74210 — X-ray Xm Phrnx&/crv Esoph C+
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). X-RAY XM PHRNX&/CRV ESOPH C+ (CPT 74210) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/74210?code_type=CPT
MLA (9th ed.)
“X-RAY XM PHRNX&/CRV ESOPH C+ (CPT 74210) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/74210?code_type=CPT. Accessed .
Chicago (notes-bibliography)
“X-RAY XM PHRNX&/CRV ESOPH C+ (CPT 74210) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/74210?code_type=CPT.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $122–$322 (25th–75th percentile) across 1,732 hospitals · 3,937 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CPT/HCPCS 74210 — 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 |
|---|---|---|---|---|---|---|---|
| TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH Inpatient | None | — | — | $1,131.16 | $565.58 | 2024-12-15 | MRF ↗ |
| TEXAS HEALTH HOSPITAL MANSFIELD Inpatient | None | — | — | $1,131.16 | $565.58 | 2024-12-15 | MRF ↗ |
| WEST FELICIANA PARISH HOSPITAL Both | Humana MCD Rep (Plan: Medicaid Replacement) | Humana MCD Rep (Plan: Medicaid Replacement) | $0.68 | $465.83 | $279.50 | 2025-08-11 | MRF ↗ |
| WEST FELICIANA PARISH HOSPITAL Both | Humana MCD Rep (Plan: Medicaid Replacement) | Humana MCD Rep (Plan: Medicaid Replacement) | $0.68 | $465.83 | $279.50 | 2025-08-11 | MRF ↗ |
| ADVENTIST HEALTH REEDLEY Outpatient | DIGNITY MCR ADV OP/PROFEE ONLY | DIGNITY MCR ADV OP/PROFEE ONLY | $0.84 | $111.00 | $21.09 | 2026-01-25 | MRF ↗ |
| COMANCHE COUNTY MEDICAL CENTER Outpatient | MPI - ALL PLANS | MPI - ALL PLANS | $0.88 | $91.49 | $59.47 | 2026-05-07 | MRF ↗ |
| ST MARYS MEDICAL CENTER Outpatient | Healthplan Medicaid | Wv Medicaid | $1.68 | — | — | 2026-05-06 | MRF ↗ |
| ST MARYS MEDICAL CENTER Outpatient | Wellpoint | Wv Medicaid | $1.76 | — | — | 2026-05-06 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | Covered California/IFP/PPO | $2.17 | $2,875.70 | $2,875.70 | 2026-03-18 | MRF ↗ |
| WYANDOTTE HOSPITAL AND MEDICAL CENTER OutpatientFacility | HAP | Self Insured | $2.24 | $416.00 | — | 2025-06-28 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | HMO | $2.49 | $2,875.70 | $2,875.70 | 2026-03-18 | MRF ↗ |
| ADVENTIST HEALTH TEHACHAPI VALLEY Outpatient | BLUE CROSS NON-MCS- ALL OTHER PLANS | BLUE CROSS NON-MCS- ALL OTHER PLANS | $2.65 | $109.00 | $29.43 | 2026-01-31 | MRF ↗ |
| ADVENTIST HEALTH HOWARD MEMORIAL Outpatient | BLUE CROSS MCS - ALL OTHER PLANS | BLUE CROSS MCS - ALL OTHER PLANS | $2.65 | $153.00 | $45.90 | 2026-01-25 | MRF ↗ |
| ADVENTIST HEALTH HOWARD MEMORIAL Outpatient | BLUE CROSS NON MCS | BLUE CROSS NON MCS | $2.65 | $153.00 | $45.90 | 2026-01-25 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $2.71 | $2,875.70 | $2,875.70 | 2026-03-18 | MRF ↗ |
| SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $2.72 | $952.04 | $952.04 | 2026-03-18 | MRF ↗ |
| Southern California Hospital At Culver City OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $2.72 | $677.04 | $677.04 | 2026-03-18 | MRF ↗ |
| ROANE MEDICAL CENTER Outpatient | Ambetter | Exchange | $3.81 | — | — | 2024-12-10 | MRF ↗ |
| ROANE MEDICAL CENTER Outpatient | Ambetter | Exchange | $3.81 | — | — | 2024-12-10 | MRF ↗ |
| FORT LOUDOUN MEDICAL CENTER Outpatient | Ambetter | Exchange | $3.81 | — | — | 2024-12-10 | MRF ↗ |
| LECONTE MEDICAL CENTER Outpatient | Ambetter | Exchange | $3.81 | — | — | 2024-12-10 | MRF ↗ |
| LECONTE MEDICAL CENTER Outpatient | Ambetter | Exchange | $3.81 | — | — | 2024-12-10 | MRF ↗ |
| FORT LOUDOUN MEDICAL CENTER Outpatient | Ambetter | Exchange | $3.81 | — | — | 2024-12-10 | MRF ↗ |
| ALBANY MEDICAL CENTER HOSPITAL OutpatientFacility | MagnaCare | All Products | $6.62 | $583.00 | $291.50 | 2025-12-31 | MRF ↗ |
| MCLAREN BAY REGION Outpatient | Medicaid - United | Medicaid - United | $7.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MCLAREN OAKLAND Outpatient | Medicaid - United | Medicaid - United | $7.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MCLAREN CENTRAL MICHIGAN Outpatient | Traditional Medicaid HMO PPO | Traditional Medicaid HMO PPO | $7.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MCLAREN BAY REGION Outpatient | Traditional Medicaid HMO PPO | Traditional Medicaid HMO PPO | $7.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MCLAREN MACOMB Outpatient | Traditional Medicaid HMO PPO | Traditional Medicaid HMO PPO | $9.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MCLAREN BAY REGION Outpatient | Medicaid - Molina | Medicaid - Molina | $9.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MCLAREN MACOMB Outpatient | Medicaid - United | Medicaid - United | $9.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MONTEFIORE MEDICAL CENTER Both | New York Medicaid | Medicaid | $9.19 | $62.08 | $264.80 | 2026-04-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT FISHERS Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT EVANSVILLE Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT MERCY Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | UHC SELF | 6575_UNITED HEALTH CARE SELF FUNDED NON-CONTRACTED VEIN 20221002 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| Ascension St. Vincent Seton Specialty Hospital Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT SALEM Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | UHC | 9470_UNITED HEALTHCARE VEIN 20250101 | $9.25 | — | — | 2026-01-01 | MRF ↗ |
| MCLAREN CENTRAL MICHIGAN Outpatient | Medicare - United | Medicare - United | $10.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MCLAREN OAKLAND Outpatient | Medicaid - Molina | Medicaid - Molina | $10.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MCLAREN MACOMB Outpatient | WC - Workers Compensation | WC - Workers Compensation | $10.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| EAST CARROLL PARISH HOSPITAL Outpatient | UNITED CHICAGO TEACHER FUND-ALL PLANS | UNITED CHICAGO TEACHER FUND-ALL PLANS | $10.13 | $75.00 | $56.25 | 2026-01-16 | MRF ↗ |
| SAVANNAH HEALTH SERVICES LLC DBA MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER Outpatient | BCBS | HIX | $10.31 | — | — | 2024-10-01 | MRF ↗ |
| SAVANNAH HEALTH SERVICES LLC DBA MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER Outpatient | BCBS | Pathway | $10.31 | — | — | 2024-10-01 | MRF ↗ |
| MCLAREN CENTRAL MICHIGAN Outpatient | Medicare - Humana | Medicare - Humana | $11.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MCLAREN MACOMB Outpatient | Medicare - Priority Health | Medicare - Priority Health | $11.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MCLAREN OAKLAND Outpatient | Medicare - United | Medicare - United | $11.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MCLAREN OAKLAND Outpatient | Tricare | Tricare | $11.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MCLAREN CENTRAL MICHIGAN Outpatient | HAP - HMO | HAP - HMO | $11.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MCLAREN CENTRAL MICHIGAN Outpatient | Traditional Medicare HMO PPO | Traditional Medicare HMO PPO | $11.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| THE UNIVERSITY OF VERMONT HEALTH NETWORK-ALICE HY Both | Humanamilitary | Tricare | — | $35.00 | $35.00 | 2026-05-09 | MRF ↗ |
| THE UNIVERSITY OF VERMONT HEALTH NETWORK-ALICE HY Both | Vaccn | — | — | $35.00 | $35.00 | 2026-05-09 | MRF ↗ |
| THE UNIVERSITY OF VERMONT HEALTH NETWORK-ALICE HY Both | Magnacare | — | — | $35.00 | $35.00 | 2026-05-09 | MRF ↗ |
| THE UNIVERSITY OF VERMONT HEALTH NETWORK-ALICE HY Both | Martinspoint | Tricare | — | $35.00 | $35.00 | 2026-05-09 | MRF ↗ |
| Mount Sinai Behavioral Health Center OutpatientFacility | United Healthcare | United Medicaid Family - Brook | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| Mount Sinai Behavioral Health Center OutpatientFacility | United Healthcare | United Medicaid Family - Msq | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| Mount Sinai Behavioral Health Center OutpatientFacility | United Healthcare | United Medicaid Schip/Child - Msq | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| Mount Sinai Behavioral Health Center OutpatientFacility | United Healthcare | United Healthcare - Essential Plan - Brook | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| MOUNT SINAI HOSPITAL OutpatientFacility | United Healthcare | United Medicaid Family - Tmsh | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| MCLAREN BAY REGION Outpatient | Tricare | Tricare | $12.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MOUNT SINAI HOSPITAL OutpatientFacility | United Healthcare | United Healthcare - Essential Plan - Tmsh | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| MCLAREN BAY REGION Outpatient | United Healthcare | United Healthcare | $12.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| MOUNT SINAI HOSPITAL OutpatientFacility | United Healthcare | United Medicaid Schip/Child - Tmsh | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| MOUNT SINAI SOUTH NASSAU OutpatientFacility | United Healthcare | United Healthcare - Essential Plan - Snch | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| MOUNT SINAI WEST OutpatientFacility | United Healthcare | United Medicaid Schip/Child - Slw | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| MCLAREN CENTRAL MICHIGAN Outpatient | Tricare | Tricare | $12.00 | $55.00 | $27.00 | 2025-02-03 | MRF ↗ |
| Mount Sinai Behavioral Health Center OutpatientFacility | United Healthcare | United Medicaid Schip/Child - Brook | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| MOUNT SINAI WEST OutpatientFacility | United Healthcare | United Medicaid Family - Slw | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| MOUNT SINAI WEST OutpatientFacility | United Healthcare | United Medicaid Family - Bi | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| Mount Sinai Behavioral Health Center OutpatientFacility | United Healthcare | United Healthcare - Essential Plan - Msq | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| MOUNT SINAI WEST OutpatientFacility | United Healthcare | United Healthcare - Essential Plan - Bi | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| MOUNT SINAI WEST OutpatientFacility | United Healthcare | United Healthcare - Essential Plan - Slw | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| MOUNT SINAI WEST OutpatientFacility | United Healthcare | United Medicaid Schip/Child - Bi | $12.00 | — | — | 2026-04-01 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | UNITED HEALTHCARE [101] | UHC MEDICARE COMPLETE | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Inpatient | GENERIC CARRIER [107] | COMMERCIAL|HUMANA|CDPHP COMMERCIAL | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | EMBLEM GHI [113] | EMBLEM GHI | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | GENERIC CARRIER [107] | COMMERCIAL|HUMANA|CDPHP COMMERCIAL | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Inpatient | UNITED HEALTHCARE [101] | UHC COMMUNITY PLAN|UHC COMMUNITY MEDICAID DENTAL|UHC ESSENTIAL 1&2|UHC CHPS|UHC ESSENTIAL 3&4 | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Inpatient | FIDELIS CARE NEW YORK [112] | FIDELIS CARE NEW YORK|FIDELIS FHP|FIDELIS CHP | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Inpatient | HIGHMARK [114] | HIGHMARK MEDICARE | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Inpatient | FIDELIS EXCHANGE [157] | FIDELIS(INCLUDING GOLD,SILVER,BRONZE AND PLATINUM) | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | UNITED HEALTHCARE [101] | UHC COMMUNITY PLAN|UHC ESSENTIAL 1&2|UHC CHPS|UHC ESSENTIAL 3&4 | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Inpatient | FIDELIS MEDICARE [176] | FIDELIS MEDICARE|FIDELIS DUAL ADVANTAGE | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | UNITED HEALTHCARE [101] | UHC MEDICARE COMPLETE|UHC DUAL COMPLETE | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | UNITED HEALTHCARE [101] | UNITED HEALTHCARE|UHC - GENERIC|UHC EMPIRE PLAN (KINGSTON)|UNITEDHEALTHCARE OXFORD|UNITED MEDICAL RESOURCES (UMR)|UHC STUDENT RESOURCES|UNITED HEALTHCARE SHARED SERVICES | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Inpatient | EXCELLUS HMO [104] | BLUE CHOICE OPTION|CHILD HEALTH PLUS|UNIVERA MYHEALTH PLUS|EXCELLUS ESSENTIAL 1&2|EXCELLUS ESSENTIAL 3&4|UNIVERA MYHEALTH|UNIVERA ESSENTIAL 1&2|HEALTHY NY|UNIVERA ESSENTIAL 1&2 | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | VETERANS ADMINISTRATION [178] | HUMANA - GENERIC|HUMANA | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Inpatient | MVP [109] | MVP OPTION|MVP CHILD HEALTH PLUS | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | FIDELIS MEDICAID 1708 | FIDELIS MEDICAID 170801, FIDELIS CHILD HEALTH PLUS 515502 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | WELLCARE MEDICARE HMO [122] | WELLCARE MEDICARE HMO|WELLCARE DUAL | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | UNITED HEALTHCARE [101] | UHC COMMUNITY PLAN|UHC ESSENTIAL 1&2|UHC CHPS|UHC ESSENTIAL 3&4 | $12.12 | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | UNITED HEALTHCARE [101] | UNITED HEALTHCARE|UHC - GENERIC|UHC EMPIRE PLAN (KINGSTON)|UNITEDHEALTHCARE OXFORD|UNITED MEDICAL RESOURCES (UMR)|UHC STUDENT RESOURCES|UNITED HEALTHCARE SHARED SERVICES | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | HIGHMARK BLUE CROSS BLUE SHIELD MEDICAID 1702 | HIGHMARK BCBS MEDICAID 170201 CHILD HEALTH PLUS 170204 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | FIDELIS CARE NEW YORK [112] | FIDELIS CARE NEW YORK|FIDELIS FHP|FIDELIS CHP | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | EXCELLUS HMO [104] | MEDICARE BLUE CHOICE|MEDICARE BLUE DUAL|UNIVERA SENIOR|MEDICARE BLUE PPO | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | GENERIC MEDICARE HMO [125] | HUMANA MEDICARE HMO|GENERIC MEDICARE HMO|ELDERPLAN|CDPHP MEDICARE HMO | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | UNITED HEALTHCARE [101] | UHC DUAL COMPLETE | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Inpatient | WELLCARE MEDICARE HMO [122] | WELLCARE DUAL | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | WELLCARE MEDICARE HMO [122] | WELLCARE MEDICARE HMO | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Inpatient | UNITED HEALTHCARE [101] | UNITED HEALTHCARE|UHC - GENERIC|UHC EMPIRE PLAN (KINGSTON)|UNITEDHEALTHCARE OXFORD|UNITED MEDICAL RESOURCES (UMR)|UHC CHPS|UHC STUDENT RESOURCES|UHC SUREST|UNITED HEALTHCARE SHARED SERVICES | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | HIGHMARK [114] | HIGHMARK|HIGHMARK INDEMNITY- OUT OF AREA|HIGHMARK HMO BLUE | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | HIGHMARK [114] | HIGHMARK MEDICARE | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Inpatient | FIDELIS EXCHANGE [157] | FIDELIS ESSENTIAL 1&2|FIDELIS ESSENTIAL 3&4 | — | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | WELLCARE MEDICARE HMO [122] | WELLCARE MEDICARE HMO|WELLCARE DUAL | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | GENERIC CARRIER [107] | HUMANA - GENERIC|HUMANA | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Inpatient | GENERIC CARRIER [107] | ST REGIS MOHAWK [10724] | — | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | EXCELLUS HMO [104] | BLUE CHOICE OPTION|CHILD HEALTH PLUS|UNIVERA MYHEALTH PLUS|EXCELLUS ESSENTIAL 1&2|EXCELLUS ESSENTIAL 3&4|UNIVERA MYHEALTH|UNIVERA ESSENTIAL 1&2|HEALTHY NY | $12.12 | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | INDEPENDENT HEALTH ASSOC MEDICAID 1710 | INDEPENDENT HEALTH MEDICAID 171001, INDEPENDENT HEALTH CHILD HEALTH PLUS 515604 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | VETERANS ADMINISTRATION [178] | HUMANA - GENERIC|HUMANA | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Outpatient | FIDELIS CARE NEW YORK [112] | FIDELIS CARE NEW YORK|FIDELIS FHP|FIDELIS CHP | $12.12 | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | MVP [109] | MH CIGNA BEHAVORIAL HEALTH|MVP|CIGNA|NALC CIGNA | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | HIGHMARK BLUE CROSS BLUE SHIELD MEDICAID 5143 | HIGHMARK BCBS ESSENTIAL 1-2 200-250 5143 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | GENERIC MEDICARE HMO [125] | HUMANA MEDICARE HMO | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | EXCELLUS HMO [104] | MEDICARE BLUE CHOICE|RRH CDHP|MEDICARE BLUE DUAL|HIGHMARK MEDICARE|UNIVERA SENIOR | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | AMERIGROUP (BLUE CROSS BLUE SHIELD WNY ALTERNATE) 1720 | AMERIGROUP (BSWNY ALTERNATE) 172001 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | FIDELIS EXCHANGE [157] | FIDELIS(INCLUDING GOLD,SILVER,BRONZE AND PLATINUM) | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Outpatient | GENERIC CARRIER [107] | ST REGIS MOHAWK [10724] | — | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Inpatient | FIDELIS CARE NEW YORK [112] | FIDELIS CARE NEW YORK|FIDELIS FHP|FIDELIS CHP | — | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | MVP [109] | MVP GOLD HMO|MVP GOLD PPO | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | MVP [109] | MVP GOLD HMO|MVP GOLD PPO | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | GENERIC MEDICARE HMO [125] | HUMANA MEDICARE HMO | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | MVP [109] | MH CIGNA BEHAVORIAL HEALTH|MVP|CIGNA|NALC CIGNA | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | UNITED HEALTHCARE MEDICAID 5158 | UNITED HEALTHCARE ESSENTIAL 1-2 200-250 5158 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | GENERIC CARRIER [107] | COMMERCIAL | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| UNITED MEMORIAL MEDICAL CENTER Outpatient | EXCELLUS HMO [104] | BLUE CHOICE OPTION|CHILD HEALTH PLUS|UNIVERA MYHEALTH PLUS|EXCELLUS ESSENTIAL 1&2|EXCELLUS ESSENTIAL 3&4|UNIVERA MYHEALTH|UNIVERA ESSENTIAL 1&2|UNIVERA ESSENTIAL 1&2 | $12.12 | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | CDPHP [187] | CDPHP COMMERCIAL | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | EXCELLUS BLUE CROSS BLUE SHIELD MEDICAID 1706 | BLUE CHOICE OPTION MEDICAID 170601 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | FIDELIS EXCHANGE [157] | FIDELIS ESSENTIAL 1&2|FIDELIS ESSENTIAL 3&4 | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | UNITED HEALTHCARE MEDICAID 1716 | UNITED HEALTHCARE MEDICAID 171601, UNITED HEALTHCARE ESSENTIAL 3-4 171602, UNITED HEALTHCARE CHILD HEALTH PLUS 515813 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | FIDELIS MEDICARE [176] | FIDELIS MEDICARE|FIDELIS DUAL ADVANTAGE | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | EXCELLUS HMO [104] | BLUE CHOICE OPTION|CHILD HEALTH PLUS|UNIVERA MYHEALTH PLUS|EXCELLUS ESSENTIAL 1&2|EXCELLUS ESSENTIAL 3&4|UNIVERA MYHEALTH|UNIVERA ESSENTIAL 1&2|HEALTHY NY|UNIVERA ESSENTIAL 1&2 | $12.12 | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Inpatient | UNITED HEALTHCARE [101] | UNITED HEALTHCARE|UHC - GENERIC|UHC EMPIRE PLAN (KINGSTON)|UNITEDHEALTHCARE OXFORD|UHC STUDENT RESOURCES|UNITED HEALTHCARE SHARED SERVICES | — | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Inpatient | FIDELIS EXCHANGE [157] | FIDELIS(INCLUDING GOLD,SILVER,BRONZE AND PLATINUM) | — | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Inpatient | FIDELIS MEDICARE [176] | FIDELIS MEDICARE|FIDELIS DUAL ADVANTAGE | — | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | MVP [109] | MVP GOLD HMO | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | MVP [109] | MVP DUAL ACCESS|MVP DUAL ACCESS COMPLETE | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Inpatient | UNITED HEALTHCARE [101] | UHC COMMUNITY PLAN|UHC COMMUNITY MEDICAID DENTAL|UHC ESSENTIAL 1&2|UHC CHPS|UHC ESSENTIAL 3&4 | — | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | MVP [109] | MVP OPTION|MVP CHILD HEALTH PLUS | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | EXCELLUS BLUE CROSS BLUE SHIELD MEDICAID 1706 | EXCELLUS ESSENTIAL 3-4 170604, EXCELLUS ESSENTIAL 1-2 200-250 2201, EXCELLUS CHILD HEALTH PLUS 220108, EXCELLUS HLTHY NY 220110 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | FIDELIS MEDICARE [176] | FIDELIS MEDICARE|FIDELIS DUAL ADVANTAGE | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Outpatient | UNITED HEALTHCARE [101] | UHC COMMUNITY PLAN|UHC COMMUNITY MEDICAID DENTAL|UHC ESSENTIAL 1&2|UHC CHPS|UHC ESSENTIAL 3&4 | $12.12 | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Outpatient | MVP [109] | MVP ESSENTIAL 1&2|MVP ESSENTIAL 3&4 | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | HIGHMARK BLUE CROSS BLUE SHIELD MEDICAID 1702 | HIGHMARK BCBS MEDICAID 170201 CHILD HEALTH PLUS 170204 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Inpatient | MVP [109] | MVP ESSENTIAL 1&2|MVP ESSENTIAL 3&4 | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NEWARK-WAYNE COMMUNITY HOSPITAL Inpatient | MVP [109] | MVP EXCHANGE-INDIVIDUAL | — | $455.42 | $296.02 | 2024-12-30 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | FIDELIS 5155 | FIDELIS METAL TIERS 515501 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | EXCELLUS INDEMNITY [127] | BLUE CHOICE|RGHS EMPLOYEE MEDICAL PLAN|EXCELLUS UNITY EMPLOYEE PLAN|HIGHMARK|HIGHMARK INDEMNITY- OUT OF AREA|HIGHMARK HMO BLUE|HIGHMARK OUT OF AREA|BLUE CROSS & BLUE SHIELD|UNIVERA|EMPIRE PLAN B/C (KINGSTON)|EXCELLUS BCBS RIT|FEDERAL BLUE CROSS & BLUE SHIELD | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Inpatient | WELLCARE MEDICARE HMO [122] | WELLCARE MEDICARE HMO|WELLCARE DUAL | — | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Outpatient | UNITED HEALTHCARE [101] | UHC MEDICARE COMPLETE|UHC DUAL COMPLETE | — | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | AETNA [100] | AETNA|AETNA DENTAL | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | UNITED HEALTHCARE MEDICAID 5158 | UNITED HEALTHCARE ESSENTIAL 1-2 200-250 5158 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | FIDELIS MEDICAID 1708 | FIDELIS MEDICAID 170801, FIDELIS CHILD HEALTH PLUS 515502 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | AETNA [100] | AETNA MEDICARE ADVANTAGE | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Outpatient | EXCELLUS HMO [104] | BLUE CHOICE OPTION|CHILD HEALTH PLUS|UNIVERA MYHEALTH PLUS|EXCELLUS ESSENTIAL 1&2|EXCELLUS ESSENTIAL 3&4|UNIVERA MYHEALTH|UNIVERA ESSENTIAL 1&2|HEALTHY NY | $12.12 | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | FIDELIS 5155 | FIDELIS METAL TIERS 515501 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | AMERIGROUP (BLUE CROSS BLUE SHIELD WNY ALTERNATE) 1720 | AMERIGROUP (BSWNY ALTERNATE) 172001 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | HIGHMARK BLUE CROSS BLUE SHIELD MEDICAID 1702 | HIGHMARK BCBS MEDICAID 170201 CHILD HEALTH PLUS 170204 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | EXCELLUS BLUE CROSS BLUE SHIELD MEDICAID 1706 | BLUE CHOICE OPTION MEDICAID 170601 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | EXCELLUS BLUE CROSS BLUE SHIELD MEDICAID 1706 | EXCELLUS ESSENTIAL 3-4 170604, EXCELLUS ESSENTIAL 1-2 200-250 2201, EXCELLUS CHILD HEALTH PLUS 220108, EXCELLUS HLTHY NY 220110 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | EXCELLUS HMO [104] | BLUE CHOICE OPTION|CHILD HEALTH PLUS|UNIVERA MYHEALTH PLUS|EXCELLUS ESSENTIAL 1&2|EXCELLUS ESSENTIAL 3&4|UNIVERA MYHEALTH|UNIVERA ESSENTIAL 1&2|HEALTHY NY | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Inpatient | EXCELLUS HMO [104] | BLUE CHOICE OPTION|CHILD HEALTH PLUS|UNIVERA MYHEALTH PLUS|EXCELLUS ESSENTIAL 1&2|EXCELLUS ESSENTIAL 3&4|UNIVERA MYHEALTH|UNIVERA ESSENTIAL 1&2|HEALTHY NY | — | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | INDEPENDENT HEALTH ASSOC MEDICAID 1710 | INDEPENDENT HEALTH MEDICAID 171001, INDEPENDENT HEALTH CHILD HEALTH PLUS 515604 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | EXCELLUS BLUE CROSS BLUE SHIELD MEDICAID 1706 | BLUE CHOICE OPTION MEDICAID 170601 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | AETNA [100] | AETNA|AETNA DENTAL | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | HIGHMARK BLUE CROSS BLUE SHIELD MEDICAID 5143 | HIGHMARK BCBS ESSENTIAL 1-2 200-250 5143 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | EXCELLUS BLUE CROSS BLUE SHIELD MEDICAID 1706 | EXCELLUS ESSENTIAL 3-4 170604, EXCELLUS ESSENTIAL 1-2 200-250 2201, EXCELLUS CHILD HEALTH PLUS 220108, EXCELLUS HLTHY NY 220110 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | GENERIC CARRIER [107] | ST REGIS MOHAWK [10724] | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Outpatient | EXCELLUS INDEMNITY [127] | BLUE CHOICE|RGHS EMPLOYEE MEDICAL PLAN|EXCELLUS UNITY EMPLOYEE PLAN|HIGHMARK|HIGHMARK INDEMNITY- OUT OF AREA|HIGHMARK HMO BLUE|HIGHMARK OUT OF AREA|BLUE CROSS & BLUE SHIELD|UNIVERA|EMPIRE PLAN B/C (KINGSTON)|EXCELLUS BCBS RIT|FEDERAL BLUE CROSS & BLUE SHIELD | — | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | UNITED HEALTHCARE MEDICAID 1716 | UNITED HEALTHCARE MEDICAID 171601, UNITED HEALTHCARE ESSENTIAL 3-4 171602, UNITED HEALTHCARE CHILD HEALTH PLUS 515813 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | INDEPENDENT HEALTH ASSOC MEDICAID 1710 | INDEPENDENT HEALTH MEDICAID 171001, INDEPENDENT HEALTH CHILD HEALTH PLUS 515604 | $12.12 | — | — | 2026-01-01 | MRF ↗ |
| GOUVERNEUR HOSPITAL Outpatient | WELLCARE MEDICARE HMO [122] | WELLCARE MEDICARE HMO|WELLCARE DUAL | — | $441.33 | $286.86 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Outpatient | CHAMPUS/TRICARE [103] | CHAMPUS/TRICARE|TRICARE FOR LIFE|MARTINS POINT/US FAMILY | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| SLHS MASSENA, INC Inpatient | GENERIC CARRIER [107] | ST REGIS MOHAWK [10724] | — | $443.66 | $288.38 | 2024-12-30 | MRF ↗ |
| GOUVERNEUR HOSPITAL Inpatient | UNITED HEALTHCARE [101] | UHC MEDICARE COMPLETE|UHC DUAL COMPLETE | — | $441.33 | $286.86 | 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.