43213 — Esophagoscopy Retro Balloon
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). ESOPHAGOSCOPY RETRO BALLOON (CPT 43213) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/43213?code_type=CPT
MLA (9th ed.)
“ESOPHAGOSCOPY RETRO BALLOON (CPT 43213) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/43213?code_type=CPT. Accessed .
Chicago (notes-bibliography)
“ESOPHAGOSCOPY RETRO BALLOON (CPT 43213) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/43213?code_type=CPT.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $1,541–$3,295 (25th–75th percentile) across 1,625 hospitals · 3,602 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CPT/HCPCS 43213 — 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 physician and sedation fees are estimated from the Medicare fee schedule scaled to commercial rates — not facility-specific quotes.
What hospitals actually negotiate
Measured
$1,541
$2,201 typical
$3,295
The middle 50% of negotiated facility rates for this procedure, measured across 1,625 hospitals. The physician and sedation 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. | $2,201 |
| Endoscopist (professional fee) Estimate national typical Medicare $225 × 1.22 commercial. | $275 |
| Anesthesia Estimate national typical Generic anesthesia (~30 min typical, median CMS base units). Medicare $123 × 3.14 commercial. Approximate — no procedure-specific anesthesia mapping for this code. | $386 |
| Likely subtotal | $2,862 |
Complete-episode estimate (typical)
~$2,862
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)
~$6,647
- 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)
- Endoscopist (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 — 4 base units (typical CMS value) × ~30 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 |
|---|---|---|---|---|---|---|---|
| CHI Memorial Hospital - Hixson Outpatient | Alliant Health | Commercial|All Plans | $0.65 | — | — | 2026-02-28 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Health Alliance | Public Exchange | — | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Blue Cross Blue Shield | Ppo | — | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Oscar Health | Exchange | $3.31 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Blue Cross Blue Shield | Blue Precision Hmo | — | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Multiplan | Ppo | — | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Joliet | Hmo | — | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Professional Benefits Administrator | Ppo | — | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Blue Cross Blue Shield | Blue Choice | — | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Zelis | Workers Comp | — | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Blue Cross Blue Shield | Hmo Illinois | — | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Union Medical | Hmo | — | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Health Alliance | Commercial | — | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Corvel | Workers Comp | — | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Humana | Medicare | $4.60 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Essential Health Partners | Hmo | $4.60 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | United Healthcare | Medicare | $4.60 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Blue Cross Blue Shield | Medicare | $4.60 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Aetna | Medicare | $4.60 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Essential Health Partners | Medicare | $4.60 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Devoted Healthcare | Medicare | $4.60 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Cigna | Medicare | $4.69 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Meridian | Medicare (Wellcare) | $4.74 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Meridian | Exchange (Ambetter) | $5.52 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| MONMOUTH MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $6.99 | $3,886.00 | $1,912.13 | 2024-12-31 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Aetna | Commercial | $7.46 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| ADVENTIST HEALTH REEDLEY Outpatient | DIGNITY MCR ADV OP/PROFEE ONLY | DIGNITY MCR ADV OP/PROFEE ONLY | $7.48 | $635.00 | $120.65 | 2026-01-25 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Hst Technologies | Epo, Ppo | $8.83 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | United Healthcare | Navigate, Core, Charter, Aco Tiered | $11.50 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | United Healthcare | All Other Plans | $12.78 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Cigna | Local Plus | $13.05 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Cigna | Hmo, Ppo, Pos | $13.05 | $20.00 | $7.00 | 2026-05-08 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | Covered California/IFP/PPO | $26.93 | — | — | 2026-03-18 | MRF ↗ |
| Southern California Hospital At Culver City OutpatientFacility | Blue Shield of California | Covered California/IFP/PPO | $27.10 | — | — | 2026-03-18 | MRF ↗ |
| SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD OutpatientFacility | Blue Shield of California | Covered California/IFP/PPO | $27.10 | — | — | 2026-03-18 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | BCBS-SC | BCBSSCBlueChoice | $28.70 | — | — | 2024-12-08 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | HMO | $30.86 | — | — | 2026-03-18 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | BCBS-SC | BCBSSCPreferredBlue | $30.90 | — | — | 2024-12-08 | MRF ↗ |
| Southern California Hospital At Culver City OutpatientFacility | Blue Shield of California | HMO | $31.05 | — | — | 2026-03-18 | MRF ↗ |
| SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD OutpatientFacility | Blue Shield of California | HMO | $31.05 | — | — | 2026-03-18 | 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 ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $33.60 | — | — | 2026-03-18 | MRF ↗ |
| SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $33.81 | — | — | 2026-03-18 | MRF ↗ |
| Southern California Hospital At Culver City OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $33.81 | — | — | 2026-03-18 | 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 ↗ |
| WEST CARROLL MEMORIAL HOSPITAL Inpatient | AMBETTER | AMBETTER | $37.20 | $2,178.00 | — | 2026-03-26 | MRF ↗ |
| WEST CARROLL MEMORIAL HOSPITAL Inpatient | AMBETTER | AMBETTER | $37.20 | $2,178.00 | — | 2026-03-26 | MRF ↗ |
| ALBANY MEDICAL CENTER HOSPITAL OutpatientFacility | MagnaCare | All Products | $42.95 | — | — | 2025-12-31 | MRF ↗ |
| ADVENTIST HEALTH TILLAMOOK Outpatient | PACIFICSOURCE - ALL PLANS | PACIFICSOURCE - ALL PLANS | $48.00 | $983.00 | $530.82 | 2026-01-31 | 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 ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCState | $50.00 | — | — | 2024-12-08 | MRF ↗ |
| WEST CARROLL MEMORIAL HOSPITAL Inpatient | UNITEDHEALTHCARE OF LOUISIANA INC | UNITEDHEALTHCARE OF LOUISIANA INC | $60.76 | $2,178.00 | — | 2026-03-26 | MRF ↗ |
| WEST CARROLL MEMORIAL HOSPITAL Inpatient | UNITEDHEALTHCARE OF LOUISIANA INC | UNITEDHEALTHCARE OF LOUISIANA INC | $60.76 | $2,178.00 | — | 2026-03-26 | MRF ↗ |
| LAKESIDE MEDICAL CENTER OutpatientFacility | UHC | Managed Medicaid | $66.88 | $4,450.00 | $1,904.16 | 2025-12-02 | MRF ↗ |
| LAKESIDE MEDICAL CENTER OutpatientFacility | UHC | CHIP | $66.88 | $4,450.00 | $1,904.16 | 2025-12-02 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM HEALTHSYNC HMO | 9227_ANTHEM HEALTHSYNC HMO VCIN 20250101 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM HEALTHSYNC POS | 9228_ANTHEM HEALTHSYNC POS VCIN 20250101 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM PATHWAY | 9230_ANTHEM PATHWAY VCIN 20250101 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM PPO PREFERRED | 9232_ANTHEM PREFERRED VCIN 20250101 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM HMO/POS | 9229_ANTHEM HMO POS VCIN 20250101 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Inpatient | SMARTHEALTH PPO | 8842_SMARTHEALTH PPO 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM TRADITIONAL | 9233_ANTHEM TRADITIONAL VCIN 20250101 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM PATHWAY X | 9231_ANTHEM PATHWAY X VCIN 20250101 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Outpatient | UNIFIED GROUP SERVICES | 8813_ANTHEM UNIFIED GROUPS VKIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | ANTHEM SHORT TERM LIMITED DURATION | 9361_ANTHEM SHORT TERM LIMITED DURATION VCIN 20250101 | — | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $76.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Outpatient | UNIFIED GROUP SERVICES | 8811_ANTHEM UNIFIED GROUPS VCIN ECIN ASIN 20241001 | — | — | — | 2026-01-01 | MRF ↗ |
| HURON VALLEY-SINAI HOSPITAL Outpatient | Hap | HAPHMO | $93.00 | — | — | 2025-01-31 | MRF ↗ |
| Harper University Hospital Outpatient | Hap | HAPHMO | $93.00 | — | — | 2025-01-31 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | UHC | 9384_UNITED HEALTHCARE CLIN 20250101 | $102.78 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | UHC | 9393_UNITED HEALTHCARE VKIN 20250101 | $102.78 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC | 9395_UNITED HEALTHCARE VRIN 20250101 | $102.78 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | UHC | 9390_UNITED HEALTHCARE VAIN 20250101 | $102.78 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC | 9395_UNITED HEALTHCARE VRIN 20250101 | $102.78 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Inpatient | UHC BEHAVIORAL HEALTH | 8231_UNITED HEALTH CARE BEHAVIORAL HEALTH 20230401 | $102.78 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Outpatient | UHC NEW | 6787_UNITED HEALTHCARE NEW BUSINESS OUTPATIENT NRIN 20230101 | $102.78 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Outpatient | UHC | 8493_UNITED HEALTHCARE SWIN 20240701 | $102.78 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | UHC NEW | 6793_UNITED HEALTHCARE NEW BUSINESS OUTPATIENT ECIN 20230101 | $102.78 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Outpatient | UHC SELF | 6788_UNITED HEALTHCARE SELF FUNDED OUTPATIENT NRIN 20230101 | $102.78 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | UHC | 9397_UNITED HEALTHCARE VWIN 20250101 | $102.78 | — | — | 2026-01-01 | MRF ↗ |
| Rehabilitation Institute Of Michigan Outpatient | Hap | HAPHMO | $104.79 | — | — | 2025-01-31 | MRF ↗ |
| HIGHLAND HOSPITAL Both | EXCELLUS BC/BS MEDICAID [1706], EXCELLUS BC/BS [2201] | BLUE CHOICE OPTION MEDICAID [170601], EXCELLUS CHILD HEALTH PLUS [220108],EXCELLUS HEALTHY NY [220110], EXCELLUS ESSENTIAL (NO MEDICAID) [220109], EXCELLUS ESSENTIAL (W/ MEDICAID) [170604], UNIVERA HEALTHY NY [220112], UNIVERA ESSENTIAL (NO MEDICAID) [220 | $127.07 | — | — | 2026-04-01 | MRF ↗ |
| STRONG MEMORIAL HOSPITAL Both | EXCELLUS BC/BS MEDICAID [1706], EXCELLUS BC/BS [2201] | BLUE CHOICE OPTION MEDICAID [170601], EXCELLUS CHILD HEALTH PLUS [220108],EXCELLUS HEALTHY NY [220110], EXCELLUS ESSENTIAL (NO MEDICAID) [220109], EXCELLUS ESSENTIAL (W/ MEDICAID) [170604], UNIVERA HEALTHY NY [220112], UNIVERA ESSENTIAL (NO MEDICAID) [220 | $127.07 | — | — | 2026-04-01 | MRF ↗ |
| HENRY FORD ALLEGIANCE HEALTH OutpatientFacility | HAP CareSource | MEDICAID | $129.73 | $3,278.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD ALLEGIANCE HEALTH OutpatientFacility | Priority Health | MEDICAID | $129.73 | $3,278.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD ALLEGIANCE HEALTH OutpatientFacility | McLaren | MEDICAID | $129.73 | $3,278.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD ALLEGIANCE HEALTH OutpatientFacility | Meridian Health Plan of MI | MEDICAID HMO | $129.73 | $3,278.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD ALLEGIANCE HEALTH OutpatientFacility | Blue Cross Complete | MEDICAID | $129.73 | $3,278.00 | — | 2025-06-28 | MRF ↗ |
| ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL OutpatientFacility | Wellpoint | NJ Family Care | $132.85 | — | — | 2026-03-04 | MRF ↗ |
| JEFFERSON STRATFORD HOSPITAL OutpatientFacility | Horizon NJ Health NJ | Medicaid | $135.80 | — | — | 2026-03-18 | MRF ↗ |
| JEFFERSON STRATFORD HOSPITAL OutpatientFacility | Horizon NJ Health NJ | Medicaid | $135.80 | — | — | 2026-03-18 | MRF ↗ |
| JEFFERSON STRATFORD HOSPITAL OutpatientFacility | Horizon NJ Health NJ | Medicaid | $135.80 | — | — | 2026-03-18 | MRF ↗ |
| HENRY FORD ALLEGIANCE HEALTH OutpatientFacility | Aetna Better Health | MEDICAID | $136.22 | $3,278.00 | — | 2025-06-28 | MRF ↗ |
| CAREWELL HEALTH MEDICAL CENTER OutpatientFacility | Horizon New Jersey Health | Managed Medicaid | $138.18 | — | — | 2025-06-17 | MRF ↗ |
| WYANDOTTE HOSPITAL AND MEDICAL CENTER OutpatientFacility | Meridian Health Plan of MI | MEDICAID HMO | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| Henry Ford Hospital OutpatientFacility | Meridian Health Plan of MI | MEDICAID HMO | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| Henry Ford Hospital OutpatientFacility | Priority Health | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD MACOMB HOSPITAL OutpatientFacility | Aetna Better Health | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD MACOMB HOSPITAL OutpatientFacility | Priority Health | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD MACOMB HOSPITAL OutpatientFacility | McLaren | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD MACOMB HOSPITAL OutpatientFacility | Meridian Health Plan of MI | MEDICAID HMO | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| WYANDOTTE HOSPITAL AND MEDICAL CENTER OutpatientFacility | McLaren | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| WYANDOTTE HOSPITAL AND MEDICAL CENTER OutpatientFacility | Priority Health | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| Henry Ford Hospital OutpatientFacility | Aetna Better Health | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| WYANDOTTE HOSPITAL AND MEDICAL CENTER OutpatientFacility | Aetna Better Health | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| WYANDOTTE HOSPITAL AND MEDICAL CENTER OutpatientFacility | HAP | HAP Caresource Medicaid | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| Henry Ford Hospital OutpatientFacility | McLaren | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD HEALTH WEST BLOOMFIELD HOSPITAL OutpatientFacility | Blue Cross Complete | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| Henry Ford Hospital OutpatientFacility | HAP | HAP Caresource Medicaid | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD HEALTH WEST BLOOMFIELD HOSPITAL OutpatientFacility | McLaren | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD HEALTH WEST BLOOMFIELD HOSPITAL OutpatientFacility | Meridian Health Plan of MI | MEDICAID HMO | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD MACOMB HOSPITAL OutpatientFacility | HAP | HAP Caresource Medicaid | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD MACOMB HOSPITAL OutpatientFacility | Blue Cross Complete | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD HEALTH WEST BLOOMFIELD HOSPITAL OutpatientFacility | HAP | HAP Caresource Medicaid | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD HEALTH WEST BLOOMFIELD HOSPITAL OutpatientFacility | Aetna Better Health | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| HENRY FORD HEALTH WEST BLOOMFIELD HOSPITAL OutpatientFacility | Priority Health | MEDICAID | $141.58 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| ALTRU HOSPITAL OutpatientFacility | Medica | Medicaid Managed Care Plan | $147.84 | — | — | 2026-03-01 | MRF ↗ |
| ALTRU HOSPITAL OutpatientFacility | Medica | Medicaid Managed Care Plan – Hmo | $147.84 | — | — | 2026-03-01 | MRF ↗ |
| HIGHLAND HOSPITAL Both | EXCELLUS BC/BS MEDICAID [1706], EXCELLUS BC/BS [2201] | BLUE CHOICE OPTION MEDICAID [170601], EXCELLUS CHILD HEALTH PLUS [220108],EXCELLUS HEALTHY NY [220110], EXCELLUS ESSENTIAL (NO MEDICAID) [220109], EXCELLUS ESSENTIAL (W/ MEDICAID) [170604], UNIVERA HEALTHY NY [220112], UNIVERA ESSENTIAL (NO MEDICAID) [220 | $149.49 | — | — | 2026-04-01 | MRF ↗ |
| Memorial Hospital For Cancer And Allied Diseases Both | [EMBLEM] | [HIP_ESS_1_2_MR/DD/TBI Pts] | $149.49 | $2,600.00 | $2,600.00 | 2024-09-15 | MRF ↗ |
| Memorial Hospital For Cancer And Allied Diseases Both | [EMBLEM] | [HIP_ESS_3_4_MR/DD/TBI Pts] | $149.49 | $2,600.00 | $2,600.00 | 2024-09-15 | MRF ↗ |
| STRONG MEMORIAL HOSPITAL Both | EXCELLUS BC/BS MEDICAID [1706], EXCELLUS BC/BS [2201] | BLUE CHOICE OPTION MEDICAID [170601], EXCELLUS CHILD HEALTH PLUS [220108],EXCELLUS HEALTHY NY [220110], EXCELLUS ESSENTIAL (NO MEDICAID) [220109], EXCELLUS ESSENTIAL (W/ MEDICAID) [170604], UNIVERA HEALTHY NY [220112], UNIVERA ESSENTIAL (NO MEDICAID) [220 | $149.49 | — | — | 2026-04-01 | MRF ↗ |
| Memorial Hospital For Cancer And Allied Diseases Both | [EMBLEM] | [HIP_ESS_1_2_HOSP_OP_DEPT] | $149.49 | $2,600.00 | $2,600.00 | 2024-09-15 | MRF ↗ |
| Memorial Hospital For Cancer And Allied Diseases Both | [EMBLEM] | [HIP_ESS_1_2_AMB_SURG] | $149.49 | $2,600.00 | $2,600.00 | 2024-09-15 | MRF ↗ |
| Memorial Hospital For Cancer And Allied Diseases Both | [EMBLEM] | [HIP_ESS_3_4_AMB_SURG] | $149.49 | $2,600.00 | $2,600.00 | 2024-09-15 | MRF ↗ |
| MONTEFIORE MEDICAL CENTER Both | New York Medicaid | Medicaid | $149.49 | $1,385.84 | $906.34 | 2026-04-01 | MRF ↗ |
| Memorial Hospital For Cancer And Allied Diseases Both | [EMBLEM] | [HIP_ESS_3_4_HOSP_OP_DEPT] | $149.49 | $2,600.00 | $2,600.00 | 2024-09-15 | MRF ↗ |
| Henry Ford Hospital OutpatientFacility | Blue Cross Complete | MEDICAID | $154.32 | $2,092.00 | — | 2025-06-28 | MRF ↗ |
| ADVENTIST HEALTH HANFORD Outpatient | UPN MCAL PROFEE | UPN MCAL PROFEE | $158.75 | $635.00 | $120.65 | 2026-01-25 | MRF ↗ |
| VANDERBILT WILSON COUNTY HOSPITAL Both | Wellpoint | Wellpoint Community Care TennCare Pediatric | $162.75 | $3,757.00 | $1,089.53 | 2025-10-01 | MRF ↗ |
| VANDERBILT TULLAHOMA-HARTON HOSPITAL Both | Wellpoint | Wellpoint Community Care TennCare Pediatric | $162.75 | $3,757.00 | $1,089.53 | 2025-10-01 | MRF ↗ |
| VANDERBILT BEDFORD HOSPITAL Both | Wellpoint | Wellpoint Community Care TennCare Adult | $162.75 | $3,757.00 | $1,089.53 | 2025-10-01 | MRF ↗ |
| VANDERBILT WILSON COUNTY HOSPITAL Both | Wellpoint | Wellpoint Community Care TennCare Adult | $162.75 | $3,757.00 | $1,089.53 | 2025-10-01 | MRF ↗ |
| VANDERBILT BEDFORD HOSPITAL Both | Wellpoint | Wellpoint Community Care TennCare Pediatric | $162.75 | $3,757.00 | $1,089.53 | 2025-10-01 | MRF ↗ |
| VANDERBILT TULLAHOMA-HARTON HOSPITAL Both | Wellpoint | Wellpoint Community Care TennCare Adult | $162.75 | $3,757.00 | $1,089.53 | 2025-10-01 | MRF ↗ |
| VANDERBILT UNIVERSITY MEDICAL CENTER Both | Wellpoint | Wellpoint Community Care TennCare Adult | $162.75 | $3,757.00 | $2,028.78 | 2025-10-01 | MRF ↗ |
| VANDERBILT UNIVERSITY MEDICAL CENTER Both | Wellpoint | Wellpoint Community Care TennCare Pediatric | $162.75 | $3,757.00 | $2,028.78 | 2025-10-01 | MRF ↗ |
| EAST CARROLL PARISH HOSPITAL Outpatient | UNITED CHICAGO TEACHER FUND-ALL PLANS | UNITED CHICAGO TEACHER FUND-ALL PLANS | $163.22 | $1,209.00 | $906.75 | 2026-01-16 | MRF ↗ |
| MCLAREN CENTRAL MICHIGAN Outpatient | Medicaid - United | Medicaid - United | $163.80 | $2,761.70 | $1,380.90 | 2025-12-31 | MRF ↗ |
| MCLAREN CARO REGION Outpatient | Traditional Medicaid HMO/PPO | Traditional Medicaid HMO/PPO | $163.80 | $2,761.70 | $1,380.90 | 2025-12-31 | MRF ↗ |
| MCLAREN LAPEER REGION Outpatient | Medicaid - United | Medicaid - United | $163.80 | $2,761.70 | $1,380.90 | 2025-12-31 | MRF ↗ |
| MCLAREN THUMB REGION Outpatient | Traditional Medicaid HMO/PPO | Traditional Medicaid HMO/PPO | $163.80 | $2,761.70 | $1,380.90 | 2025-12-31 | MRF ↗ |
| MCLAREN OAKLAND Outpatient | Medicaid - United | Medicaid - United | $163.80 | $2,761.70 | $1,380.90 | 2025-12-31 | MRF ↗ |
| MCLAREN FLINT Outpatient | Traditional Medicaid HMO/PPO | Traditional Medicaid HMO/PPO | $163.80 | $2,761.70 | $1,380.90 | 2025-12-31 | MRF ↗ |
| MCLAREN CARO REGION Outpatient | Medicaid - United | Medicaid - United | $163.80 | $2,761.70 | $1,380.90 | 2025-12-31 | MRF ↗ |
| MCLAREN THUMB REGION Outpatient | Medicaid - United | Medicaid - United | $163.80 | $2,761.70 | $1,380.90 | 2025-12-31 | MRF ↗ |
| MCLAREN FLINT Outpatient | Medicaid - United | Medicaid - United | $163.80 | $2,761.70 | $1,380.90 | 2025-12-31 | MRF ↗ |
| MCLAREN LAPEER REGION Outpatient | Traditional Medicaid HMO/PPO | Traditional Medicaid HMO/PPO | $163.80 | $2,761.70 | $1,380.90 | 2025-12-31 | MRF ↗ |
| MCLAREN PORT HURON Outpatient | Medicaid - United | Medicaid - United | $163.80 | $2,761.70 | $1,380.90 | 2025-12-31 | MRF ↗ |
| MCLAREN OAKLAND Outpatient | Medicaid - United | Medicaid - United | $163.80 | $2,761.70 | $1,380.90 | 2025-12-31 | MRF ↗ |
| MCLAREN BAY REGION Outpatient | Medicaid - United | Medicaid - United | $163.80 | $2,761.70 | $1,380.90 | 2025-12-31 | 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.