4301150 — Sulfamethoxazole-tmp Ds Tablet
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). SULFAMETHOXAZOLE-TMP DS TABLET (CDM 4301150) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/4301150?code_type=CDM
MLA (9th ed.)
“SULFAMETHOXAZOLE-TMP DS TABLET (CDM 4301150) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/4301150?code_type=CDM. Accessed .
Chicago (notes-bibliography)
“SULFAMETHOXAZOLE-TMP DS TABLET (CDM 4301150) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/4301150?code_type=CDM.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $1–$1 (25th–75th percentile) across 3 hospitals · 42 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CDM 4301150 — 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 |
|---|---|---|---|---|---|---|---|
| WOOSTER COMMUNITY HOSPITAL Outpatient | UHC MCAID | UHC MCAID | $0.40 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | CARESOURCE MCAID | CARESOURCE MCAID | $0.40 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | BUCKEYE MCAID-ALL OTHER PLANS | BUCKEYE MCAID-ALL OTHER PLANS | $0.40 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | UHC MCAID | UHC MCAID | $0.40 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | CARESOURCE MCAID | CARESOURCE MCAID | $0.40 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | BUCKEYE MCAID-ALL OTHER PLANS | BUCKEYE MCAID-ALL OTHER PLANS | $0.40 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | MOLINA MCAID | MOLINA MCAID | $0.41 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | MOLINA MCAID | MOLINA MCAID | $0.41 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AMERIHEALTH MCAID-ALL PLANS | AMERIHEALTH MCAID-ALL PLANS | $0.42 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AETNA MCAID | AETNA MCAID | $0.42 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AMERIHEALTH MCAID-ALL PLANS | AMERIHEALTH MCAID-ALL PLANS | $0.42 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | ANTHEM MCAID | ANTHEM MCAID | $0.42 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | ANTHEM MCAID | ANTHEM MCAID | $0.42 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AETNA MCAID | AETNA MCAID | $0.42 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AETNA MCR ADV | AETNA MCR ADV | $0.53 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AETNA MCR ADV | AETNA MCR ADV | $0.53 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AULTCARE/PRIMECARE MCR ADV | AULTCARE/PRIMECARE MCR ADV | $0.64 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AULTCARE/PRIMECARE MCR ADV | AULTCARE/PRIMECARE MCR ADV | $0.64 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | CLARITY HEALTH - ALL PLANS | CLARITY HEALTH - ALL PLANS | $0.65 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | CLARITY HEALTH - ALL PLANS | CLARITY HEALTH - ALL PLANS | $0.65 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | CERCO-ALL PLANS | CERCO-ALL PLANS | $0.91 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | CERCO-ALL PLANS | CERCO-ALL PLANS | $0.91 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AULTCARE WAYNE COUNTY | AULTCARE WAYNE COUNTY | $0.98 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AULTCARE/PRIMETIME EXCH | AULTCARE/PRIMETIME EXCH | $0.98 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AULTCARE WAYNE COUNTY | AULTCARE WAYNE COUNTY | $0.98 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | RAYCO-ALL PLANS | RAYCO-ALL PLANS | $0.98 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | RAYCO-ALL PLANS | RAYCO-ALL PLANS | $0.98 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AULTCARE/PRIMETIME EXCH | AULTCARE/PRIMETIME EXCH | $0.98 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AETNA EMPLOYEE | AETNA EMPLOYEE | $0.99 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AETNA EMPLOYEE | AETNA EMPLOYEE | $0.99 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTH OHIO NETWORK EMPLOYER | HEALTH OHIO NETWORK EMPLOYER | $1.04 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | CHRISTIAN HEALTH MINISTRIES-ALL PLANS | CHRISTIAN HEALTH MINISTRIES-ALL PLANS | $1.04 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | WAYNE COUNTY-ALL PLANS | WAYNE COUNTY-ALL PLANS | $1.04 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | CIGNA-ALL OTHER PLANS | CIGNA-ALL OTHER PLANS | $1.04 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTH OHIO NETWORK EMPLOYER | HEALTH OHIO NETWORK EMPLOYER | $1.04 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | CIGNA-ALL OTHER PLANS | CIGNA-ALL OTHER PLANS | $1.04 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | CHRISTIAN HEALTH MINISTRIES-ALL PLANS | CHRISTIAN HEALTH MINISTRIES-ALL PLANS | $1.04 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | WAYNE COUNTY-ALL PLANS | WAYNE COUNTY-ALL PLANS | $1.04 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTHSMART ACCEL | HEALTHSMART ACCEL | $1.08 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTHSMART ACCEL | HEALTHSMART ACCEL | $1.08 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | SUMMACARE PREFERRED CHOICE | SUMMACARE PREFERRED CHOICE | $1.08 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | SUMMACARE PREFERRED CHOICE | SUMMACARE PREFERRED CHOICE | $1.08 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTHSMART COMPLETE PPO-ALL OTHER PLANS | HEALTHSMART COMPLETE PPO-ALL OTHER PLANS | $1.11 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTH OHIO NETWORK PPO-ALL OTHER PLANS | HEALTH OHIO NETWORK PPO-ALL OTHER PLANS | $1.11 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | ANTHEM PPO/HMO/HIX | ANTHEM PPO/HMO/HIX | $1.11 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | ANTHEM PPO/HMO/HIX | ANTHEM PPO/HMO/HIX | $1.11 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | OHIO HEALTH GROUP HLTHY - ALL OTHER PLANS | OHIO HEALTH GROUP HLTHY - ALL OTHER PLANS | $1.11 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | OHIO HEALTH CHOICE SUPP | OHIO HEALTH CHOICE SUPP | $1.11 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTH OHIO NETWORK PPO-ALL OTHER PLANS | HEALTH OHIO NETWORK PPO-ALL OTHER PLANS | $1.11 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTHSMART COMPLETE PPO-ALL OTHER PLANS | HEALTHSMART COMPLETE PPO-ALL OTHER PLANS | $1.11 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | OHIO HEALTH GROUP HLTHY - ALL OTHER PLANS | OHIO HEALTH GROUP HLTHY - ALL OTHER PLANS | $1.11 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | OHIO HEALTH CHOICE SUPP | OHIO HEALTH CHOICE SUPP | $1.11 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | MED MUTUAL OF OH TRAD-ALL OTHER PLANS | MED MUTUAL OF OH TRAD-ALL OTHER PLANS | $1.12 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | MED MUTUAL OF OH TRAD-ALL OTHER PLANS | MED MUTUAL OF OH TRAD-ALL OTHER PLANS | $1.12 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | MED MUTUAL OF OH SUPERMED | MED MUTUAL OF OH SUPERMED | $1.12 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | MED MUTUAL OF OH EXCHANGE | MED MUTUAL OF OH EXCHANGE | $1.12 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | MED MUTUAL OF OH SUPERMED | MED MUTUAL OF OH SUPERMED | $1.12 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | MED MUTUAL OF OH EXCHANGE | MED MUTUAL OF OH EXCHANGE | $1.12 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTH PLAN OF UPPER OHIO-ALL PLANS | HEALTH PLAN OF UPPER OHIO-ALL PLANS | $1.15 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTH PLAN OF UPPER OHIO-ALL PLANS | HEALTH PLAN OF UPPER OHIO-ALL PLANS | $1.15 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | THE HEALTH PLAN COMM - ALL OTHER PLANS | THE HEALTH PLAN COMM - ALL OTHER PLANS | $1.15 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | THE HEALTH PLAN COMM - ALL OTHER PLANS | THE HEALTH PLAN COMM - ALL OTHER PLANS | $1.15 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AETNA COVENTRY-ALL OTHER PLANS | AETNA COVENTRY-ALL OTHER PLANS | $1.16 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AETNA COVENTRY-ALL OTHER PLANS | AETNA COVENTRY-ALL OTHER PLANS | $1.16 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | OHIO HEALTH GROUP PREF | OHIO HEALTH GROUP PREF | $1.16 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | OHIO HEALTH GROUP PREF | OHIO HEALTH GROUP PREF | $1.16 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AULTCARE/PRIMETIME-ALL OTHER PLANS | AULTCARE/PRIMETIME-ALL OTHER PLANS | $1.17 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | AULTCARE/PRIMETIME-ALL OTHER PLANS | AULTCARE/PRIMETIME-ALL OTHER PLANS | $1.17 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTHSMART PPO | HEALTHSMART PPO | $1.18 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTHSMART PPO | HEALTHSMART PPO | $1.18 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | ANTHEM TRAD-ALL OTHER PLANS | ANTHEM TRAD-ALL OTHER PLANS | $1.20 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | ANTHEM TRAD-ALL OTHER PLANS | ANTHEM TRAD-ALL OTHER PLANS | $1.20 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | SUMMACARE-ALL OTHER PLANS | SUMMACARE-ALL OTHER PLANS | $1.21 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | SUMMACARE-ALL OTHER PLANS | SUMMACARE-ALL OTHER PLANS | $1.21 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | OHIO HEALTH CHOICE-ALL OTHER PLANS | OHIO HEALTH CHOICE-ALL OTHER PLANS | $1.22 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | OHIO HEALTH CHOICE-ALL OTHER PLANS | OHIO HEALTH CHOICE-ALL OTHER PLANS | $1.22 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HUMANA-ALL OTHER PLANS | HUMANA-ALL OTHER PLANS | $1.22 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HUMANA-ALL OTHER PLANS | HUMANA-ALL OTHER PLANS | $1.22 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | OSU-ALL PLANS | OSU-ALL PLANS | $1.24 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | OSU-ALL PLANS | OSU-ALL PLANS | $1.24 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTHSMART HPO | HEALTHSMART HPO | $1.24 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | UHC COMM-ALL OTHER PLANS | UHC COMM-ALL OTHER PLANS | $1.24 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | UHC COMM-ALL OTHER PLANS | UHC COMM-ALL OTHER PLANS | $1.24 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | HEALTHSMART HPO | HEALTHSMART HPO | $1.24 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | CENTRAL BENEFITS-ALL PLANS | CENTRAL BENEFITS-ALL PLANS | $1.25 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | FLORA-ALL PLANS | FLORA-ALL PLANS | $1.25 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | CENTRAL BENEFITS-ALL PLANS | CENTRAL BENEFITS-ALL PLANS | $1.25 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | FIRST HEALTH-ALL PLANS | FIRST HEALTH-ALL PLANS | $1.25 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | FLORA-ALL PLANS | FLORA-ALL PLANS | $1.25 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | FIRST HEALTH-ALL PLANS | FIRST HEALTH-ALL PLANS | $1.25 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | PHCS-ALL PLANS | PHCS-ALL PLANS | $1.26 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | BEECH STREET-ALL PLANS | BEECH STREET-ALL PLANS | $1.26 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | PHCS-ALL PLANS | PHCS-ALL PLANS | $1.26 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | BEECH STREET-ALL PLANS | BEECH STREET-ALL PLANS | $1.26 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | OPTUM VA CCN OP ONLY | OPTUM VA CCN OP ONLY | $1.30 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| WOOSTER COMMUNITY HOSPITAL Outpatient | OPTUM VA CCN OP ONLY | OPTUM VA CCN OP ONLY | $1.30 | $1.30 | $1.30 | 2026-01-21 | MRF ↗ |
| GOTHENBURG HEALTH Outpatient | United Healthcare | Veterans Affair Community Care | $15.00 | $25.00 | $23.00 | 2025-06-11 | MRF ↗ |
| GOTHENBURG HEALTH Outpatient | Aetna | Medicare Advantage | $16.00 | $25.00 | $23.00 | 2025-06-11 | MRF ↗ |
| GOTHENBURG HEALTH Outpatient | Blue Cross Blue Shield | Medicare Advantage | $16.00 | $25.00 | $23.00 | 2025-06-11 | MRF ↗ |
| GOTHENBURG HEALTH Outpatient | Nebraska Total Care | Commercial | $23.00 | $25.00 | $23.00 | 2025-06-11 | MRF ↗ |
| GOTHENBURG HEALTH Outpatient | Blue Cross Blue Shield | Commercial | $24.00 | $25.00 | $23.00 | 2025-06-11 | MRF ↗ |
| GOTHENBURG HEALTH Outpatient | Aetna | Commercial | $24.00 | $25.00 | $23.00 | 2025-06-11 | MRF ↗ |
| PAWNEE COUNTY MEMORIAL HOSPITAL Both | Blue Cross Blue Shield | Medicare Advantage | $2,745.00 | $3,978.00 | $3,182.00 | 2026-05-22 | MRF ↗ |
| PAWNEE COUNTY MEMORIAL HOSPITAL Both | United Healthcare | Medicare Advantage | $2,745.00 | $3,978.00 | $3,182.00 | 2026-05-22 | MRF ↗ |
| PAWNEE COUNTY MEMORIAL HOSPITAL Both | Medica Choice | Medicare Advantage | $2,745.00 | $3,978.00 | $3,182.00 | 2026-05-22 | MRF ↗ |
| PAWNEE COUNTY MEMORIAL HOSPITAL Both | Aetna | Medicare Advantage | $2,745.00 | $3,978.00 | $3,182.00 | 2026-05-22 | MRF ↗ |
| PAWNEE COUNTY MEMORIAL HOSPITAL Both | Medica Choice | Commercial | $3,620.00 | $3,978.00 | $3,182.00 | 2026-05-22 | MRF ↗ |
| PAWNEE COUNTY MEMORIAL HOSPITAL Both | Ambetter | Commercial | $3,700.00 | $3,978.00 | $3,182.00 | 2026-05-22 | MRF ↗ |
| PAWNEE COUNTY MEMORIAL HOSPITAL Both | Aetna | Commercial | $3,739.00 | $3,978.00 | $3,182.00 | 2026-05-22 | MRF ↗ |
| PAWNEE COUNTY MEMORIAL HOSPITAL Both | United Healthcare | Commercial | $3,779.00 | $3,978.00 | $3,182.00 | 2026-05-22 | MRF ↗ |
| PAWNEE COUNTY MEMORIAL HOSPITAL Both | Blue Cross Blue Shield | Commercial | $3,779.00 | $3,978.00 | $3,182.00 | 2026-05-22 | MRF ↗ |
| PAWNEE COUNTY MEMORIAL HOSPITAL Both | Medica IFB | Commercial | $3,819.00 | $3,978.00 | $3,182.00 | 2026-05-22 | MRF ↗ |
| PAWNEE COUNTY MEMORIAL HOSPITAL Both | Midlands Choice | Commercial | $3,819.00 | $3,978.00 | $3,182.00 | 2026-05-22 | MRF ↗ |