPITAL OutpatientFacility | Amerihealth | F8102_Amerihealth | $20.00 | — | — | 2026-04-01 | MRF ↗ |
| OSS ORTHOPAEDIC HOSPITAL OutpatientFacility | Geisinger Health Plan | F8109_Geisinger Health Plan - Medicaid Chip | $20.00 | — | — | 2026-04-01 | MRF ↗ |
| OSS ORTHOPAEDIC HOSPITAL OutpatientFacility | Amerihealth | F8102_Amerihealth | $20.00 | — | — | 2026-04-01 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Outpatient | Aetna | Aetna Better Health CHIP | $20.00 | $455.00 | $104.65 | 2026-04-14 | MRF ↗ |
| OSS ORTHOPAEDIC HOSPITAL OutpatientFacility | Geisinger Health Plan | F8109_Geisinger Health Plan - Medicaid Chip | $20.00 | — | — | 2026-04-01 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $20.00 | $455.00 | $104.65 | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $21.00 | $455.00 | $100.10 | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $21.00 | $455.00 | $100.10 | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $21.00 | $455.00 | $100.10 | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $21.00 | $455.00 | $100.10 | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| AHN WEXFORD HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| AHN WEXFORD HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas D-SNP Medicare | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Amerihealth | Amerihealth Caritas Medicare (NY) | $21.00 | — | — | 2026-04-14 | MRF ↗ |
| COOSA VALLEY MEDICAL CENTER Outpatient | Humana | PPO | $22.00 | $22.00 | $5.00 | 2026-01-28 | MRF ↗ |
| WEST PENN HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid HC | $22.00 | $455.00 | $122.85 | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $22.00 | $455.00 | $81.90 | 2026-04-14 | MRF ↗ |
| COOSA VALLEY MEDICAL CENTER Outpatient | Humana | Medicare Advantage | $22.00 | $22.00 | $5.00 | 2026-01-28 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL Outpatient | AMERIHEALTH CARITAS | MANAGED MEDICAID | $22.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - POCONO Outpatient | GEISINGER | MANAGED MEDICAID | $22.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - DICKSON CITY Outpatient | GEISINGER | MANAGED MEDICAID | $22.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - DICKSON CITY Outpatient | AMERIHEALTH CARITAS | MANAGED MEDICAID | $22.00 | — | — | 2025-08-01 | MRF ↗ |
| COOSA VALLEY MEDICAL CENTER Outpatient | Humana | HMO | $22.00 | $22.00 | $5.00 | 2026-01-28 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - POCONO Outpatient | AMERIHEALTH CARITAS | MANAGED MEDICAID | $22.00 | — | — | 2025-08-01 | MRF ↗ |
| COOSA VALLEY MEDICAL CENTER Outpatient | Blue Cross Blue Shield of Alabama | Medicare Advantage | $22.00 | $22.00 | $5.00 | 2026-01-28 | MRF ↗ |
| WEST PENN HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid CHC | $22.00 | $455.00 | $122.85 | 2026-04-14 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - HAZLETON Outpatient | UNITED HEALTHCARE | CHIP | $23.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - HAZLETON Outpatient | UNITED HEALTHCARE | MANAGED MEDICAID | $23.00 | — | — | 2025-08-01 | MRF ↗ |
| SAINT VINCENT HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid CHC | $23.00 | $455.00 | $81.90 | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid HC | $23.00 | $455.00 | $104.65 | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid HC | $23.00 | $455.00 | $81.90 | 2026-04-14 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS OutpatientFacility | United Healthcare Community | Managed Medicaid | $23.00 | — | — | 2024-12-31 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - HAZLETON Outpatient | AMERIHEALTH CARITAS | MANAGED MEDICAID | $23.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - POCONO Outpatient | UNITED HEALTHCARE | CHIP | $23.00 | — | — | 2025-08-01 | MRF ↗ |
| JEFFERSON HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid CHC | $23.00 | $455.00 | $86.45 | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for Kids | $23.00 | $455.00 | $86.45 | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid HC | $23.00 | $455.00 | $86.45 | 2026-04-14 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - POCONO Outpatient | UNITED HEALTHCARE | MANAGED MEDICAID | $23.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - DICKSON CITY Outpatient | UNITED HEALTHCARE | CHIP | $23.00 | — | — | 2025-08-01 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for Kids | $23.00 | $455.00 | $104.65 | 2026-04-14 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - DICKSON CITY Outpatient | UNITED HEALTHCARE | MANAGED MEDICAID | $23.00 | — | — | 2025-08-01 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center for You Medicaid CHC | $23.00 | $455.00 | $104.65 | 2026-04-14 | MRF ↗ |
| LEXINGTON REGIONAL HEALTH CENTER OutpatientFacility | BCBS | ALL PRODUCTS | $23.75 | $25.00 | $24.00 | 2025-12-28 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - HAZLETON Outpatient | GEISINGER | MANAGED MEDICAID | $23.80 | — | — | 2025-08-01 | MRF ↗ |
| WEST PENN HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $24.00 | $455.00 | $122.85 | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $24.00 | $455.00 | $100.10 | 2026-04-14 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS OutpatientFacility | PA Health & Wellness Community Health Choices | Dual Plan Managed Medicaid | $24.00 | — | — | 2024-12-31 | MRF ↗ |
| JEFFERSON HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $24.00 | $455.00 | $86.45 | 2026-04-14 | MRF ↗ |
| LEXINGTON REGIONAL HEALTH CENTER OutpatientFacility | UHC | ALL PRODUCTS | $24.00 | $25.00 | $24.00 | 2025-12-28 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Outpatient | Aetna | Aetna Better Health CHIP | $24.00 | $455.00 | $109.20 | 2026-04-14 | MRF ↗ |
| JEFFERSON ABINGTON HOSPITAL OutpatientFacility | Keystone First | JAB001 Caid CHIP | $24.60 | — | — | 2026-03-18 | MRF ↗ |
| JEFFERSON LANSDALE HOSPITAL OutpatientFacility | Keystone First | JAB002 Caid CHIP | $24.60 | — | — | 2026-03-18 | MRF ↗ |
| JEFFERSON LANSDALE HOSPITAL OutpatientFacility | Keystone First | JAB002 Caid MCO | $24.60 | — | — | 2026-03-18 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL Outpatient | UNITED HEALTHCARE | MANAGED MEDICAID | $24.60 | — | — | 2025-08-01 | MRF ↗ |
| JEFFERSON ABINGTON HOSPITAL OutpatientFacility | Keystone First | JAB001 Caid MCO | $24.60 | — | — | 2026-03-18 | MRF ↗ |
| CHP-LVHN JV, LLC d/b/a Lehigh Valley Hospital - Gilbertsville Outpatient | GEISINGER | MANAGED MEDICAID | $25.00 | — | — | 2025-08-01 | MRF ↗ |
| LEXINGTON REGIONAL HEALTH CENTER OutpatientFacility | MIDLANDS CHOICE | ALL PRODUCTS | $25.00 | $25.00 | $24.00 | 2025-12-28 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL Outpatient | GEISINGER | MANAGED MEDICAID | $25.00 | — | — | 2025-08-01 | MRF ↗ |
| CHP-LVHN JV, LLC d/b/a Lehigh Valley Hospital - Gilbertsville Outpatient | GEISINGER | MANAGED MEDICAID | $25.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - POCONO Outpatient | HIGHMARK WHOLECARE/GATEWAY | MANAGED MEDICAID | $25.40 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL Outpatient | HIGHMARK WHOLECARE/GATEWAY | MANAGED MEDICAID | $25.40 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - DICKSON CITY Outpatient | HIGHMARK WHOLECARE/GATEWAY | MANAGED MEDICAID | $25.40 | — | — | 2025-08-01 | MRF ↗ |
| CHP-LVHN JV, LLC d/b/a Lehigh Valley Hospital - Gilbertsville Outpatient | HIGHMARK WHOLECARE/GATEWAY | MANAGED MEDICAID | $25.40 | — | — | 2025-08-01 | MRF ↗ |
| CHP-LVHN JV, LLC d/b/a Lehigh Valley Hospital - Gilbertsville Outpatient | HIGHMARK WHOLECARE/GATEWAY | MANAGED MEDICAID | $25.40 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - HAZLETON Outpatient | HIGHMARK WHOLECARE/GATEWAY | MANAGED MEDICAID | $25.40 | — | — | 2025-08-01 | MRF ↗ |
| JEFFERSON STRATFORD HOSPITAL OutpatientFacility | PA Health_Wellness CHC | JNJ001_JNJ002_JNJ003 CHC | $26.00 | — | — | 2026-03-18 | MRF ↗ |
| THOMAS JEFFERSON UNIVERSITY HOSPITAL OutpatientFacility | PA Health_Wellness CHC | JCC001 JCC002 CHC | $26.00 | — | — | 2026-03-18 | MRF ↗ |
| JEFFERSON LANSDALE HOSPITAL OutpatientFacility | PA Health_Wellness CHC | JAB002 CHC | $26.00 | — | — | 2026-03-18 | MRF ↗ |
| JEFFERSON HEALTH- NORTHEAST OutpatientFacility | PA Health_Wellness CHC | JNE001_JNE002_JNE003 CHC | $26.00 | — | — | 2026-03-18 | MRF ↗ |
| JEFFERSON STRATFORD HOSPITAL OutpatientFacility | PA Health_Wellness CHC | JNJ001_JNJ002_JNJ003 CHC | $26.00 | — | — | 2026-03-18 | MRF ↗ |
| JEFFERSON STRATFORD HOSPITAL OutpatientFacility | PA Health_Wellness CHC | JNJ001_JNJ002_JNJ003 CHC | $26.00 | — | — | 2026-03-18 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - POCONO Outpatient | AETNA | MANAGED MEDICAID | $26.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - DICKSON CITY Outpatient | AETNA | MANAGED MEDICAID | $26.00 | — | — | 2025-08-01 | MRF ↗ |
| JEFFERSON HEALTH- NORTHEAST OutpatientFacility | PA Health_Wellness CHC | JNE001_JNE002_JNE003 CHC | $26.00 | — | — | 2026-03-18 | MRF ↗ |
| Jefferson Methodist Hospital OutpatientFacility | PA Health_Wellness CHC | JCC001 JCC002 CHC | $26.00 | — | — | 2026-03-18 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS OutpatientFacility | UPMC For You | Managed Medicaid | $26.00 | — | — | 2024-12-31 | MRF ↗ |
| Magee Rehabilitation Hospital OutpatientFacility | Magee PA Health_Wellness | Medicaid | $26.00 | — | — | 2026-03-18 | MRF ↗ |
| JEFFERSON ABINGTON HOSPITAL OutpatientFacility | PA Health_Wellness CHC | JAB001 CHC | $26.00 | — | — | 2026-03-18 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $26.40 | $455.00 | $100.10 | 2026-04-14 | MRF ↗ |
| ALLEGHENY GENERAL HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $26.40 | — | — | 2026-04-14 | MRF ↗ |
| WESTFIELD MEMORIAL HOSPITAL, INC Outpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $26.40 | $455.00 | $100.10 | 2026-04-14 | MRF ↗ |
| CANONSBURG GENERAL HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $26.40 | — | — | 2026-04-14 | MRF ↗ |
| JEFFERSON HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $26.40 | — | — | 2026-04-14 | MRF ↗ |
| WEST PENN HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $26.40 | — | — | 2026-04-14 | MRF ↗ |
| GROVE CITY MEDICAL CENTER Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $26.40 | — | — | 2026-04-14 | MRF ↗ |
| ALLEGHENY VALLEY HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $26.40 | — | — | 2026-04-14 | MRF ↗ |
| SAINT VINCENT HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $26.40 | — | — | 2026-04-14 | MRF ↗ |
| AHN WEXFORD HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $26.40 | — | — | 2026-04-14 | MRF ↗ |
| FORBES HOSPITAL Inpatient | Pennsylvania Health and Wellness | PA Health and Wellness Medicaid CHC | $26.40 | — | — | 2026-04-14 | MRF ↗ |
| Magee Rehabilitation Hospital OutpatientFacility | Magee Aetna Better Health | CHIP | $26.42 | — | — | 2026-03-18 | MRF ↗ |
| UPMC PINNACLE HOSPITALS OutpatientFacility | AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $27.00 | — | — | 2026-03-06 | MRF ↗ |
| CHP-LVHN JV, LLC d/b/a Lehigh Valley Hospital - Gilbertsville Outpatient | JEFFERSON HEALTH PARTNERS | MANAGED MEDICAID | $27.00 | — | — | 2025-08-01 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS OutpatientFacility | Keystone First Community Health Choices | Dual Plan Managed Medicaid | $27.00 | — | — | 2024-12-31 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - HAZLETON Outpatient | JEFFERSON HEALTH PARTNERS | MANAGED MEDICAID | $27.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - HAZLETON Outpatient | PA HEALTH & WELLNESS | MANAGED MEDICAID | $27.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - POCONO Outpatient | JEFFERSON HEALTH PARTNERS | MANAGED MEDICAID | $27.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - POCONO Outpatient | PA HEALTH & WELLNESS | MANAGED MEDICAID | $27.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - DICKSON CITY Outpatient | JEFFERSON HEALTH PARTNERS | MANAGED MEDICAID | $27.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL Outpatient | PA HEALTH & WELLNESS | MANAGED MEDICAID | $27.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL - DICKSON CITY Outpatient | PA HEALTH & WELLNESS | MANAGED MEDICAID | $27.00 | — | — | 2025-08-01 | MRF ↗ |
| LEHIGH VALLEY HOSPITAL Outpatient | JEFFERSON HEALTH PARTNERS | MANAGED MEDICAID | $27.00 | — | — | 2025-08-01 | MRF ↗ |
Showing the first 200 rate rows. The CSV export above returns up to 1,000 rows — filter by state to narrow a code with more than that.