43274 — Ercp Duct Stent Placement
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). ERCP DUCT STENT PLACEMENT (HCPCS 43274) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/43274?code_type=HCPCS
MLA (9th ed.)
“ERCP DUCT STENT PLACEMENT (HCPCS 43274) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/43274?code_type=HCPCS. Accessed .
Chicago (notes-bibliography)
“ERCP DUCT STENT PLACEMENT (HCPCS 43274) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/43274?code_type=HCPCS.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $3,283–$8,116 (25th–75th percentile) across 1,919 hospitals · 5,309 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CPT/HCPCS 43274 — 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
$3,283
$5,993 typical
$8,116
The middle 50% of negotiated facility rates for this procedure, measured across 1,919 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. | $5,993 |
| Endoscopist (professional fee) Estimate national typical Medicare $402 × 1.22 commercial. | $491 |
| 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 | $6,869 |
Complete-episode estimate (typical)
~$6,869
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)
~$10,654
- 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 ↗ |
| O U MEDICAL CENTER Outpatient | Humana | Healthy Horizons Medicaid | — | $6,787.74 | $678.77 | 2026-05-22 | MRF ↗ |
| O U MEDICAL CENTER Outpatient | Humana | Healthy Horizons Medicaid | — | $6,787.74 | $678.77 | 2026-05-14 | MRF ↗ |
| O U MEDICAL CENTER Outpatient | Humana | Healthy Horizons Medicaid | — | $6,787.74 | $678.77 | 2026-05-06 | MRF ↗ |
| GROSSMONT HOSPITAL Outpatient | Aetna | First Health - Leased/CCN | $4.95 | $9,215.00 | $6,911.25 | 2026-04-01 | MRF ↗ |
| UMASS MEMORIAL MEDICAL CENTER/UNIVERSITY CAMPUS Outpatient | WELLSENSE MEDICAID [10901] | All WELLSENSE MEDICAID (FORMERLY BMC) UM [75] Plans | $7.20 | $39,728.24 | $39,728.24 | 2026-03-26 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Zelis | Workers Comp | — | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Professional Benefits Administrator | Ppo | — | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Corvel | Workers Comp | — | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Health Alliance | Commercial | — | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Blue Cross Blue Shield | Ppo | — | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Joliet | Hmo | — | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Blue Cross Blue Shield | Blue Precision Hmo | — | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Blue Cross Blue Shield | Blue Choice | — | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Union Medical | Hmo | — | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Multiplan | Ppo | — | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Oscar Health | Exchange | $8.32 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Health Alliance | Public Exchange | — | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Blue Cross Blue Shield | Hmo Illinois | — | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| UMASS MEMORIAL MEDICAL CENTER/UNIVERSITY CAMPUS Outpatient | GRANTS [20507] | All TB GETCHELL [226] Plans | $8.43 | $39,728.24 | $39,728.24 | 2026-03-26 | MRF ↗ |
| UMASS MEMORIAL MEDICAL CENTER/UNIVERSITY CAMPUS Outpatient | WELLSENSE MEDICAID [10901] | All WELLSENSE SPECIAL KIDS (FORMERLY BMC) UM [255] Plans | $9.00 | $39,728.24 | $39,728.24 | 2026-03-26 | MRF ↗ |
| SHARP CHULA VISTA MEDICAL CENTER Outpatient | Community Health Group | Community Health Group - Cal Mediconnect | $10.50 | $9,215.00 | $6,911.25 | 2026-04-01 | MRF ↗ |
| UMASS MEMORIAL HEALTH - HARRINGTON HOSPITAL Outpatient | WELLSENSE MEDICAID [10901] | All WELLSENSE MEDICAID (FORMERLY BMC) HR [40] Plans | $11.34 | $19,630.01 | $19,630.01 | 2026-04-03 | MRF ↗ |
| SHARP CHULA VISTA MEDICAL CENTER Outpatient | San Diego Pace | San Diego Pace | $11.53 | $9,215.00 | $6,911.25 | 2026-04-01 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Essential Health Partners | Hmo | $11.55 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Aetna | Medicare | $11.55 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Blue Cross Blue Shield | Medicare | $11.55 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Humana | Medicare | $11.55 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | United Healthcare | Medicare | $11.55 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Devoted Healthcare | Medicare | $11.55 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Essential Health Partners | Medicare | $11.55 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Cigna | Medicare | $11.78 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Meridian | Medicare (Wellcare) | $11.90 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| MONMOUTH MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $12.67 | $7,040.00 | $5,753.89 | 2024-12-31 | MRF ↗ |
| ADVENTIST HEALTH REEDLEY Outpatient | DIGNITY MCR ADV OP/PROFEE ONLY | DIGNITY MCR ADV OP/PROFEE ONLY | $13.36 | $1,137.00 | $216.03 | 2026-01-25 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Meridian | Exchange (Ambetter) | $13.86 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| PARKLAND HEALTH & HOSPITAL SYSTEM OutpatientFacility | WELLPOINT [1007] | ABOVE FPIL WELLPOINT CHIP PERINATE [100709] | $15.93 | $47,705.12 | $19,082.05 | 2026-05-29 | MRF ↗ |
| PARKLAND HEALTH & HOSPITAL SYSTEM OutpatientFacility | WELLPOINT [1007] | BELOW FPIL WELLPOINT CHIP PERINATE [100708] | $15.93 | $47,705.12 | $19,082.05 | 2026-05-29 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Aetna | Commercial | $18.72 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Hst Technologies | Epo, Ppo | $22.18 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | BCBS-SC | BCBSSCBlueChoice | $28.70 | — | — | 2024-12-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | United Healthcare | Navigate, Core, Charter, Aco Tiered | $28.87 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | BCBS-SC | BCBSSCPreferredBlue | $30.90 | — | — | 2024-12-08 | MRF ↗ |
| UMASS MEMORIAL MEDICAL CENTER/UNIVERSITY CAMPUS Outpatient | FALLON MEDICAID [10904] | All FALLON MCO UM [104] Plans | $31.84 | $60,974.22 | $60,974.22 | 2026-03-26 | MRF ↗ |
| UMASS MEMORIAL MEDICAL CENTER/UNIVERSITY CAMPUS Outpatient | MASSHEALTH [20302] | All MASSHEALTH UM [10] Plans | $31.84 | $60,974.22 | $60,974.22 | 2026-03-26 | MRF ↗ |
| UMASS MEMORIAL MEDICAL CENTER/UNIVERSITY CAMPUS Outpatient | FALLON MEDICAID [10904] | All FALLON ACO UM [130] Plans | $31.84 | $60,974.22 | $60,974.22 | 2026-03-26 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | United Healthcare | All Other Plans | $32.08 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCBlueChoice | $33.10 | — | — | 2024-12-08 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCPreferredBlue | $33.10 | — | — | 2024-12-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Cigna | Hmo, Ppo, Pos | $33.55 | $39.00 | $13.65 | 2026-05-08 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Both | Cigna | Local Plus | $33.55 | $39.00 | $13.65 | 2026-05-08 | 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 ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $38.20 | $10,325.00 | $9,808.75 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $38.20 | $10,325.00 | $9,808.75 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | UnitedHealth Group of WI | Medicare Advantage | $38.20 | $10,325.00 | $9,808.75 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $39.23 | $10,325.00 | $9,808.75 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $40.27 | $10,325.00 | $9,808.75 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Point Comfort Underwriters | Organizational | $41.30 | $10,325.00 | $9,808.75 | 2026-02-20 | MRF ↗ |
| UMASS MEMORIAL MEDICAL CENTER/UNIVERSITY CAMPUS Outpatient | TUFTS MEDICAID [10908] | All TUFTS TOGETHER UM [121] Plans | $46.87 | $60,974.22 | $60,974.22 | 2026-03-26 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $49.56 | $10,325.00 | $9,808.75 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $49.56 | $10,325.00 | $9,808.75 | 2026-02-20 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | BCBS-SC | BCBSSCState | $50.00 | — | — | 2024-12-08 | MRF ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCState | $50.00 | — | — | 2024-12-08 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCState | $50.00 | — | — | 2024-12-08 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Point Comfort Underwriters | Organizational | $50.59 | $10,325.00 | $9,808.75 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $50.59 | $10,325.00 | $9,808.75 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $50.59 | $10,324.00 | $9,807.80 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $50.59 | $10,324.00 | $9,807.80 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $51.62 | $10,324.00 | $9,807.80 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $52.66 | $10,325.00 | $9,808.75 | 2026-02-20 | MRF ↗ |
| HERITAGE VALLEY BEAVER Outpatient | UPMC HEALTH PLAN | UPMC COMMERCIAL | $52.66 | $3,532.50 | $953.78 | 2024-12-30 | MRF ↗ |
| HERITAGE VALLEY BEAVER Outpatient | UPMC HEALTH PLAN | UPMC COMMERCIAL | $52.66 | $3,532.50 | $953.78 | 2025-01-14 | MRF ↗ |
| HERITAGE VALLEY BEAVER Outpatient | UPMC HEALTH PLAN | UPMC COMMERCIAL | $52.66 | $3,532.50 | $953.78 | 2025-01-14 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $53.68 | $10,324.00 | $9,807.80 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Point Comfort Underwriters | Organizational | $55.75 | $10,324.00 | $9,807.80 | 2026-02-20 | MRF ↗ |
| MERCYONE DUBUQUE MEDICAL CENTER OutpatientFacility | IOWA DEPT OF PUBLIC HEALTH | CARE FOR YOURSELF | $62.90 | — | $17,883.96 | 2026-03-31 | MRF ↗ |
| EAST CARROLL PARISH HOSPITAL Outpatient | UNITED CHICAGO TEACHER FUND-ALL PLANS | UNITED CHICAGO TEACHER FUND-ALL PLANS | $66.83 | $495.00 | $371.25 | 2026-01-16 | MRF ↗ |
| LAKESIDE MEDICAL CENTER OutpatientFacility | UHC | Managed Medicaid | $66.88 | $13,488.00 | $5,975.31 | 2025-12-02 | MRF ↗ |
| LAKESIDE MEDICAL CENTER OutpatientFacility | UHC | CHIP | $66.88 | $13,488.00 | $5,975.31 | 2025-12-02 | MRF ↗ |
| THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC BothFacility | NETWORK HEALTH PLANS - Medicare-HMO | Medicare Advantage | $68.41 | $14,871.20 | $8,327.87 | 2025-01-01 | MRF ↗ |
| MERCYONE DUBUQUE MEDICAL CENTER OutpatientFacility | STEPHENSON CTY HEALTH | STEPHENSON COUNTY HEALTH | $71.46 | — | $17,883.96 | 2026-03-31 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | Covered California/IFP/PPO | $71.76 | — | — | 2026-03-18 | MRF ↗ |
| Southern California Hospital At Culver City OutpatientFacility | Blue Shield of California | Covered California/IFP/PPO | $71.76 | — | — | 2026-03-18 | MRF ↗ |
| SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD OutpatientFacility | Blue Shield of California | Covered California/IFP/PPO | $71.76 | — | — | 2026-03-18 | MRF ↗ |
| FHN MEMORIAL HOSPITAL Outpatient | ECOH - ALL OTHER PLANS | ECOH - ALL OTHER PLANS | $75.00 | $3,397.00 | $2,717.60 | 2026-02-23 | MRF ↗ |
| FHN MEMORIAL HOSPITAL Outpatient | ECOH NIHP | ECOH NIHP | $75.00 | $3,397.00 | $2,717.60 | 2026-02-23 | MRF ↗ |
| CHRIST HOSPITAL Outpatient | UHC COMMUNITY MEDICAID [2175] | HB XR UHC INDIANA PATHWAYS MEDICAID | $80.55 | $14,784.79 | $9,577.78 | 2025-12-19 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | HMO | $82.23 | — | — | 2026-03-18 | MRF ↗ |
| Southern California Hospital At Culver City OutpatientFacility | Blue Shield of California | HMO | $82.23 | — | — | 2026-03-18 | MRF ↗ |
| SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD OutpatientFacility | Blue Shield of California | HMO | $82.23 | — | — | 2026-03-18 | MRF ↗ |
| JEFFERSON HOSPITAL Outpatient | University of Pittsburgh Medical Center | University of Pittsburgh Medical Center Commercial | $89.13 | — | — | 2026-04-14 | MRF ↗ |
| SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $89.54 | — | — | 2026-03-18 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $89.54 | — | — | 2026-03-18 | MRF ↗ |
| Southern California Hospital At Culver City OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $89.54 | — | — | 2026-03-18 | 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 ↗ |
| UPMC MCKEESPORT HOSPITAL OutpatientFacility | UPMC Health Plan | Commercial | $93.93 | $5,056.00 | $3,033.60 | 2026-03-06 | MRF ↗ |
| UPMC MERCY OutpatientFacility | UPMC Health Plan | Commercial | $95.34 | $7,137.00 | $4,282.20 | 2026-03-06 | MRF ↗ |
| UPMC MERCY OutpatientFacility | UPMC Health Plan | Commercial | $95.34 | $7,137.00 | $4,282.20 | 2026-03-06 | MRF ↗ |
| UPMC PASSAVANT OutpatientFacility | UPMC Health Plan | Commercial | $96.12 | $4,865.00 | $2,919.00 | 2026-03-07 | MRF ↗ |
| UPMC PASSAVANT OutpatientFacility | UPMC Health Plan | Commercial | $96.12 | $4,865.00 | $2,919.00 | 2026-03-07 | MRF ↗ |
| Upmc Presbyterian Shadyside OutpatientFacility | UPMC Health Plan | Commercial | $97.74 | $8,984.00 | $5,390.40 | 2026-03-06 | MRF ↗ |
| UPMC EAST OutpatientFacility | UPMC Health Plan | Commercial | $98.53 | $5,092.00 | $3,055.20 | 2026-03-06 | MRF ↗ |
| UPMC ST MARGARET OutpatientFacility | UPMC Health Plan | Commercial | $99.65 | $6,668.00 | $4,000.80 | 2026-03-06 | MRF ↗ |
| UPMC ST MARGARET OutpatientFacility | UPMC Health Plan | Commercial | $99.65 | $6,668.00 | $4,000.80 | 2026-03-06 | MRF ↗ |
| CENTRO MEDICO DEL NORESTE BothFacility | MENONITA ASES | MENONITA REFORMA | $100.00 | $979.96 | — | 2025-11-28 | MRF ↗ |
| CENTRO MEDICO DEL NORESTE BothFacility | MENONITA ASES | MENONITA IPA 650 | $100.00 | $979.96 | — | 2025-11-28 | MRF ↗ |
| COMMUNITY HOSPITAL, LLC OutpatientFacility | Cigna | New Business | $101.91 | $645.00 | $17,516.43 | 2026-03-31 | MRF ↗ |
| EAST CARROLL PARISH HOSPITAL Outpatient | UNITED AT&T-ALL PLANS | UNITED AT&T-ALL PLANS | $102.71 | $495.00 | $371.25 | 2026-01-16 | MRF ↗ |
| Rehabilitation Institute Of Michigan Outpatient | Hap | HAPHMO | $104.79 | — | — | 2025-01-31 | MRF ↗ |
| MCLAREN OAKLAND Outpatient | Medicaid - Meridian | Medicaid - Meridian | $106.00 | $1,052.00 | $526.00 | 2025-02-03 | MRF ↗ |
| UPMC JAMESON OutpatientFacility | UPMC Health Plan | Commercial | $106.31 | — | — | 2026-03-06 | MRF ↗ |
| MCLAREN CENTRAL MICHIGAN Outpatient | Medicaid - United | Medicaid - United | $108.00 | $1,052.00 | $526.00 | 2025-02-03 | MRF ↗ |
| CENTRO MEDICO DEL NORESTE BothFacility | IMC PRIVADO | INTERNATIONAL MEDICAL CARD | $110.00 | $979.96 | — | 2025-11-28 | MRF ↗ |
| United Memorial Medical Center Outpatient | Blue Cross Blue Shield of Texas | HMO | $115.00 | $144.00 | $144.00 | 2025-03-24 | MRF ↗ |
| United Memorial Medical Center Outpatient | Blue Cross Blue Shield of Texas | PPO | $115.00 | $144.00 | $144.00 | 2025-03-24 | MRF ↗ |
| United Memorial Medical Center Outpatient | Blue Cross Blue Shield of Texas | Blue Advantage | $115.00 | $144.00 | $144.00 | 2025-03-24 | MRF ↗ |
| ALTUS BAYTOWN HOSPITAL Outpatient | Blue Cross Blue Shield of Texas | PPO | $115.00 | $144.00 | $144.00 | 2026-04-01 | MRF ↗ |
| ALTUS BAYTOWN HOSPITAL Outpatient | Blue Cross Blue Shield of Texas | Blue Advantage | $115.00 | $144.00 | $144.00 | 2026-04-01 | MRF ↗ |
| ALTUS BAYTOWN HOSPITAL Outpatient | Blue Cross Blue Shield of Texas | HMO | $115.00 | $144.00 | $144.00 | 2026-04-01 | MRF ↗ |
| COMMUNITY HOSPITAL, LLC OutpatientFacility | Cigna | New Business | $115.49 | $731.00 | $17,516.43 | 2026-03-31 | MRF ↗ |
| MCLAREN NORTHERN MICHIGAN Outpatient | Medicaid - Molina | Medicaid - Molina | $119.00 | $1,052.00 | $526.00 | 2025-02-03 | MRF ↗ |
| CHI ST LUKE'S HEALTH BRAZOSPORT Outpatient | Aetna | Medicare|All Plans | — | — | — | 2026-02-28 | MRF ↗ |
| MCLAREN CENTRAL MICHIGAN Outpatient | Medicaid - Molina | Medicaid - Molina | $127.00 | $1,052.00 | $526.00 | 2025-02-03 | MRF ↗ |
| MCLAREN CENTRAL MICHIGAN Outpatient | Traditional Medicaid HMO PPO | Traditional Medicaid HMO PPO | $134.00 | $1,052.00 | $526.00 | 2025-02-03 | MRF ↗ |
| MCLAREN BAY REGION Outpatient | Medicaid - United | Medicaid - United | $134.00 | $1,052.00 | $526.00 | 2025-02-03 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $135.27 | — | — | 2026-01-01 | MRF ↗ |
| UMASS MEMORIAL MEDICAL CENTER/UNIVERSITY CAMPUS Outpatient | WELLSENSE MEDICAID [10901] | All WELLSENSE MEDICAID (FORMERLY BMC) UM [75] Plans | $139.00 | $60,974.22 | $60,974.22 | 2026-03-26 | MRF ↗ |
| UMASS MEMORIAL MEDICAL CENTER/UNIVERSITY CAMPUS Outpatient | MGB MEDICAID [10906] | All MGB (FORMERLY AHP) ACO UM [212] Plans | $139.00 | $60,974.22 | $60,974.22 | 2026-03-26 | MRF ↗ |
| UMASS MEMORIAL MEDICAL CENTER/UNIVERSITY CAMPUS Outpatient | HNE MEDICAID [10905] | All HEALTH NEW ENGLAND/MINUTEMAN MCO UM [222] Plans | $139.00 | $60,974.22 | $60,974.22 | 2026-03-26 | MRF ↗ |
| UMASS MEMORIAL MEDICAL CENTER/UNIVERSITY CAMPUS Outpatient | INSTITUTION [10406] | All WORCESTER RECOVERY UM [233] Plans | $139.00 | $60,974.22 | $60,974.22 | 2026-03-26 | MRF ↗ |
| CONEMAUGH MEMORIAL MEDICAL CENTER Outpatient | Upmc Health Plan | Upmc Health | $139.53 | $14,266.84 | $5,706.74 | 2026-05-18 | MRF ↗ |
| MCLAREN OAKLAND Outpatient | Medicaid - United | Medicaid - United | $141.00 | $1,052.00 | $526.00 | 2025-02-03 | MRF ↗ |
| COMMUNITY HOSPITAL, LLC OutpatientFacility | Aetna | PPO | $143.19 | $645.00 | $17,516.43 | 2026-03-31 | MRF ↗ |
| MCLAREN BAY REGION Outpatient | Traditional Medicaid HMO PPO | Traditional Medicaid HMO PPO | $150.00 | $1,052.00 | $526.00 | 2025-02-03 | MRF ↗ |
| MCLAREN CENTRAL MICHIGAN Outpatient | Medicaid - Meridian | Medicaid - Meridian | $151.00 | $1,052.00 | $526.00 | 2025-02-03 | MRF ↗ |
| MCLAREN MACOMB Outpatient | Medicaid - Meridian | Medicaid - Meridian | $151.00 | $1,052.00 | $526.00 | 2025-02-03 | MRF ↗ |
| MCLAREN NORTHERN MICHIGAN Outpatient | Traditional Medicaid HMO PPO | Traditional Medicaid HMO PPO | $153.00 | $1,052.00 | $526.00 | 2025-02-03 | MRF ↗ |
| MCLAREN NORTHERN MICHIGAN Outpatient | Medicaid - United | Medicaid - United | $153.00 | $1,052.00 | $526.00 | 2025-02-03 | MRF ↗ |
| MAGEE WOMENS HOSPITAL OF UPMC HEALTH SYSTEM OutpatientFacility | UPMC Health Plan | Commercial | $156.59 | $5,994.00 | $3,596.40 | 2026-03-06 | MRF ↗ |
| MAGEE WOMENS HOSPITAL OF UPMC HEALTH SYSTEM OutpatientFacility | UPMC Health Plan | Commercial | $156.59 | $5,994.00 | $3,596.40 | 2026-03-06 | MRF ↗ |
| FRANCISCAN HEALTH OLYMPIA & CHICAGO HEIGHTS Outpatient | ALT TRADITIONAL MEDICAID SECONDARY [109200] | IN MCD-SSCR-ILLINOIS | $157.50 | $28,874.89 | $6,410.23 | 2026-01-01 | MRF ↗ |
| FRANCISCAN HEALTH OLYMPIA & CHICAGO HEIGHTS Outpatient | MEDICAID [1092] | IN MCD-SSCR-ILLINOIS | $157.50 | $28,874.89 | $6,410.23 | 2026-01-01 | MRF ↗ |
| FRANCISCAN HEALTH OLYMPIA & CHICAGO HEIGHTS Outpatient | MANAGED HEALTH SERVICES [1302] | IN MCD-SSCR-ILLINOIS | $157.50 | $28,874.89 | $6,410.23 | 2026-01-01 | MRF ↗ |
| FRANCISCAN HEALTH OLYMPIA & CHICAGO HEIGHTS Outpatient | MDWISE [1175] | IN MCD-SSCR-ILLINOIS | $157.50 | $28,874.89 | $6,410.23 | 2026-01-01 | MRF ↗ |
| FRANCISCAN HEALTH OLYMPIA & CHICAGO HEIGHTS Outpatient | MEDICAID ILLINOIS [1091] | IN MCD-SSCR-ILLINOIS | $157.50 | $28,874.89 | $6,410.23 | 2026-01-01 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL OutpatientFacility | Pacific Source | All | — | — | — | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL OutpatientFacility | First Health Network | All | — | — | — | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL OutpatientFacility | Tricare | All | $158.82 | — | — | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL OutpatientFacility | Prime Health | All | — | — | — | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL OutpatientFacility | Humana | Medicare Advantage | $158.82 | — | — | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL OutpatientFacility | Montana Health CoOp | All | — | — | — | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL OutpatientFacility | Blue Cross Blue Shield | Medicare Advantage | $158.82 | — | — | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL OutpatientFacility | UHC | Medicare Advantage | $158.82 | — | — | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL OutpatientFacility | Interwest Health | All | — | — | — | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL OutpatientFacility | Coventry | All | — | — | — | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL OutpatientFacility | VA Health | All | $158.82 | — | — | 2026-03-28 | MRF ↗ |
| COMMUNITY HOSPITAL, LLC OutpatientFacility | Aetna | PPO | $162.28 | $731.00 | $17,516.43 | 2026-03-31 | MRF ↗ |
| MCLAREN OAKLAND Outpatient | Traditional Medicaid HMO PPO | Traditional Medicaid HMO PPO | $164.00 | $1,052.00 | $526.00 | 2025-02-03 | MRF ↗ |
| CHI Memorial Hospital - Hixson Outpatient | BCBS - TN | Commercial|Network S | $167.00 | — | — | 2026-02-28 | MRF ↗ |
| ROCHESTER GENERAL HOSPITAL Outpatient | UNITED BEHAVORIAL HEALTH [120] | UNITED BEHAVORIAL HEALTH [12001] | — | $804.37 | $804.37 | 2024-12-30 | MRF ↗ |
| ROCHESTER GENERAL HOSPITAL Outpatient | UNITED BEHAVORIAL HEALTH [120] | UNITED BEHAVORIAL HEALTH [12001] | — | $804.37 | $804.37 | 2024-12-30 | MRF ↗ |
| ROCHESTER GENERAL HOSPITAL Inpatient | MULTIPLAN [141] | MULTIPLAN [14101] | — | $804.37 | $804.37 | 2024-12-30 | MRF ↗ |
| ROCHESTER GENERAL HOSPITAL Inpatient | HIGHMARK [114] | HIGHMARK [11401] | — | $804.37 | $804.37 | 2024-12-30 | MRF ↗ |
| ROCHESTER GENERAL HOSPITAL Outpatient | HIGHMARK [114] | HIGHMARK [11401] | — | $804.37 | $804.37 | 2024-12-30 | MRF ↗ |
| ROCHESTER GENERAL HOSPITAL Outpatient | HIGHMARK [114] | HIGHMARK MEDICARE [11402] | — | $804.37 | $804.37 | 2024-12-30 | MRF ↗ |
| ROCHESTER GENERAL HOSPITAL Inpatient | EMBLEM GHI [113] | EMBLEM GHI [11301] | — | $804.37 | $804.37 | 2024-12-30 | MRF ↗ |
| ROCHESTER GENERAL HOSPITAL Inpatient | EMBLEM GHI [113] | EMBLEM GHI [11301] | — | $804.37 | $804.37 | 2024-12-30 | 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.