85 — Level Iii Peripheral Endovascular And Transcatheter Procedures
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). LEVEL III PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES (EAPG 85) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/85?code_type=EAPG
MLA (9th ed.)
“LEVEL III PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES (EAPG 85) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/85?code_type=EAPG. Accessed .
Chicago (notes-bibliography)
“LEVEL III PERIPHERAL ENDOVASCULAR AND TRANSCATHETER PROCEDURES (EAPG 85) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/85?code_type=EAPG.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $5,352–$12,131 (25th–75th percentile) across 86 hospitals · 93 payers.
“Negotiated” is the hospital’s negotiated facility rate for this EAPG 85 — 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 |
|---|---|---|---|---|---|---|---|
| ST MARY'S REGIONAL MEDICAL CENTER Outpatient | Blue Cross Blue Shield Of Ok | Advantage | $644.92 | — | — | 2026-07-15 | MRF ↗ |
| ST MARY'S REGIONAL MEDICAL CENTER Outpatient | Blue Cross Blue Shield Of Ok | Qhp | $644.92 | — | — | 2026-07-15 | MRF ↗ |
| ST MARY'S REGIONAL MEDICAL CENTER Outpatient | Blue Cross Blue Shield Of Ok | Ppo | $824.17 | — | — | 2026-07-15 | MRF ↗ |
| ST MARY'S REGIONAL MEDICAL CENTER Outpatient | Blue Choice | Managed Care | $936.16 | — | — | 2026-07-15 | MRF ↗ |
| SAUK PRAIRIE HOSPITAL OutpatientFacility | Humana | Managed Medicaid | $2,055.32 | — | — | 2026-01-29 | MRF ↗ |
| SAUK PRAIRIE HOSPITAL OutpatientFacility | United Healthcare | Managed Medicaid | $2,055.32 | — | — | 2026-01-29 | MRF ↗ |
| SAUK PRAIRIE HOSPITAL OutpatientFacility | Anthem BCBS | Managed Medicaid | $2,055.32 | — | — | 2026-01-29 | MRF ↗ |
| SAUK PRAIRIE HOSPITAL OutpatientFacility | Quartz | Managed Medicaid | $2,055.32 | — | — | 2026-01-29 | MRF ↗ |
| SAUK PRAIRIE HOSPITAL OutpatientFacility | Dean Health Plan | Managed Medicaid | $2,055.32 | — | — | 2026-01-29 | MRF ↗ |
| SAUK PRAIRIE HOSPITAL OutpatientFacility | GHC | Managed Medicaid | $2,055.32 | — | — | 2026-01-29 | MRF ↗ |
| SOUTHWESTERN VERMONT MEDICAL CENTER Outpatient | Cdphp | Essential Plan 3 & 4 | $2,067.48 | — | — | 2026-07-15 | MRF ↗ |
| SOUTHWESTERN VERMONT MEDICAL CENTER Outpatient | Cdphp | Essential Plan 1 & 2 | $2,067.48 | — | — | 2026-07-15 | MRF ↗ |
| SOUTHWESTERN VERMONT MEDICAL CENTER Outpatient | Uhc | Medicaid | $2,067.48 | — | — | 2026-07-15 | MRF ↗ |
| SOUTHWESTERN VERMONT MEDICAL CENTER Outpatient | Mvp | Essential Plan 1,2,5,6 | $2,067.48 | — | — | 2026-07-15 | MRF ↗ |
| SOUTHWESTERN VERMONT MEDICAL CENTER Outpatient | Mvp | Medicaid | $2,067.48 | — | — | 2026-07-15 | MRF ↗ |
| GENEVA GENERAL HOSPITAL OutpatientFacility | MVP Health Care | Managed Medicaid | $2,130.67 | — | — | 2025-08-07 | MRF ↗ |
| GENEVA GENERAL HOSPITAL OutpatientFacility | Excellus Blue Choice Options | Managed Medicaid | $2,367.41 | — | — | 2025-08-07 | MRF ↗ |
| SOLDIERS AND SAILORS MEMORIAL HOSPITAL OF YATES OutpatientFacility | Fidelis | Managed Medicaid | $2,367.41 | — | — | 2025-08-07 | MRF ↗ |
| GENEVA GENERAL HOSPITAL OutpatientFacility | Aetna | Managed Medicaid | $2,367.41 | — | — | 2025-08-07 | MRF ↗ |
| SOLDIERS AND SAILORS MEMORIAL HOSPITAL OF YATES OutpatientFacility | United Healthcare | Managed Medicaid | $2,367.41 | — | — | 2025-08-07 | MRF ↗ |
| GENEVA GENERAL HOSPITAL OutpatientFacility | United Healthcare | Managed Medicaid | $2,367.41 | — | — | 2025-08-07 | MRF ↗ |
| ELLENVILLE REGIONAL HOSPITAL OutpatientFacility | Galaxy Health | Workers Comp | $2,551.98 | — | — | 2026-05-22 | MRF ↗ |
| ELLENVILLE REGIONAL HOSPITAL OutpatientFacility | EmblemHealth | Medicaid | $2,604.12 | — | — | 2026-05-22 | MRF ↗ |
| ELLENVILLE REGIONAL HOSPITAL OutpatientFacility | EmblemHealth | Essential Plan 3/Essential Plan 4 | $2,604.12 | — | — | 2026-05-22 | MRF ↗ |
| ELLENVILLE REGIONAL HOSPITAL OutpatientFacility | United Healthcare | CHIP/Family Health Plus/Medicaid | $2,604.12 | — | — | 2026-05-22 | MRF ↗ |
| ELLENVILLE REGIONAL HOSPITAL OutpatientFacility | Hamaspik Choice | Medicaid | $2,604.12 | — | — | 2026-05-22 | MRF ↗ |
| SOLDIERS AND SAILORS MEMORIAL HOSPITAL OF YATES OutpatientFacility | Fidelis | Medicare Advantage | $2,604.15 | — | — | 2025-08-07 | MRF ↗ |
| ELLENVILLE REGIONAL HOSPITAL OutpatientFacility | WellCare | Child Health Plus/Family Health Plus/Medicaid | $2,734.35 | — | — | 2026-05-22 | MRF ↗ |
| ELLENVILLE REGIONAL HOSPITAL OutpatientFacility | MVP Health Care of NY | Child Health Plus/Family Health Plus/HARP/Medicaid | $2,734.35 | — | — | 2026-05-22 | MRF ↗ |
| STRONG MEMORIAL HOSPITAL Outpatient | EXCELLUS BLUE CROSS BLUE SHIELD MEDICAID [1706] | BLUE CHOICE OPTION MEDICAID [170601] | $2,785.65 | — | — | 2026-04-01 | MRF ↗ |
| STRONG MEMORIAL HOSPITAL Outpatient | EXCELLUS BLUE CROSS BLUE SHIELD [2201], OUT AREA BLUE CROSS BLUE SHIELD, UNIVERA, EXCELLUS BLUE CROSS BLUE SHIELD MEDICAID [1706] | EXCELLUS CHILD HEALTH PLUS [220108], EXCELLUS ESS Q 1 2 [220109],EXCELLUS HLTHY NY [220110], EXCELLUS ESSENTIAL PA 3 AND 4 [170604] | $2,785.65 | — | — | 2026-04-01 | MRF ↗ |
| STRONG MEMORIAL HOSPITAL Outpatient | UNITED HEALTHCARE MEDICAID [1716] | UNITED HEALTHCARE MEDICAID [171601] | $2,785.65 | — | — | 2026-04-01 | MRF ↗ |
| STRONG MEMORIAL HOSPITAL Outpatient | FIDELIS [5155],FIDELIS [1708] | FIDELIS MEDICAID [170801], FIDELIS CHILD HEALTH PLUS [515502] | $2,785.65 | — | — | 2026-04-01 | MRF ↗ |
| STRONG MEMORIAL HOSPITAL Outpatient | AMERIGROUP (BLUE CROSS BLUE SHIELD WNY ALTERNATE) [1720] | AMERIGROUP (BSWNY ALTERNATE) [172001] | $2,785.65 | — | — | 2026-04-01 | MRF ↗ |
| GENEVA GENERAL HOSPITAL OutpatientFacility | Fidelis | Managed Medicaid | $2,840.89 | — | — | 2025-08-07 | MRF ↗ |
| ELLENVILLE REGIONAL HOSPITAL OutpatientFacility | EmblemHealth | Essential Plan 1/Essential Plan 2 | $3,124.89 | — | — | 2026-05-22 | MRF ↗ |
| STRONG MEMORIAL HOSPITAL Outpatient | UNITED HEALTHCARE [5158] | UNITED HEALTHCARE ESSENTIAL PQ 1 AND 2 [515812] | $3,203.50 | — | — | 2026-04-01 | MRF ↗ |
| STRONG MEMORIAL HOSPITAL Outpatient | MVP MEDICAID [1712] | MVP OPTION MEDICAID [171201], MVP CHILD HEALTH PLUS [290004] | $3,342.78 | — | — | 2026-04-01 | MRF ↗ |
| NASSAU UNIVERSITY MEDICAL CENTER OutpatientFacility | Molina Healthcare (FKA Affinity) | Essential Plan 3 & 4 | $3,371.23 | — | — | 2025-10-28 | MRF ↗ |
| NASSAU UNIVERSITY MEDICAL CENTER OutpatientFacility | Anthem Blue Cross and Blue Shield (FKA Empire) | Managed Medicaid | $3,371.23 | — | — | 2025-10-28 | MRF ↗ |
| NASSAU UNIVERSITY MEDICAL CENTER OutpatientFacility | EmblemHealth | Managed Medicaid | $3,371.23 | — | — | 2025-10-28 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | FIDELIS 5155 | FIDELIS METAL TIERS 515501 | $3,412.55 | — | — | 2026-01-01 | MRF ↗ |
| STRONG MEMORIAL HOSPITAL Outpatient | MOLINA HEALTHCARE [1723], MOLINA HEALTHCARE [5189] | MOLINA HEALTHCARE [172301], MOLINA CHILD HEALTH PLUS [518901] | $3,482.06 | — | — | 2026-04-01 | MRF ↗ |
| NASSAU UNIVERSITY MEDICAL CENTER OutpatientFacility | United Healthcare | Managed Medicaid | $3,708.35 | — | — | 2025-10-28 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | FIDELIS 5155 | FIDELIS METAL TIERS 515501 | $3,814.03 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | FIDELIS 5155 | FIDELIS METAL TIERS 515501 | $3,814.03 | — | — | 2026-01-01 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | FIDELIS 5155 | FIDELIS METAL TIERS 515501 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | FIDELIS MEDICAID 1708 | FIDELIS MEDICAID 170801, FIDELIS CHILD HEALTH PLUS 515502 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | HIGHMARK BLUE CROSS BLUE SHIELD MEDICAID 5143 | HIGHMARK BCBS ESSENTIAL 1-2 200-250 5143 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | UNITED HEALTHCARE MEDICAID 1716 | UNITED HEALTHCARE MEDICAID 171601, UNITED HEALTHCARE ESSENTIAL 3-4 171602, UNITED HEALTHCARE CHILD HEALTH PLUS 515813 | $4,014.77 | — | — | 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 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | HIGHMARK BLUE CROSS BLUE SHIELD MEDICAID 1702 | HIGHMARK BCBS MEDICAID 170201 CHILD HEALTH PLUS 170204 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | AMERIGROUP (BLUE CROSS BLUE SHIELD WNY ALTERNATE) 1720 | AMERIGROUP (BSWNY ALTERNATE) 172001 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | EXCELLUS BLUE CROSS BLUE SHIELD MEDICAID 1706 | BLUE CHOICE OPTION MEDICAID 170601 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | HIGHMARK BLUE CROSS BLUE SHIELD MEDICAID 1702 | HIGHMARK BCBS MEDICAID 170201 CHILD HEALTH PLUS 170204 | $4,014.77 | — | — | 2026-01-01 | 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 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | MOLINA HEALTHCARE 1723 | MOLINA MEDICAID 172301, MOLINA CHILD HEALTH PLUS 518901 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | FIDELIS MEDICAID 1708 | FIDELIS MEDICAID 170801, FIDELIS CHILD HEALTH PLUS 515502 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | EXCELLUS BLUE CROSS BLUE SHIELD MEDICAID 1706 | BLUE CHOICE OPTION MEDICAID 170601 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | AMERIGROUP (BLUE CROSS BLUE SHIELD WNY ALTERNATE) 1720 | AMERIGROUP (BSWNY ALTERNATE) 172001 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | HIGHMARK BLUE CROSS BLUE SHIELD MEDICAID 1702 | HIGHMARK BCBS MEDICAID 170201 CHILD HEALTH PLUS 170204 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | HIGHMARK BLUE CROSS BLUE SHIELD MEDICAID 1702 | HIGHMARK BCBS MEDICAID 170201 CHILD HEALTH PLUS 170204 | $4,014.77 | — | — | 2026-01-01 | 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 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | EXCELLUS BLUE CROSS BLUE SHIELD MEDICAID 1706 | BLUE CHOICE OPTION MEDICAID 170601 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | UNITED HEALTHCARE MEDICAID 5158 | UNITED HEALTHCARE ESSENTIAL 1-2 200-250 5158 | $4,014.77 | — | — | 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 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | AMERIGROUP (BLUE CROSS BLUE SHIELD WNY ALTERNATE) 1720 | AMERIGROUP (BSWNY ALTERNATE) 172001 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | UNITED HEALTHCARE MEDICAID 1716 | UNITED HEALTHCARE MEDICAID 171601, UNITED HEALTHCARE ESSENTIAL 3-4 171602, UNITED HEALTHCARE CHILD HEALTH PLUS 515813 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | HIGHMARK BLUE CROSS BLUE SHIELD MEDICAID 1702 | HIGHMARK BCBS MEDICAID 170201 CHILD HEALTH PLUS 170204 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | AMERIGROUP (BLUE CROSS BLUE SHIELD WNY ALTERNATE) 1720 | AMERIGROUP (BSWNY ALTERNATE) 172001 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | FIDELIS MEDICAID 1708 | FIDELIS MEDICAID 170801, FIDELIS CHILD HEALTH PLUS 515502 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | FIDELIS MEDICAID 1708 | FIDELIS MEDICAID 170801, FIDELIS CHILD HEALTH PLUS 515502 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | UNIVERA HEALTHCARE 1706 | UNIVERA MEDICAID 170607, UNIVERA ESSENTIAL 3-4 170605, UNIVERA ESSENTIAL 1-2 200-250 2201, UNIVERA CHILD HEALTH PLUS 220118, UNIVERA HLTHY NY 220112 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | FIDELIS MEDICAID 1708 | FIDELIS MEDICAID 170801, FIDELIS CHILD HEALTH PLUS 515502 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | MOLINA HEALTHCARE 1723 | MOLINA MEDICAID 172301, MOLINA CHILD HEALTH PLUS 518901 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | UNIVERA HEALTHCARE 1706 | UNIVERA MEDICAID 170607, UNIVERA ESSENTIAL 3-4 170605, UNIVERA ESSENTIAL 1-2 200-250 2201, UNIVERA CHILD HEALTH PLUS 220118, UNIVERA HLTHY NY 220112 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | UNITED HEALTHCARE MEDICAID 1716 | UNITED HEALTHCARE MEDICAID 171601, UNITED HEALTHCARE ESSENTIAL 3-4 171602, UNITED HEALTHCARE CHILD HEALTH PLUS 515813 | $4,014.77 | — | — | 2026-01-01 | 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 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | UNITED HEALTHCARE MEDICAID 5158 | UNITED HEALTHCARE ESSENTIAL 1-2 200-250 5158 | $4,014.77 | — | — | 2026-01-01 | MRF ↗ |
| NASSAU UNIVERSITY MEDICAL CENTER OutpatientFacility | Molina Healthcare (FKA Affinity) | Essential Plan 1 & 2 | $4,045.48 | — | — | 2025-10-28 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | MOLINA HEALTHCARE 1723 | MOLINA MEDICAID 172301, MOLINA CHILD HEALTH PLUS 518901 | $4,416.25 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | MOLINA HEALTHCARE 1723 | MOLINA MEDICAID 172301, MOLINA CHILD HEALTH PLUS 518901 | $4,416.25 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | AMERIGROUP (BLUE CROSS BLUE SHIELD WNY ALTERNATE) 1720 | AMERIGROUP (BSWNY ALTERNATE) 172001 | $4,416.25 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | UNITED HEALTHCARE MEDICAID 5158 | UNITED HEALTHCARE ESSENTIAL 1-2 200-250 5158 | $4,616.99 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | UNITED HEALTHCARE MEDICAID 5158 | UNITED HEALTHCARE ESSENTIAL 1-2 200-250 5158 | $4,616.99 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | UNITED HEALTHCARE MEDICAID 5158 | UNITED HEALTHCARE ESSENTIAL 1-2 200-250 5158 | $4,616.99 | — | — | 2026-01-01 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN FOX VALLEY OutpatientFacility | My Choice Wisconsin | WI MEDICAID MYCHOICE WI-CARE WI | $4,678.11 | — | — | 2026-03-24 | MRF ↗ |
| GENEVA GENERAL HOSPITAL OutpatientFacility | Fidelis | Commercial | $4,734.82 | — | — | 2025-08-07 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN FOX VALLEY OutpatientFacility | Chorus Community Health Plan | WI MEDICAID CHORUS COMMUNITY HEALTH PLANS (CCHP) | $4,771.67 | — | — | 2026-03-24 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | FIDELIS 5155 | FIDELIS METAL TIERS 515501 | $4,777.58 | — | — | 2026-01-01 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | MVP MEDICAID 1712 | MVP OPTION MEDICAID 171201, MVP CHILD HEALTH PLUS 290004 | $4,817.72 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | MVP MEDICAID 1712 | MVP OPTION MEDICAID 171201, MVP CHILD HEALTH PLUS 290004 | $4,817.72 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | MVP MEDICAID 1712 | MVP OPTION MEDICAID 171201, MVP CHILD HEALTH PLUS 290004 | $4,817.72 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | MVP MEDICAID 1712 | MVP OPTION MEDICAID 171201, MVP CHILD HEALTH PLUS 290004 | $4,817.72 | — | — | 2026-01-01 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | MVP MEDICAID 1712 | MVP OPTION MEDICAID 171201, MVP CHILD HEALTH PLUS 290004 | $4,817.72 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | MOLINA HEALTHCARE 1723 | MOLINA MEDICAID 172301, MOLINA CHILD HEALTH PLUS 518901 | $5,018.46 | — | — | 2026-01-01 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN FOX VALLEY OutpatientFacility | Molina Healthcare of Wisconsin | WI MEDICAID MOLINA HEALTHCARE | $5,099.14 | — | — | 2026-03-24 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN FOX VALLEY OutpatientFacility | Managed Health Services | WI MEDICAID MANAGED HEALTH SERVICES & NETWORK HEALTH | $5,099.14 | — | — | 2026-03-24 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN FOX VALLEY OutpatientFacility | My Choice Wisconsin | WI MEDICAID TRILOGY | $5,239.49 | — | — | 2026-03-24 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | Dean Health Plan Medicaid | Mco Deancare | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | Community Care Medicaid | Mco Community Care Family Care | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | Molina Healthcare Of Il Medicaid | Mco Molina Il | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | Icare Medicaid | Mco Icare | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | Chorus Community Health Plan Medicaid | Mco Chorus Community Health Plan | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | Anthem Medicaid | Mco Anthem | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | Aetna Better Health Medicaid | Mco Aetna Better Health Il | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | Meridian Medicaid | Mco Meridian Health Plan Il | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | My Choice Medicaid | Mco Hmo My Choice | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | Molina Healthcare Of Wi Medicaid | Mco Molina Healthcare Of Wi | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | Ghc Eau Claire Medicaid | Mco Ghc Eau Claire | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | United Healthcare Medicaid | Mco United Healthcare | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | Mercy Care Medicaid | Mco Mercycare | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| UNIVERSITY OF WI HOSPITALS & CLINICS AUTHORITY Outpatient | Managed Health Services Medicaid | Mco Managed Health/Network Health Plans | $5,269.73 | — | — | 2026-07-15 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN FOX VALLEY OutpatientFacility | Anthem Blue Cross Blue Shield | WI MEDICAID ANTHEM | $5,379.83 | — | — | 2026-03-24 | MRF ↗ |
| ELLENVILLE REGIONAL HOSPITAL OutpatientFacility | MVP Health Care of NY | Essential Plan 1&2 | $5,598.93 | — | — | 2026-05-22 | MRF ↗ |
| ELLENVILLE REGIONAL HOSPITAL OutpatientFacility | MVP Health Care of NY | Essential Plan 3&4 | $5,598.93 | — | — | 2026-05-22 | MRF ↗ |
| STRONG MEMORIAL HOSPITAL Outpatient | MVP [2900], MVP MEDICAID [1712] | MVP ESSENTIAL (NO MEDICAID) [290005], MVP ESSENTIAL (W/ MEDICAID) [171204] | $5,710.58 | — | — | 2026-04-01 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN OutpatientFacility | My Choice Wisconsin | WI MEDICAID MYCHOICE WI-CARE WI | $5,723.10 | — | — | 2026-03-23 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN OutpatientFacility | United Healthcare Insurance Company | WI MEDICAID UHC COMMUNITY PLAN | $5,723.10 | — | — | 2026-03-23 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN OutpatientFacility | Chorus Community Health Plan | WI MEDICAID CHORUS COMMUNITY HEALTH PLANS (CCHP) | $5,837.56 | — | — | 2026-03-23 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN FOX VALLEY OutpatientFacility | ICare | WI Medicaid I Care - CFV | $5,847.64 | — | — | 2026-03-24 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | INDEPENDENT HEALTH ASSOC MEDICAID 1710 | INDEPENDENT HEALTH MEDICAID 171001, INDEPENDENT HEALTH CHILD HEALTH PLUS 515604 | $6,022.16 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | INDEPENDENT HEALTH ASSOC MEDICAID 1710 | INDEPENDENT HEALTH MEDICAID 171001, INDEPENDENT HEALTH CHILD HEALTH PLUS 515604 | $6,222.89 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | INDEPENDENT HEALTH ASSOC MEDICAID 1710 | INDEPENDENT HEALTH MEDICAID 171001, INDEPENDENT HEALTH CHILD HEALTH PLUS 515604 | $6,222.89 | — | — | 2026-01-01 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN OutpatientFacility | Managed Health Services | WI MEDICAID MANAGED HEALTH SERVICES & NETWORK HEALTH | $6,238.18 | — | — | 2026-03-23 | MRF ↗ |
| STRONG MEMORIAL HOSPITAL Outpatient | MOLINA HEALTHCARE [5189] | MOLINA ESSENTIAL PQ 1 AND 2 [518902], MOLINA ESSENTIAL PA 3 AND 4 [172302] | $6,267.71 | — | — | 2026-04-01 | MRF ↗ |
| STRONG MEMORIAL HOSPITAL Outpatient | FIDELIS [5155],FIDELIS [1708] | FIDELIS ESS PQ 1 AND 2 [515503],FIDELIS ESSENTIAL PA 3 AND 4 [170804] | $6,267.71 | — | — | 2026-04-01 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN OutpatientFacility | My Choice Wisconsin | WI MEDICAID MY CHOICE | $6,409.87 | — | — | 2026-03-23 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN OutpatientFacility | Molina Healthcare of Wisconsin | WI MEDICAID MOLINA HEALTHCARE | $6,409.87 | — | — | 2026-03-23 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN OutpatientFacility | Anthem Blue Cross Blue Shield | WI MEDICAID ANTHEM | $6,581.56 | — | — | 2026-03-23 | MRF ↗ |
| THE WOMEN'S HOSPITAL OutpatientFacility | Meridian Health IL | Managed Medicaid | $7,024.77 | — | — | 2026-02-13 | MRF ↗ |
| THE WOMEN'S HOSPITAL OutpatientFacility | Aetna Better Health IL | Managed Medicaid | $7,024.77 | — | — | 2026-02-13 | MRF ↗ |
| THE WOMEN'S HOSPITAL OutpatientFacility | Molina IL | Managed Medicaid | $7,024.77 | — | — | 2026-02-13 | MRF ↗ |
| THE WOMEN'S HOSPITAL OutpatientFacility | Blue Cross Blue Shield of Illinois | Managed Medicaid | $7,024.77 | — | — | 2026-02-13 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Outpatient | Blue Cross Blue Shield | Medicaid- Aca, Fhp, Icp | $7,024.77 | — | — | 2026-09-20 | MRF ↗ |
| GIBSON GENERAL HOSPITAL OutpatientFacility | MeridianHealth (IL) | Managed Medicaid | $7,024.77 | — | — | 2026-02-11 | MRF ↗ |
| GIBSON GENERAL HOSPITAL OutpatientFacility | Blue Cross Blue Shield of Illinois | Managed Medicaid | $7,024.77 | — | — | 2026-02-11 | MRF ↗ |
| GIBSON GENERAL HOSPITAL OutpatientFacility | Wellcare (IL) Medicaid | Managed Medicaid | $7,024.77 | — | — | 2026-02-11 | MRF ↗ |
| LAKEWOOD RANCH MEDICAL CENTER Outpatient | United Healthcare | Medicaid | $7,047.00 | — | — | 2026-07-15 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Outpatient | Clear Health Alliance | Medicaid | $7,047.29 | — | — | 2026-07-15 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Outpatient | Humana | Medicaid | $7,047.29 | — | — | 2026-07-15 | MRF ↗ |
| MANATEE MEMORIAL HOSPITAL Outpatient | United Healthcare | Medicaid | $7,047.29 | — | — | 2026-07-15 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Outpatient | Sunshine State Health | Medicaid | $7,047.29 | — | — | 2026-07-15 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Outpatient | Wellcare | Medicaid | $7,047.29 | — | — | 2026-07-15 | MRF ↗ |
| CHILDRENS HOSPITAL OF WISCONSIN OutpatientFacility | ICare | WI MEDICAID I CARE | $7,153.87 | — | — | 2026-03-23 | MRF ↗ |
| SILVER CROSS HOSPITAL AND MEDICAL CENTERS Outpatient | Meridian | Medicaid | $7,235.52 | — | — | 2026-09-20 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Outpatient | United Healthcare | Medicaid | $7,329.18 | — | — | 2026-07-15 | MRF ↗ |
| MANATEE MEMORIAL HOSPITAL Outpatient | Humana | Medicaid | $7,399.65 | — | — | 2026-07-15 | MRF ↗ |
| MANATEE MEMORIAL HOSPITAL Outpatient | Staywell | Wellcare Medicaid | $7,399.65 | — | — | 2026-07-15 | MRF ↗ |
| LAKEWOOD RANCH MEDICAL CENTER Outpatient | Staywell | Wellcare Medicaid | $7,400.00 | — | — | 2026-07-15 | MRF ↗ |
| LAKEWOOD RANCH MEDICAL CENTER Outpatient | Humana | Medicaid | $7,400.00 | — | — | 2026-07-15 | MRF ↗ |
| MANATEE MEMORIAL HOSPITAL Outpatient | Vivada | Medicaid | $7,540.60 | — | — | 2026-07-15 | MRF ↗ |
| LAKEWOOD RANCH MEDICAL CENTER Outpatient | Vivada | Medicaid | $7,541.00 | — | — | 2026-07-15 | MRF ↗ |
| NASSAU UNIVERSITY MEDICAL CENTER OutpatientFacility | Molina Healthcare (FKA Affinity) | Managed Medicaid | $7,585.27 | — | — | 2025-10-28 | MRF ↗ |
| NASSAU UNIVERSITY MEDICAL CENTER OutpatientFacility | Anthem Blue Cross and Blue Shield (FKA Empire) | Essential | $7,585.27 | — | — | 2025-10-28 | MRF ↗ |
| NASSAU UNIVERSITY MEDICAL CENTER OutpatientFacility | Healthfirst | Managed Medicaid | $7,585.27 | — | — | 2025-10-28 | MRF ↗ |
| LAKEWOOD RANCH MEDICAL CENTER Outpatient | Aetna | Medicaid | $7,611.07 | — | — | 2026-07-15 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Outpatient | Aetna | Medicaid | $7,611.07 | — | — | 2026-07-15 | MRF ↗ |
| MANATEE MEMORIAL HOSPITAL Outpatient | Aetna | Medicaid | $7,611.07 | — | — | 2026-07-15 | MRF ↗ |
| LAKEWOOD RANCH MEDICAL CENTER Outpatient | Sunshine State Health | Medicaid | $7,752.00 | — | — | 2026-07-15 | MRF ↗ |
| MANATEE MEMORIAL HOSPITAL Outpatient | Sunshine State Health | Medicaid | $7,752.01 | — | — | 2026-07-15 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Outpatient | Molina | Medicaid | $7,752.01 | — | — | 2026-07-15 | MRF ↗ |
| STURDY MEMORIAL HOSPITAL Outpatient | Mass Health | Medicaid | $8,067.39 | — | — | 2026-07-15 | MRF ↗ |
| STURDY MEMORIAL HOSPITAL Outpatient | Boston Medical Center /Wellsense- | Non-Metals (Baco) | $8,067.39 | — | — | 2026-07-15 | MRF ↗ |
| MILFORD REGIONAL MEDICAL CENTER Outpatient | Tufts Health Together | Medicaid | $8,124.47 | — | — | 2026-07-15 | MRF ↗ |
| MILFORD REGIONAL MEDICAL CENTER Outpatient | Fallon 365 / Wellforce | Medicaid | $8,124.47 | — | — | 2026-07-15 | MRF ↗ |
| MILFORD REGIONAL MEDICAL CENTER Outpatient | Masshealth | — | $8,124.47 | — | — | 2026-07-15 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | MVP MEDICAID 1712 | MVP ESSENTIAL 3-4 171204, MVP ESSENTIAL 1-2 200-250 2900 | $8,230.28 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | MVP MEDICAID 1712 | MVP ESSENTIAL 3-4 171204, MVP ESSENTIAL 1-2 200-250 2900 | $8,230.28 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | MVP MEDICAID 1712 | MVP ESSENTIAL 3-4 171204, MVP ESSENTIAL 1-2 200-250 2900 | $8,230.28 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | MVP MEDICAID 1712 | MVP ESSENTIAL 3-4 171204, MVP ESSENTIAL 1-2 200-250 2900 | $8,230.28 | — | — | 2026-01-01 | MRF ↗ |
| ST JAMES HOSPITAL Outpatient | MVP MEDICAID 1712 | MVP ESSENTIAL 3-4 171204, MVP ESSENTIAL 1-2 200-250 2900 | $8,230.28 | — | — | 2026-01-01 | MRF ↗ |
| CONFLUENCE HEALTH HOSPITAL Outpatient | Molina Apple Health | MOLINA AH BLIND_DISABLED | $8,260.42 | $8,260.42 | — | 2024-07-01 | MRF ↗ |
| CONFLUENCE HEALTH HOSPITAL Outpatient | Molina Apple Health | MOLINA AH | $8,260.42 | $8,260.42 | — | 2024-07-01 | MRF ↗ |
| CONFLUENCE HEALTH HOSPITAL Outpatient | Molina Apple Health | MOLINA BEHAVIORAL HEALTH ONLY | $8,260.42 | $8,260.42 | — | 2024-07-01 | MRF ↗ |
| SOUTHWESTERN VERMONT MEDICAL CENTER Outpatient | Hne | Medicaid | $8,368.75 | — | — | 2026-07-15 | MRF ↗ |
| SOUTHWESTERN VERMONT MEDICAL CENTER Outpatient | Bmc | Healthnet Plan | $8,368.75 | — | — | 2026-07-15 | MRF ↗ |
| MANATEE MEMORIAL HOSPITAL Outpatient | Simply | Medicaid | $8,456.74 | — | — | 2026-07-15 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Outpatient | Prestigehealth | Medicaid | $8,456.74 | — | — | 2026-07-15 | MRF ↗ |
| MANATEE MEMORIAL HOSPITAL Outpatient | Amerigroup | Medicaid | $8,456.74 | — | — | 2026-07-15 | MRF ↗ |
| LAKEWOOD RANCH MEDICAL CENTER Outpatient | Simply | Medicaid | $8,457.00 | — | — | 2026-07-15 | MRF ↗ |
| LAKEWOOD RANCH MEDICAL CENTER Outpatient | Amerigroup | Medicaid | $8,457.00 | — | — | 2026-07-15 | MRF ↗ |
| CONFLUENCE HEALTH HOSPITAL Outpatient | UHC Apple Health | NORTHWEST PHYSICIAN NETWORK | $8,481.68 | $8,481.68 | — | 2024-07-01 | MRF ↗ |
| CONFLUENCE HEALTH HOSPITAL Outpatient | UHC Apple Health | UNITED HEALTHCARE BEHAVIORAL HEALTH ONLY | $8,481.68 | $8,481.68 | — | 2024-07-01 | MRF ↗ |
| CONFLUENCE HEALTH HOSPITAL Outpatient | UHC Apple Health | UNITED HEALTH CARE AH | $8,481.68 | $8,481.68 | — | 2024-07-01 | MRF ↗ |
| MIDWESTERN REGION MED CENTER, INC Outpatient | County Care | Medicaid All Plans | $8,840.36 | — | — | 2026-03-27 | MRF ↗ |
| MIDWESTERN REGION MED CENTER, INC Outpatient | Meridian | Medicaid All Plans | $8,840.36 | — | — | 2026-03-27 | MRF ↗ |
| CONFLUENCE HEALTH HOSPITAL Outpatient | CHPW Apple Health | CHP WASHINGTON HEALTH | $8,961.08 | $8,961.08 | — | 2024-07-01 | MRF ↗ |
| CONFLUENCE HEALTH HOSPITAL Outpatient | CHPW Apple Health | CHP-BEHAVIORAL HEALTH ONLY | $8,961.08 | $8,961.08 | — | 2024-07-01 | MRF ↗ |
| CONFLUENCE HEALTH HOSPITAL Outpatient | CHPW Apple Health | CHP AH | $8,961.08 | $8,961.08 | — | 2024-07-01 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | FIDELIS MEDICAID 1708 | FIDELIS ESSENTIAL 3-4 170804, FIDELIS ESSENTIAL 1-2 200-250 5155 | $9,033.23 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | FIDELIS MEDICAID 1708 | FIDELIS ESSENTIAL 3-4 170804, FIDELIS ESSENTIAL 1-2 200-250 5155 | $9,033.23 | — | — | 2026-01-01 | MRF ↗ |
| NICHOLAS H NOYES MEMORIAL HOSPITAL Outpatient | MOLINA HEALTHCARE 1723 | MOLINA ESSENTIAL 3-4 172302, MOLINA ESSENTIAL 1-2 200-250 5189 | $9,033.23 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | MOLINA HEALTHCARE 1723 | MOLINA ESSENTIAL 3-4 172302, MOLINA ESSENTIAL 1-2 200-250 5189 | $9,033.23 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | HIGHMARK BLUE CROSS BLUE SHIELD MEDICAID 5143 | HIGHMARK BCBS ESSENTIAL 1-2 200-250 5143 | $9,033.23 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | FIDELIS MEDICAID 1708 | FIDELIS ESSENTIAL 3-4 170804, FIDELIS ESSENTIAL 1-2 200-250 5155 | $9,033.23 | — | — | 2026-01-01 | MRF ↗ |
| JONES MEMORIAL HOSPITAL Outpatient | MOLINA HEALTHCARE 1723 | MOLINA ESSENTIAL 3-4 172302, MOLINA ESSENTIAL 1-2 200-250 5189 | $9,033.23 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | HIGHMARK BLUE CROSS BLUE SHIELD MEDICAID 5143 | HIGHMARK BCBS ESSENTIAL 1-2 200-250 5143 | $9,033.23 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | FIDELIS MEDICAID 1708 | FIDELIS ESSENTIAL 3-4 170804, FIDELIS ESSENTIAL 1-2 200-250 5155 | $9,033.23 | — | — | 2026-01-01 | MRF ↗ |
| F F THOMPSON HOSPITAL Outpatient | MOLINA HEALTHCARE 1723 | MOLINA ESSENTIAL 3-4 172302, MOLINA ESSENTIAL 1-2 200-250 5189 | $9,033.23 | — | — | 2026-01-01 | MRF ↗ |
Showing the first 200 rate rows. The CSV export above returns up to 1,000 rows — filter by state to narrow a code with more than that.