97162 — Pt Eval Mod Complex 30 Min
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). PT EVAL MOD COMPLEX 30 MIN (CPT 97162) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/97162?code_type=CPT
MLA (9th ed.)
“PT EVAL MOD COMPLEX 30 MIN (CPT 97162) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/97162?code_type=CPT. Accessed .
Chicago (notes-bibliography)
“PT EVAL MOD COMPLEX 30 MIN (CPT 97162) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/97162?code_type=CPT.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $109–$309 (25th–75th percentile) across 3,230 hospitals · 11,047 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CPT/HCPCS 97162 — 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 surgeon and anesthesia figures are estimates from the Medicare fee schedule scaled to commercial rates — not facility-specific quotes.
What hospitals actually negotiate
Measured
$109
$193 typical
$309
The middle 50% of negotiated facility rates for this procedure, measured across 3,230 hospitals. Surgeon & anesthesia 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. | $193 |
| Surgeon (professional fee) Estimate national typical Medicare PFS $98 × 1.22 commercial. | $119 |
| Likely subtotal | $312 |
Surgical episode (typical)
~$312
Your recovery plan — adjust to what your surgeon told you
After surgery, 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)
~$4,097
How each figure is sourced
- Hospital facility (actual)
- source: Hospital MRF (45 CFR 180)
- Surgeon (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
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 |
|---|---|---|---|---|---|---|---|
| TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH Inpatient | None | — | — | $478.87 | $239.44 | 2024-12-15 | MRF ↗ |
| TEXAS HEALTH HOSPITAL MANSFIELD Inpatient | None | — | — | $478.87 | $239.44 | 2024-12-15 | MRF ↗ |
| HANCOCK COUNTY HEALTH SYSTEM Outpatient | WELLMARK HMO-ALL OTHER PLANS | WELLMARK HMO-ALL OTHER PLANS | $0.31 | $269.00 | $201.75 | 2026-03-26 | MRF ↗ |
| MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL OutpatientFacility | LA Care Health | Managed Medi-Cal | $0.75 | $5.00 | $0.95 | 2026-03-26 | MRF ↗ |
| MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL OutpatientFacility | Health Net | Managed Medi-Cal | $0.90 | $5.00 | $0.95 | 2026-03-26 | MRF ↗ |
| CEDARS-SINAI MEDICAL CENTER Outpatient | SCAN Health Plan | Medicare Advantage | — | $1,695.42 | $1,102.02 | 2025-11-26 | MRF ↗ |
| TORRANCE MEMORIAL MEDICAL CENTER Outpatient | Health Net of California, Inc. | Medicare Advantage | — | $1,152.00 | $944.64 | 2025-11-26 | MRF ↗ |
| TORRANCE MEMORIAL MEDICAL CENTER Outpatient | United Healthcare | Medicare Advantage | — | $1,152.00 | $944.64 | 2025-11-26 | MRF ↗ |
| ST MARY'S HOSPITAL OutpatientFacility | Amerigroup | Medicaid/Peachcare | $1.00 | $416.00 | $270.40 | 2025-01-01 | MRF ↗ |
| TORRANCE MEMORIAL MEDICAL CENTER Both | SCAN | Medicare Advantage | — | $1,152.00 | $944.64 | 2025-11-26 | MRF ↗ |
| CEDARS-SINAI MEDICAL CENTER Inpatient | UHC of California, dba UnitedHealthcare of California and fka PacificCare of California | Medicare Advantage | — | $2,203.72 | $1,432.42 | 2025-11-26 | MRF ↗ |
| TORRANCE MEMORIAL MEDICAL CENTER Inpatient | California Physicians' Service dba Blue Shield of California | HMO | — | $1,152.00 | $944.64 | 2025-11-26 | MRF ↗ |
| TORRANCE MEMORIAL MEDICAL CENTER Inpatient | United Healthcare | HMO | — | $1,152.00 | $944.64 | 2025-11-26 | MRF ↗ |
| TORRANCE MEMORIAL MEDICAL CENTER Inpatient | California Physicians' Service dba Blue Shield of California | Covered | — | $1,152.00 | $944.64 | 2025-11-26 | MRF ↗ |
| TORRANCE MEMORIAL MEDICAL CENTER Inpatient | United Healthcare | POS | — | $1,152.00 | $944.64 | 2025-11-26 | MRF ↗ |
| TORRANCE MEMORIAL MEDICAL CENTER Outpatient | Aetna Health of California, Inc. and Aetna Health Management LLC | Medicare Advantage | — | $1,152.00 | $944.64 | 2025-11-26 | MRF ↗ |
| TORRANCE MEMORIAL MEDICAL CENTER Outpatient | Humana Health Plan, Inc. | Medicare Advantage | — | $1,152.00 | $944.64 | 2025-11-26 | MRF ↗ |
| TORRANCE MEMORIAL MEDICAL CENTER Outpatient | Health Net of California, Inc. | HMO | — | $1,152.00 | $944.64 | 2025-11-26 | MRF ↗ |
| SHARP MESA VISTA HOSPITAL Outpatient | Blue Shield | Blue Shield - Promise | $1.10 | $480.00 | $360.00 | 2026-04-01 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | UnitedHealth Group of WI | Medicare Advantage | $1.15 | $310.00 | $294.50 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $1.15 | $310.00 | $294.50 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $1.15 | $310.00 | $294.50 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $1.18 | $310.00 | $294.50 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Point Comfort Underwriters | Organizational | $1.24 | $310.00 | $294.50 | 2026-02-20 | MRF ↗ |
| EXCELSIOR SPRINGS HOSPITAL BothFacility | HUMANA INC. - Medicare-HMO | Medicare Advantage | $1.25 | $379.00 | $379.00 | 2025-12-12 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $1.26 | $263.00 | $249.85 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $1.26 | $263.00 | $249.85 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $1.29 | $263.00 | $249.85 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Point Comfort Underwriters | Organizational | $1.29 | $263.00 | $249.85 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $1.34 | $263.00 | $249.85 | 2026-02-20 | MRF ↗ |
| FIELD HEALTH SYSTEM Both | United Healthcare | Default | $1.45 | $148.00 | $111.00 | 2025-03-07 | MRF ↗ |
| MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL InpatientFacility | Health Net | Commercial | $1.50 | $5.00 | $0.95 | 2026-03-26 | MRF ↗ |
| MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL InpatientFacility | Health Net | Exchange PPO | $1.50 | $5.00 | $0.95 | 2026-03-26 | MRF ↗ |
| MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL InpatientFacility | Health Net | Exchange HMO | $1.50 | $5.00 | $0.95 | 2026-03-26 | MRF ↗ |
| MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL OutpatientFacility | Alta | Managed Medi-Cal | $1.50 | $5.00 | $0.95 | 2026-03-26 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $1.78 | $363.00 | $344.85 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $1.78 | $363.00 | $344.85 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $1.81 | $363.00 | $344.85 | 2026-02-20 | MRF ↗ |
| MERCY HOSPITAL COLUMBUS OutpatientFacility | CENTIVO CONTRACTED [320505] | HB MNCK CENTIVO 165% MEDICARE | $1.85 | $181.00 | $117.65 | 2026-03-14 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $1.89 | $363.00 | $344.85 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Point Comfort Underwriters | Organizational | $1.96 | $363.00 | $344.85 | 2026-02-20 | MRF ↗ |
| WYANDOTTE HOSPITAL AND MEDICAL CENTER OutpatientFacility | HAP | Self Insured | $2.05 | $319.00 | — | 2025-06-28 | MRF ↗ |
| MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL OutpatientFacility | Blue Shield of California | EPN | $2.05 | $5.00 | $0.95 | 2026-03-26 | MRF ↗ |
| MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL OutpatientFacility | United Healthcare | Commercial | $2.14 | $5.00 | $0.95 | 2026-03-26 | MRF ↗ |
| SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD OutpatientFacility | Blue Shield of California | Covered California/IFP/PPO | $2.17 | $629.70 | $629.70 | 2026-03-18 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | Covered California/IFP/PPO | $2.17 | $450.12 | $450.12 | 2026-03-18 | MRF ↗ |
| Southern California Hospital At Culver City OutpatientFacility | Blue Shield of California | Covered California/IFP/PPO | $2.17 | $629.70 | $629.70 | 2026-03-18 | MRF ↗ |
| MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL OutpatientFacility | Blue Shield of California | Commercial | $2.27 | $5.00 | $0.95 | 2026-03-26 | MRF ↗ |
| MERCY HOSPITAL COLUMBUS OutpatientFacility | CENTIVO CONTRACTED [320505] | HB MNCK CENTIVO 165% MEDICARE | $2.28 | $224.00 | $145.60 | 2026-03-14 | MRF ↗ |
| Southern California Hospital At Culver City OutpatientFacility | Blue Shield of California | HMO | $2.48 | $629.70 | $629.70 | 2026-03-18 | MRF ↗ |
| SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD OutpatientFacility | Blue Shield of California | HMO | $2.48 | $629.70 | $629.70 | 2026-03-18 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | HMO | $2.48 | $450.12 | $450.12 | 2026-03-18 | MRF ↗ |
| CHERRY COUNTY HOSPITAL Outpatient | AMBETTER COMM - ALL PLANS | AMBETTER COMM - ALL PLANS | $2.52 | $242.55 | $242.55 | 2026-04-24 | MRF ↗ |
| SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $2.70 | $629.70 | $629.70 | 2026-03-18 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $2.70 | $450.12 | $450.12 | 2026-03-18 | MRF ↗ |
| Southern California Hospital At Culver City OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $2.70 | $629.70 | $629.70 | 2026-03-18 | MRF ↗ |
| MERCY HOSPITAL COLUMBUS OutpatientFacility | CENTIVO CONTRACTED [320505] | HB MNCK CENTIVO 165% MEDICARE | $2.72 | $267.00 | $173.55 | 2026-03-14 | MRF ↗ |
| MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL InpatientFacility | Brand New Day | Medicare Advantage | $3.00 | $5.00 | $0.95 | 2026-03-26 | MRF ↗ |
| MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL OutpatientFacility | Santa Monica UNITE HERE | Commercial | $3.00 | $5.00 | $0.95 | 2026-03-26 | MRF ↗ |
| SAVOY MEDICAL CENTER OutpatientFacility | United Healthcare | PPO | $3.01 | $464.31 | $278.59 | 2026-03-15 | MRF ↗ |
| SAVOY MEDICAL CENTER OutpatientFacility | United Healthcare | HMO Other | $3.01 | $464.31 | $278.59 | 2026-03-15 | MRF ↗ |
| LAKEVIEW HOSPITAL BothFacility | HP MEDICAID REPLACEMENT [950307] | HP CARE PMAP [50327] | $3.02 | $418.00 | $154.66 | 2026-03-31 | MRF ↗ |
| MERCY HOSPITAL COLUMBUS OutpatientFacility | CENTIVO CONTRACTED [320505] | HB MNCK CENTIVO 165% MEDICARE | $3.15 | $309.00 | $200.85 | 2026-03-14 | MRF ↗ |
| WEST FELICIANA PARISH HOSPITAL Both | Humana MCD Rep (Plan: Medicaid Replacement) | Humana MCD Rep (Plan: Medicaid Replacement) | $3.58 | $369.65 | $221.79 | 2025-08-11 | MRF ↗ |
| MERCY HOSPITAL COLUMBUS OutpatientFacility | CENTIVO CONTRACTED [320505] | HB MNCK CENTIVO 165% MEDICARE | $3.58 | $351.00 | $228.15 | 2026-03-14 | MRF ↗ |
| WEST FELICIANA PARISH HOSPITAL Both | Humana MCD Rep (Plan: Medicaid Replacement) | Humana MCD Rep (Plan: Medicaid Replacement) | $3.58 | $369.65 | $221.79 | 2025-08-11 | MRF ↗ |
| EXCELSIOR SPRINGS HOSPITAL BothFacility | HUMANA INC - Medicare-HMO | Medicare Advantage | $3.79 | $379.00 | $379.00 | 2025-12-12 | MRF ↗ |
| UnityPoint Health - Trinity Moline InpatientFacility | United Healthcare | PPO | — | $289.92 | $231.94 | 2026-01-28 | MRF ↗ |
| MARTIN LUTHER KING, JR. COMMUNITY HOSPITAL InpatientFacility | MultiPlan | Commercial | $4.00 | $5.00 | $0.95 | 2026-03-26 | MRF ↗ |
| MERCY HOSPITAL COLUMBUS OutpatientFacility | CENTIVO CONTRACTED [320505] | HB MNCK CENTIVO 165% MEDICARE | $4.01 | $393.00 | $255.45 | 2026-03-14 | MRF ↗ |
| MERCY HOSPITAL COLUMBUS OutpatientFacility | CENTIVO CONTRACTED [320505] | HB MNCK CENTIVO 165% MEDICARE | $4.45 | $436.00 | $283.40 | 2026-03-14 | MRF ↗ |
| LOS ANGELES COMMUNITY HOSPITAL OutpatientFacility | Blue Shield of California | Commercial/IFP | $4.75 | $450.12 | $450.12 | 2026-03-18 | MRF ↗ |
| MERCY HOSPITAL COLUMBUS OutpatientFacility | CENTIVO CONTRACTED [320505] | HB MNCK CENTIVO 165% MEDICARE | $4.89 | $479.00 | $311.35 | 2026-03-14 | MRF ↗ |
| MERCY HOSPITAL COLUMBUS OutpatientFacility | CENTIVO CONTRACTED [320505] | HB MNCK CENTIVO 165% MEDICARE | $5.31 | $521.00 | $338.65 | 2026-03-14 | MRF ↗ |
| THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC BothFacility | ARISE HEALTH PLAN - WPS HEALTH PLAN INC - Commercial-Indemnity | Other Commercial | $5.40 | $305.00 | $170.80 | 2025-01-01 | MRF ↗ |
| THEDACARE REGIONAL MEDICAL CENTER - APPLETON INC BothFacility | ARISE ADMINISTRATORS - WPS HEALTH PLAN INC - Commercial-Indemnity | Other Commercial | $5.40 | $305.00 | $170.80 | 2025-01-01 | MRF ↗ |
| CONEMAUGH MINERS MEDICAL CENTER Outpatient | Bcbs Of Pa | Highmark Medicare Advantage | $5.49 | $352.00 | $140.80 | 2026-05-13 | MRF ↗ |
| CONEMAUGH MINERS MEDICAL CENTER Outpatient | Bcbs Of Pa | Highmark Medicare Advantage | $5.49 | $352.00 | $140.80 | 2026-05-22 | MRF ↗ |
| MERCY HOSPITAL COLUMBUS OutpatientFacility | CENTIVO CONTRACTED [320505] | HB MNCK CENTIVO 165% MEDICARE | $5.74 | $563.00 | $365.95 | 2026-03-14 | MRF ↗ |
| HUNTINGTON HOSPITAL Outpatient | California PhysiciansÆ Service, dba Blue Shield of California | Medi-Cal | — | $653.52 | $424.79 | 2025-11-26 | MRF ↗ |
| ALBANY MEDICAL CENTER HOSPITAL OutpatientFacility | MagnaCare | All Products | $7.15 | — | — | 2025-12-31 | MRF ↗ |
| MT SAN RAFAEL HOSPITAL Both | WELLPOINT (AMGRP) | WELLPOINT (AMGRP) | $7.39 | $369.50 | — | 2026-03-31 | MRF ↗ |
| MT SAN RAFAEL HOSPITAL Both | COLORADO ACCESS | COLORADO ACCESS | $7.39 | $369.50 | — | 2026-03-31 | MRF ↗ |
| MT SAN RAFAEL HOSPITAL Both | DENVER HEALTH MED PLAN | DENVER HEALTH MED PLAN | $7.39 | $369.50 | — | 2026-03-31 | MRF ↗ |
| MT SAN RAFAEL HOSPITAL Both | MEDICAID | MEDICAID BEACON HEALTH | $7.39 | $369.50 | — | 2026-03-31 | MRF ↗ |
| MT SAN RAFAEL HOSPITAL Both | UHC COMMUNITY PLAN | UHC COMMUNITY PLAN | $7.39 | $369.50 | — | 2026-03-31 | MRF ↗ |
| MT SAN RAFAEL HOSPITAL Both | MEDICAID | MEDICAID COLORADO | $7.39 | $369.50 | — | 2026-03-31 | MRF ↗ |
| MT SAN RAFAEL HOSPITAL Both | MEDICAID | MISC MEDICAID GET NAME | $7.39 | $369.50 | — | 2026-03-31 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL BothFacility | Tricare | All | $8.41 | $268.00 | $268.00 | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL BothFacility | UHC | Medicare Advantage | $8.41 | $268.00 | $268.00 | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL BothFacility | VA Health | All | $8.41 | $268.00 | $268.00 | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL BothFacility | Blue Cross Blue Shield | Medicare Advantage | $8.41 | $268.00 | $268.00 | 2026-03-28 | MRF ↗ |
| FALLON MEDICAL COMPLEX HOSPITAL BothFacility | Humana | Medicare Advantage | $8.41 | $268.00 | $268.00 | 2026-03-28 | MRF ↗ |
| HELEN KELLER HOSPITAL Both | CIGNA | CIGNA COMMERCIAL | $8.77 | $35.09 | $35.09 | 2026-03-27 | MRF ↗ |
| HELEN KELLER HOSPITAL Both | CIGNA | CIGNA COMMERCIAL-ALLEG | $8.77 | $35.09 | $35.09 | 2026-03-27 | MRF ↗ |
| HELEN KELLER HOSPITAL Both | CIGNA | CIGNA COMMERCIAL-PPO | $8.77 | $35.09 | $35.09 | 2026-03-27 | MRF ↗ |
| HELEN KELLER HOSPITAL Both | CIGNA | CIGNA COMMERCIAL-BH | $8.77 | $35.09 | $35.09 | 2026-03-27 | MRF ↗ |
| HELEN KELLER HOSPITAL Both | CIGNA | CIGNA COMMERCIAL | $8.77 | $35.09 | $35.09 | 2026-03-27 | MRF ↗ |
| HELEN KELLER HOSPITAL Both | CIGNA | CIGNA COMMERCIAL-BH | $8.77 | $35.09 | $35.09 | 2026-03-27 | MRF ↗ |
| HELEN KELLER HOSPITAL Both | CIGNA | CIGNA COMMERCIAL-PPO | $8.77 | $35.09 | $35.09 | 2026-03-27 | MRF ↗ |
| HELEN KELLER HOSPITAL Both | CIGNA | CIGNA COMMERCIAL-ALLEG | $8.77 | $35.09 | $35.09 | 2026-03-27 | MRF ↗ |
| RURAL WELLNESS STROUD HOSPITAL Both | Medicaid | Traditional | — | $317.22 | $190.33 | 2026-03-23 | MRF ↗ |
| THE PHYSICIANS' HOSPITAL IN ANADARKO Both | Medicaid | Traditional | — | $317.22 | $190.33 | 2026-03-23 | MRF ↗ |
| MERCY HOSPITAL JEFFERSON OutpatientFacility | MOLINA HEALTHCARE MEDICAID [20265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $9.88 | $152.00 | $98.80 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL JEFFERSON OutpatientFacility | MOLINA HEALTHCARE MEDICAID CONTRACTED [320265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $9.88 | $152.00 | $98.80 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL JEFFERSON OutpatientFacility | MERIDIAN MEDICAID CONTRACTED [320430] | HB WASH JEFN LINC SAMC MERIDIAN HEALTH PLAN OF IL MEDICAID 103% | $9.88 | $152.00 | $98.80 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL SOUTH OutpatientFacility | MERIDIAN MEDICAID CONTRACTED [320430] | HB WASH JEFN LINC SAMC MERIDIAN HEALTH PLAN OF IL MEDICAID 103% | $9.88 | $152.00 | $98.80 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL SOUTH OutpatientFacility | MOLINA HEALTHCARE MEDICAID CONTRACTED [320265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $9.88 | $152.00 | $98.80 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL SOUTH OutpatientFacility | MOLINA HEALTHCARE MEDICAID [20265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $9.88 | $152.00 | $98.80 | 2026-03-12 | MRF ↗ |
| VISTA MEDICAL CENTER EAST Outpatient | Medicaid | Medicaid | $10.27 | $810.90 | $810.90 | 2025-03-31 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC | 9395_UNITED HEALTHCARE VRIN 20250101 | $10.90 | $394.00 | $236.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Outpatient | UHC NEW | 6787_UNITED HEALTHCARE NEW BUSINESS OUTPATIENT NRIN 20230101 | $10.90 | $265.00 | $159.00 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT HOSPITAL Outpatient | UHC SELF | 6788_UNITED HEALTHCARE SELF FUNDED OUTPATIENT NRIN 20230101 | $10.90 | $265.00 | $159.00 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CLAY Both | UHC | 9384_UNITED HEALTHCARE CLIN 20250101 | $10.90 | $322.00 | $193.20 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Inpatient | UHC | 8493_UNITED HEALTHCARE SWIN 20240701 | $10.90 | $300.00 | $180.00 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WARRICK Inpatient | UHC BEHAVIORAL HEALTH | 8231_UNITED HEALTH CARE BEHAVIORAL HEALTH 20230401 | $10.90 | $300.00 | $180.00 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT ANDERSON Both | UHC | 9390_UNITED HEALTHCARE VAIN 20250101 | $10.90 | $300.00 | $180.00 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT CARMEL Outpatient | UHC NEW | 6793_UNITED HEALTHCARE NEW BUSINESS OUTPATIENT ECIN 20230101 | $10.90 | $265.00 | $159.00 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT RANDOLPH Both | UHC | 9395_UNITED HEALTHCARE VRIN 20250101 | $10.90 | $394.00 | $236.40 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | UHC | 9393_UNITED HEALTHCARE VKIN 20250101 | $10.90 | $298.00 | $178.80 | 2026-01-01 | MRF ↗ |
| ASCENSION ST VINCENT WILLIAMSPORT Both | UHC | 9397_UNITED HEALTHCARE VWIN 20250101 | $10.90 | $322.00 | $193.20 | 2026-01-01 | MRF ↗ |
| MERCY HOSPITAL WASHINGTON OutpatientFacility | MOLINA HEALTHCARE MEDICAID CONTRACTED [320265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $11.83 | $182.00 | $118.30 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL WASHINGTON OutpatientFacility | MOLINA HEALTHCARE MEDICAID [20265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $11.83 | $182.00 | $118.30 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL WASHINGTON OutpatientFacility | MERIDIAN MEDICAID CONTRACTED [320430] | HB WASH JEFN LINC SAMC MERIDIAN HEALTH PLAN OF IL MEDICAID 103% | $11.83 | $182.00 | $118.30 | 2026-03-12 | MRF ↗ |
| OUR LADY OF THE LAKE SURGICAL HOSPITAL BothFacility | Aetna | Medicare Advantage | $11.97 | $95.00 | — | 2026-03-17 | MRF ↗ |
| OUR LADY OF THE LAKE SURGICAL HOSPITAL BothFacility | Aetna | All Plans | $11.97 | $95.00 | — | 2026-03-17 | MRF ↗ |
| COLUMBUS COMMUNITY HOSPITAL Outpatient | United Healthcare Commercial | PPO/HMO | — | $250.00 | $187.50 | 2026-03-31 | MRF ↗ |
| IRON COUNTY MEDICAL CENTER Outpatient | Healthlink | HMO/PPO/Traditional | $12.44 | $263.00 | $236.70 | 2026-03-03 | MRF ↗ |
| SUNRISE HOSPITAL AND MEDICAL CENTER OutpatientFacility | Aetna | MCR | $12.92 | — | — | 2026-03-01 | MRF ↗ |
| MOUNTAINVIEW HOSPITAL Outpatient | Aetna | MCR | $12.92 | — | — | 2026-03-01 | MRF ↗ |
| SOUTHERN HILLS HOSPITAL AND MEDICAL CENTER Outpatient | Aetna | MCR | $12.92 | — | — | 2026-03-01 | MRF ↗ |
| MERCY HOSPITAL SOUTH OutpatientFacility | MERIDIAN MEDICAID CONTRACTED [320430] | HB WASH JEFN LINC SAMC MERIDIAN HEALTH PLAN OF IL MEDICAID 103% | $13.00 | $200.00 | $130.00 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL SOUTH OutpatientFacility | MOLINA HEALTHCARE MEDICAID CONTRACTED [320265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $13.00 | $200.00 | $130.00 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL SOUTH OutpatientFacility | MOLINA HEALTHCARE MEDICAID [20265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $13.00 | $200.00 | $130.00 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL LINCOLN OutpatientFacility | MERIDIAN MEDICAID CONTRACTED [320430] | HB WASH JEFN LINC SAMC MERIDIAN HEALTH PLAN OF IL MEDICAID 103% | $13.13 | $202.00 | $131.30 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL LINCOLN OutpatientFacility | MOLINA HEALTHCARE MEDICAID CONTRACTED [320265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $13.13 | $202.00 | $131.30 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL LINCOLN OutpatientFacility | MOLINA HEALTHCARE MEDICAID [20265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $13.13 | $202.00 | $131.30 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL LINCOLN OutpatientFacility | MOLINA HEALTHCARE MEDICAID CONTRACTED [320265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $13.13 | $202.00 | $131.30 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL LINCOLN OutpatientFacility | MERIDIAN MEDICAID CONTRACTED [320430] | HB WASH JEFN LINC SAMC MERIDIAN HEALTH PLAN OF IL MEDICAID 103% | $13.13 | $202.00 | $131.30 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL LINCOLN OutpatientFacility | MOLINA HEALTHCARE MEDICAID [20265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $13.13 | $202.00 | $131.30 | 2026-03-12 | MRF ↗ |
| ST DAVID'S SOUTH AUSTIN MEDICAL CENTER Outpatient | Superior Health Plan | STAR | $13.50 | $270.00 | $270.00 | 2026-03-01 | MRF ↗ |
| ST DAVID'S SOUTH AUSTIN MEDICAL CENTER Outpatient | Superior Health Plan | CHPFC | $13.50 | $270.00 | $270.00 | 2026-03-01 | MRF ↗ |
| ST DAVID'S SOUTH AUSTIN MEDICAL CENTER Outpatient | Superior Health Plan | STARPLUS | $13.50 | $270.00 | $270.00 | 2026-03-01 | MRF ↗ |
| ST DAVID'S SOUTH AUSTIN MEDICAL CENTER Outpatient | Superior Health Plan | CHIP | $13.50 | $270.00 | $270.00 | 2026-03-01 | MRF ↗ |
| SAINT PETER'S UNIVERSITY HOSPITAL Both | Horizon Mercy | HORIZON NJ HEALTH MANAGED MD | $14.00 | $1,039.00 | $1,025.00 | 2025-11-19 | MRF ↗ |
| SAINT PETER'S UNIVERSITY HOSPITAL Both | Horizon Mercy | HORIZON NJ HEALTH MANAGED MD | $14.00 | $996.00 | $982.00 | 2025-11-19 | MRF ↗ |
| SAINT PETER'S UNIVERSITY HOSPITAL Both | Horizon Mercy | HORIZON NJ HEALTH MANAGED MD | $14.00 | $860.00 | $846.00 | 2025-11-19 | MRF ↗ |
| STURDY MEMORIAL HOSPITAL Outpatient | Tufts (Point32Health) | Commercial | — | — | — | 2026-05-08 | MRF ↗ |
| STURDY MEMORIAL HOSPITAL Outpatient | Cigna | Commercial | — | — | — | 2026-05-08 | MRF ↗ |
| JEFFERSON STRATFORD HOSPITAL OutpatientFacility | Horizon NJ Health NJ | Medicaid | $14.12 | — | — | 2026-03-18 | MRF ↗ |
| JEFFERSON STRATFORD HOSPITAL OutpatientFacility | Horizon NJ Health NJ | Medicaid | $14.12 | — | — | 2026-03-18 | MRF ↗ |
| JEFFERSON STRATFORD HOSPITAL OutpatientFacility | Horizon NJ Health NJ | Medicaid | $14.12 | — | — | 2026-03-18 | MRF ↗ |
| H Lee Moffitt Cancer Center & Research Institute I Both | Health First | Medicare Advantage - Outpatient | $14.21 | $74.00 | $37.00 | 2025-10-24 | MRF ↗ |
| H Lee Moffitt Cancer Center & Research Institute I Both | BlueCross | Medicare Advantage - Outpatient | $14.21 | $74.00 | $37.00 | 2025-10-24 | MRF ↗ |
| H Lee Moffitt Cancer Center & Research Institute I Both | United HC | Medicare Advantage - Outpatient | $14.21 | $74.00 | $37.00 | 2025-10-24 | MRF ↗ |
| KENT COUNTY MEMORIAL HOSPITAL OutpatientFacility | CONNECTICUT GENERAL LIFE INSURANCE COMPANY | COMMERCIAL | — | $303.00 | $106.05 | 2026-02-28 | MRF ↗ |
| H Lee Moffitt Cancer Center & Research Institute I Both | Molina | Medicare Advantage - Outpatient | $14.50 | $74.00 | $37.00 | 2025-10-24 | MRF ↗ |
| HEALTHSOURCE SAGINAW Inpatient | Meridian Health Plan | Medicaid | — | $173.00 | $173.00 | 2026-04-01 | MRF ↗ |
| SUNRISE HOSPITAL AND MEDICAL CENTER OutpatientFacility | United | MGMCD | — | — | — | 2026-03-01 | MRF ↗ |
| MOUNTAINVIEW HOSPITAL Outpatient | Aetna | MCR | $14.68 | — | — | 2026-03-01 | MRF ↗ |
| MOUNTAINVIEW HOSPITAL Outpatient | United | MGMCD | — | — | — | 2026-03-01 | MRF ↗ |
| SOUTHERN HILLS HOSPITAL AND MEDICAL CENTER Outpatient | Aetna | MCR | $14.68 | — | — | 2026-03-01 | MRF ↗ |
| SUNRISE HOSPITAL AND MEDICAL CENTER OutpatientFacility | Aetna | MCR | $14.68 | — | — | 2026-03-01 | MRF ↗ |
| MERCY HOSPITAL ST LOUIS OutpatientFacility | MOLINA HEALTHCARE MEDICAID CONTRACTED [320265] | HB STLO CAPE MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $14.69 | $226.00 | $146.90 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL ST LOUIS OutpatientFacility | MERIDIAN MEDICAID CONTRACTED [320430] | HB STLO CAPE MERIDIAN HEALTH PLAN OF IL MEDICAID 103% | $14.69 | $226.00 | $146.90 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL ST LOUIS OutpatientFacility | MOLINA HEALTHCARE MEDICAID [20265] | HB STLO CAPE MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $14.69 | $226.00 | $146.90 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL ST LOUIS OutpatientFacility | AETNA MEDICAID CONTRACTED [320009] | HB STLO CAPE AETNA BETTER HEALTH OF IL MEDICAID NEW 040125 | $14.69 | $226.00 | $146.90 | 2026-03-12 | MRF ↗ |
| AVERA ST LUKES Outpatient | Wellmark Insurance | Hmo | — | $285.00 | $256.50 | 2026-05-09 | MRF ↗ |
| AVERA ST LUKES Outpatient | Wellmark Insurance | Ppo | — | $285.00 | $256.50 | 2026-05-09 | MRF ↗ |
| DEQUINCY MEMORIAL HOSPITAL Both | UNITED HEALTHCARE | UHC SHARED SAVINGS OP | — | $272.00 | — | 2026-01-15 | MRF ↗ |
| DEQUINCY MEMORIAL HOSPITAL Both | UMR O/P | UMR IP | — | $272.00 | — | 2026-01-15 | MRF ↗ |
| DEQUINCY MEMORIAL HOSPITAL Both | UMR O/P | UMR OP | — | $272.00 | — | 2026-01-15 | MRF ↗ |
| DEQUINCY MEMORIAL HOSPITAL Both | UNITED HEALTHCARE | UHC COMM IP | — | $272.00 | — | 2026-01-15 | MRF ↗ |
| DEQUINCY MEMORIAL HOSPITAL Both | CIGNA | CIGNA OP | $14.82 | $272.00 | — | 2026-01-15 | MRF ↗ |
| DEQUINCY MEMORIAL HOSPITAL Both | CIGNA | CIGNA IP | $14.82 | $272.00 | — | 2026-01-15 | MRF ↗ |
| DEQUINCY MEMORIAL HOSPITAL Both | UNITED HEALTHCARE | UHC COMM OP | — | $272.00 | — | 2026-01-15 | MRF ↗ |
| DEQUINCY MEMORIAL HOSPITAL Both | UNITED HEALTHCARE | UHC SHARED SAVINGS IP | — | $272.00 | — | 2026-01-15 | MRF ↗ |
| H Lee Moffitt Cancer Center & Research Institute I Both | CarePlus | Medicare Advantage - Outpatient | $14.92 | $74.00 | $37.00 | 2025-10-24 | MRF ↗ |
| H Lee Moffitt Cancer Center & Research Institute I Both | Devoted | Medicare Advantage - Outpatient | $14.92 | $74.00 | $37.00 | 2025-10-24 | MRF ↗ |
| H Lee Moffitt Cancer Center & Research Institute I Both | Baycare | Medicare Advantage - Outpatient | $14.92 | $74.00 | $37.00 | 2025-10-24 | MRF ↗ |
| BAYAMON MEDICAL CENTER Outpatient | None | — | — | $43.00 | $43.00 | 2026-03-31 | MRF ↗ |
| LANE REGIONAL MEDICAL CENTER Outpatient | Humana Inc. | Commercial | $15.00 | $86.00 | $30.00 | 2026-05-27 | MRF ↗ |
| DEQUINCY MEMORIAL HOSPITAL Both | AETNA | AETNA OP | $15.28 | $272.00 | — | 2026-01-15 | MRF ↗ |
| DEQUINCY MEMORIAL HOSPITAL Both | AETNA | AETNA SWING | $15.28 | $272.00 | — | 2026-01-15 | MRF ↗ |
| DEQUINCY MEMORIAL HOSPITAL Both | AETNA | AETNA IP | $15.28 | $272.00 | — | 2026-01-15 | MRF ↗ |
| HCA FLORIDA PASADENA HOSPITAL A PART OF HCA FLORID Outpatient | Access 2 Healthcare Physicians Freedom Optimum Group Members | MGMCR | $15.47 | $329.12 | $329.12 | 2026-03-01 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | Amerihealth | SelectHealthPlan | — | $158.00 | $118.50 | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | Humana | HumanaMgdMCaid | — | $158.00 | $118.50 | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | Wellcare | CenteneHNWellcareMgdMCare | — | $158.00 | $118.50 | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | Humana | HumanaMgdMCare | — | $158.00 | $118.50 | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | Aetna | AetnaCommercial | — | $158.00 | $118.50 | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | Multiplan | BeechStreetWC | — | $158.00 | $118.50 | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | United Healthcare | UnitedNonOptions | — | $158.00 | $118.50 | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | United Healthcare | UnitedOptions | — | $158.00 | $118.50 | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | Humana | HumanaCommercial | — | $158.00 | $118.50 | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | Centene | AmbetterHIX | — | $158.00 | $118.50 | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | Centene | AbsoluteMgdMCaid | — | $158.00 | $118.50 | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | Centene | AmbetterHIX | — | $158.00 | $118.50 | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | Medcost | MedCostPPO | — | $158.00 | $118.50 | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | Molina Healthcare Of Texas (Claims Only) | MolinaMgdMCaid | — | $158.00 | $118.50 | 2024-12-08 | 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.