A9604 — Sm 153 Lexidronam
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). Sm 153 lexidronam (HCPCS A9604) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/A9604?code_type=HCPCS
MLA (9th ed.)
“Sm 153 lexidronam (HCPCS A9604) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/A9604?code_type=HCPCS. Accessed .
Chicago (notes-bibliography)
“Sm 153 lexidronam (HCPCS A9604) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/A9604?code_type=HCPCS.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $4,393–$24,178 (25th–75th percentile) across 1,478 hospitals · 3,345 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CPT/HCPCS A9604 — 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 |
|---|---|---|---|---|---|---|---|
| SAMARITAN HOSPITAL OF TROY, NEW YORK OutpatientFacility | VNA Homecare Options | Medicaid | — | $57,456.00 | $48,837.60 | 2025-01-01 | MRF ↗ |
| JOHNSON MEMORIAL HOSPITAL OutpatientFacility | CTCare | Medicare Advantage | — | $95,760.00 | $52,668.00 | 2025-01-01 | MRF ↗ |
| SUNNYVIEW HOSPITAL AND REHABILITATION CENTER OutpatientFacility | VNA Homecare Options | Medicaid | — | $57,456.00 | $48,837.60 | 2025-01-01 | MRF ↗ |
| JOHNSON MEMORIAL HOSPITAL OutpatientFacility | CTCare | Medicare Advantage | — | $95,760.00 | $52,668.00 | 2025-01-01 | MRF ↗ |
| SAINT MARY'S HOSPITAL OutpatientFacility | CTCare | Medicare Advantage | — | $57,456.00 | $31,600.80 | 2025-01-01 | MRF ↗ |
| ST PETER'S HOSPITAL OutpatientFacility | VNA Homecare Options | Medicaid | — | $57,456.00 | $48,837.60 | 2025-01-01 | MRF ↗ |
| GEISINGER MEDICAL CENTER Outpatient | United Healthcare | United Healthcare - Commercial | $1.27 | $113,980.16 | $70,667.70 | 2025-07-01 | MRF ↗ |
| HENRY FORD HEALTH WEST BLOOMFIELD HOSPITAL OutpatientFacility | HAP | Self Insured | $2.10 | $17,205.00 | — | 2025-06-28 | MRF ↗ |
| LOWELL GENERAL HOSPITAL Outpatient | TUFTS HEALTH PLAN [100263] | THP POS/EPO [10026306] | $16.52 | $14,793.00 | $10,355.10 | 2025-01-01 | MRF ↗ |
| LOWELL GENERAL HOSPITAL Outpatient | TUFTS HEALTH PLAN [100263] | THP SELECT [10026309] | $16.52 | $14,793.00 | $10,355.10 | 2025-01-01 | MRF ↗ |
| LOWELL GENERAL HOSPITAL Outpatient | TUFTS HEALTH PLAN [100263] | IRON CLAD INSURANCE [10026304] | $16.52 | $14,793.00 | $10,355.10 | 2025-01-01 | MRF ↗ |
| LOWELL GENERAL HOSPITAL Outpatient | TUFTS HEALTH PLAN [100263] | THP GIC NAVIGATOR POS [10026312] | $16.52 | $14,793.00 | $10,355.10 | 2025-01-01 | MRF ↗ |
| LOWELL GENERAL HOSPITAL Outpatient | TUFTS HEALTH PLAN [100263] | THP HMO OUT IPA [10026302] | $16.52 | $14,793.00 | $10,355.10 | 2025-01-01 | MRF ↗ |
| ST JOE MERCY HOSPITAL SYSTEM LIVONIA OutpatientFacility | VACCN United | Veterans Affairs | $20.50 | $95,760.00 | $62,244.00 | 2025-01-01 | MRF ↗ |
| ST JOE MERCY HOSPITAL SYSTEM LIVONIA OutpatientFacility | VACCN United | Veterans Affairs | $20.50 | $95,760.00 | $62,244.00 | 2025-01-01 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | BCBS-SC | BCBSSCBlueChoice | $28.70 | — | — | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | BCBS-SC | BCBSSCPreferredBlue | $30.90 | — | — | 2024-12-08 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCPreferredBlue | $33.10 | — | — | 2024-12-08 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCBlueChoice | $33.10 | — | — | 2024-12-08 | MRF ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCPreferredBlue | $34.60 | — | — | 2024-12-08 | MRF ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCBlueChoice | $34.60 | — | — | 2024-12-08 | MRF ↗ |
| MONMOUTH MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $42.01 | $23,340.00 | $17,259.85 | 2024-12-31 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCState | $50.00 | — | — | 2024-12-08 | MRF ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCState | $50.00 | — | — | 2024-12-08 | MRF ↗ |
| COASTAL CAROLINA HOSPITAL Outpatient | BCBS-SC | BCBSSCState | $50.00 | — | — | 2024-12-08 | MRF ↗ |
| MONMOUTH MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $56.88 | $31,600.80 | $17,259.85 | 2024-12-31 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $57.00 | $15,406.00 | $14,635.70 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | UnitedHealth Group of WI | Medicare Advantage | $57.00 | $15,406.00 | $14,635.70 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $57.00 | $15,406.00 | $14,635.70 | 2026-02-20 | MRF ↗ |
| MID-COLUMBIA MEDICAL CENTER Outpatient | PROVIDENCE PPO - ALL PLANS | PROVIDENCE PPO - ALL PLANS | $58.00 | $17,032.00 | $8,175.36 | 2026-05-13 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $58.54 | $15,406.00 | $14,635.70 | 2026-02-20 | MRF ↗ |
| SAN ANTONIO REGIONAL HOSPITAL Outpatient | ANTHEM BLUE CROSS EXCHG | ANTHEM BLUE CROSS EXCHG | $58.65 | $26,830.00 | $13,415.00 | 2026-04-02 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $60.08 | $15,406.00 | $14,635.70 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Point Comfort Underwriters | Organizational | $61.62 | $15,406.00 | $14,635.70 | 2026-02-20 | MRF ↗ |
| SAINT MARY'S HOSPITAL OutpatientFacility | UHC | All Products | $62.00 | $57,456.00 | $31,600.80 | 2025-01-01 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $62.72 | $13,067.00 | $12,413.65 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $62.72 | $13,067.00 | $12,413.65 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $64.03 | $13,067.00 | $12,413.65 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Point Comfort Underwriters | Organizational | $64.03 | $13,067.00 | $12,413.65 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $64.03 | $13,067.00 | $12,413.65 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $64.03 | $13,067.00 | $12,413.65 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $65.33 | $13,067.00 | $12,413.65 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $66.64 | $13,067.00 | $12,413.65 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $67.95 | $13,067.00 | $12,413.65 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Point Comfort Underwriters | Organizational | $70.56 | $13,067.00 | $12,413.65 | 2026-02-20 | MRF ↗ |
| SAINT MARY'S HOSPITAL OutpatientFacility | Aetna | Aetna Whole Health | $80.00 | $57,456.00 | $31,600.80 | 2025-01-01 | MRF ↗ |
| MONMOUTH MEDICAL CENTER OutpatientFacility | Brighton Health Plan | All Products | $82.15 | $23,340.00 | $17,259.85 | 2024-12-31 | MRF ↗ |
| ST PETER'S HOSPITAL OutpatientFacility | MVP | Individual Plan | $89.00 | $57,456.00 | $48,837.60 | 2025-01-01 | MRF ↗ |
| HURON VALLEY-SINAI HOSPITAL Outpatient | Hap | HAPHMO | $93.00 | — | — | 2025-01-31 | MRF ↗ |
| Harper University Hospital Outpatient | Hap | HAPHMO | $93.00 | — | — | 2025-01-31 | MRF ↗ |
| Rehabilitation Institute Of Michigan Outpatient | Hap | HAPHMO | $104.79 | — | — | 2025-01-31 | MRF ↗ |
| ST PETER'S HOSPITAL BothFacility | Empire | Medicare Advantage | $107.00 | $57,456.00 | $48,837.60 | 2025-01-01 | MRF ↗ |
| BANNER MCKEE MEDICAL CENTER OutpatientFacility | Banner Health | Banner Choice Plus/Banner Select | $111.54 | $434.00 | $197.04 | 2026-03-02 | MRF ↗ |
| ST CATHERINE OF SIENA HOSPITAL OutpatientFacility | Beacon Health Options | Medicare | $112.18 | $337,056.00 | — | 2026-02-19 | MRF ↗ |
| ST FRANCIS HOSPITAL & MEDICAL CENTER OutpatientFacility | United Behavioral Health | All Products | $124.10 | $57,456.00 | $31,600.80 | 2025-01-01 | MRF ↗ |
| ST FRANCIS HOSPITAL & MEDICAL CENTER OutpatientFacility | United Behavioral Health | All Products | $124.10 | $57,456.00 | $31,600.80 | 2025-01-01 | MRF ↗ |
| ST PETER'S HOSPITAL OutpatientFacility | BSNENY | Medicare Advantage | $157.00 | $57,456.00 | $48,837.60 | 2025-01-01 | MRF ↗ |
| ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL OutpatientFacility | Wellpoint | NJ Family Care | $157.19 | — | — | 2026-03-04 | MRF ↗ |
| HOMESTEAD HOSPITAL Both | VISTA | COVENTRY MEDICAID | $167.89 | $18,452.00 | $11,993.80 | 2026-03-30 | MRF ↗ |
| Southern California Hospital At Culver City OutpatientFacility | Blue Shield of California | Covered California/IFP/PPO | $171.58 | — | — | 2026-03-18 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | Covered California/IFP/PPO | $171.58 | — | — | 2026-03-18 | MRF ↗ |
| SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD OutpatientFacility | Blue Shield of California | Covered California/IFP/PPO | $171.58 | — | — | 2026-03-18 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | BCBS | Cap | $174.11 | — | — | 2026-03-01 | MRF ↗ |
| Wesley Rehabilitation Hospital, An Affiliate Of En Outpatient | BCBS | BlueChoice | $174.11 | — | — | 2026-03-01 | MRF ↗ |
| CHELSEA HOSPITAL OutpatientFacility | Magellan Behavioral Health | Summit_Pinnacle | $181.00 | $95,760.00 | $62,244.00 | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL ST ANN'S OutpatientFacility | UHC | All Products | $187.00 | $57,456.00 | $37,346.40 | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL EAST & WEST OutpatientFacility | UHC | All Products | $187.00 | $57,456.00 | $37,346.40 | 2025-01-01 | MRF ↗ |
| MOUNT CARMEL ST ANN'S OutpatientFacility | UHC | All Products | $187.00 | $57,456.00 | $37,346.40 | 2025-01-01 | MRF ↗ |
| Southern California Hospital At Culver City OutpatientFacility | Blue Shield of California | HMO | $196.63 | — | — | 2026-03-18 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | HMO | $196.63 | — | — | 2026-03-18 | MRF ↗ |
| SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD OutpatientFacility | Blue Shield of California | HMO | $196.63 | — | — | 2026-03-18 | MRF ↗ |
| NAZARETH HOSPITAL OutpatientFacility | Independence Blue Cross | HMO_PPO | $211.00 | $57,456.00 | $39,644.64 | 2025-01-01 | MRF ↗ |
| MERCY CATHOLIC MEDICAL CENTER- MERCY FITZGERALD OutpatientFacility | Independence Blue Cross | Traditional | $211.00 | $134,064.00 | $76,014.29 | 2025-01-01 | MRF ↗ |
| MERCY CATHOLIC MEDICAL CENTER- MERCY FITZGERALD OutpatientFacility | Independence Blue Cross | HMO_PPO | $211.00 | $134,064.00 | $87,543.79 | 2025-01-01 | MRF ↗ |
| NAZARETH HOSPITAL OutpatientFacility | Independence Blue Cross | Traditional | $211.00 | $57,456.00 | $39,644.64 | 2025-01-01 | MRF ↗ |
| LINDSBORG COMMUNITY HOSPITAL Outpatient | BCBS -ALL PLANS | BCBS -ALL PLANS | $213.00 | $24,753.40 | $17,327.38 | 2026-04-06 | MRF ↗ |
| Southern California Hospital At Culver City OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $214.09 | — | — | 2026-03-18 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $214.09 | — | — | 2026-03-18 | MRF ↗ |
| SOUTHERN CALIFORNIA HOSPITAL AT HOLLYWOOD OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $214.09 | — | — | 2026-03-18 | MRF ↗ |
| HOSPITAL DISTRICT #1 OF RICE COUNTY OutpatientFacility | Blue Cross Blue Shield Kansas | POS | $215.13 | — | — | 2026-03-24 | MRF ↗ |
| LABETTE HEALTH OutpatientFacility | BCBS | All Products | $215.13 | — | — | 2025-06-28 | MRF ↗ |
| LABETTE HEALTH OutpatientFacility | BCBS | All Products | $215.13 | — | — | 2025-06-28 | MRF ↗ |
| ST FRANCIS HOSPITAL OutpatientFacility | Independence Blue cross | HMO_PPO | $223.00 | $57,456.00 | $22,982.40 | 2025-01-01 | MRF ↗ |
| ST MARY MEDICAL CENTER OutpatientFacility | Independence Blue Cross | Traditional | $223.00 | $134,064.00 | $84,728.45 | 2025-01-01 | MRF ↗ |
| JOHNSON MEMORIAL HOSPITAL OutpatientFacility | UHC | All products | $223.00 | $95,760.00 | $52,668.00 | 2025-01-01 | MRF ↗ |
| JOHNSON MEMORIAL HOSPITAL OutpatientFacility | UHC | All products | $223.00 | $95,760.00 | $52,668.00 | 2025-01-01 | MRF ↗ |
| SALINA REGIONAL HEALTH CENTER Outpatient | BCBS BLUE CHOICE/SELECT - ALL OTHER PLANS | BCBS BLUE CHOICE/SELECT - ALL OTHER PLANS | $225.11 | $24,753.40 | $17,327.38 | 2026-01-12 | MRF ↗ |
| Mercy Hospital, Inc OutpatientFacility | BCBS - KS | Commercial | $225.89 | — | — | 2026-03-06 | MRF ↗ |
| Mercy Hospital, Inc OutpatientFacility | BCBS - KS | Commercial | $225.89 | — | — | 2026-03-06 | MRF ↗ |
| MEMORIAL HOSPITAL Outpatient | BCBS - ALL PLANS | BCBS - ALL PLANS | $227.50 | $24,753.40 | $24,753.40 | 2026-02-18 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | United Healthcare | Commercial | $231.00 | $16,903.06 | $13,522.45 | 2025-01-28 | MRF ↗ |
| ST MARY MEDICAL CENTER OutpatientFacility | Independence Blue Cross | HMO_PPO | $233.00 | $134,064.00 | $84,728.45 | 2025-01-01 | MRF ↗ |
| SALINA REGIONAL HEALTH CENTER Outpatient | BCBS CAP | BCBS CAP | $236.96 | $24,753.40 | $17,327.38 | 2026-01-12 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Security Health Plan | Badgercare Plus | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | My Choice Wisconsin, Inc. | Family Care / Family Care Partnership - Medicaid | — | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Anthem BCBS | Medicare Advantage | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | My Choice Wisconsin, Inc. | Family Care / Family Care Partnership - Medicare | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Group Health Cooperative of Eau Claire | Medicaid | — | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | My Choice Wisconsin, Inc. | Medicare Dual Advantage | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | My Choice Wisconsin, Inc. | Medicaid SSI | — | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | United Health Care | Medicare Advantage | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | United Health Care | VA Plan | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | United Health Care | Medicaid | — | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Humana | Medicare Advantage | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Security Health Plan | Medicare Advantage | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Anthem BCBS | Medicaid | — | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Anthem BCBS | Medicare Advantage | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Quartz Health Solutions, Inc | Senior Preferred | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Quartz Health Solutions, Inc | Medicaid/BadgerCare | — | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | My Choice Wisconsin, Inc. | Family Care / Family Care Partnership - Medicare | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Anthem BCBS | Medicaid | — | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | My Choice Wisconsin, Inc. | Medicare Dual Advantage | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Group Health Cooperative of Eau Claire | Medicaid | — | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | My Choice Wisconsin, Inc. | Family Care / Family Care Partnership - Medicaid | — | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Humana | Medicare Advantage | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | My Choice Wisconsin, Inc. | Medicaid SSI | — | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | United Health Care | VA Plan | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | United Health Care | Medicare Advantage | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Security Health Plan | Medicare Advantage | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | United Health Care | Medicaid | — | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Security Health Plan | Badgercare Plus | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Quartz Health Solutions, Inc | Medicaid/BadgerCare | — | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Quartz Health Solutions, Inc | Senior Preferred | $247.86 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| ST. CATHERINE HOSPITAL - GARDEN CITY OutpatientFacility | Blue Cross Blue Shield of Kansas | Commercial PPO/HMO | $254.95 | $34,492.50 | $13,797.00 | 2024-12-02 | MRF ↗ |
| ST MARY'S HOSPITAL OutpatientFacility | Cigna | All products | $258.00 | $134,064.00 | $87,141.60 | 2025-01-01 | MRF ↗ |
| CHELSEA HOSPITAL OutpatientFacility | Magellan Behavioral Health | All Products | $275.00 | $95,760.00 | $62,244.00 | 2025-01-01 | MRF ↗ |
| BOB WILSON MEMORIAL HOSPITAL OutpatientFacility | Blue Cross Blue Shield of Kansas | Commercial PPO/HMO | $287.15 | $34,492.50 | $13,797.00 | 2026-02-03 | MRF ↗ |
| BOB WILSON MEMORIAL HOSPITAL OutpatientFacility | Blue Cross Blue Shield of Kansas | Commercial PPO/HMO | $287.15 | $34,492.50 | $13,797.00 | 2026-02-03 | MRF ↗ |
| LMH Both | BLUE CROSS BLUE SHIELD | BLUE CROSS BLUE SHIELD KANSAS BLUE CHOICE | $293.79 | $16,461.00 | $4,115.25 | 2026-03-23 | MRF ↗ |
| LMH Both | BLUE CROSS BLUE SHIELD | BLUE CROSS BLUE SHIELD KANSAS BLUE CHOICE | $293.79 | $16,461.00 | $4,115.25 | 2026-03-23 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Corvel | Automobile liability / Accident & Health | $296.46 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Corvel | Workers' Compensation | $296.46 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Corvel | Workers' Compensation | $296.46 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Corvel | Automobile liability / Accident & Health | $296.46 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| Bob Wilson Memorial Hospital OutpatientFacility | Blue Cross Blue Shield of Kansas | Commercial PPO/HMO | $299.41 | $34,492.50 | $13,797.00 | 2024-12-02 | MRF ↗ |
| Bob Wilson Memorial Hospital OutpatientFacility | Blue Cross Blue Shield of Kansas | Commercial PPO/HMO | $299.41 | $34,492.50 | $13,797.00 | 2024-12-02 | MRF ↗ |
| HCA HOUSTON HEALTHCARE SOUTHEAST Outpatient | Texas Athletic Network | Premier | $300.00 | $86,427.72 | $86,427.72 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON REHABILITATION HOSPITAL SOUTHEAST Outpatient | Texas Athletic Network | Premier | $300.00 | $86,427.72 | $86,427.72 | 2026-03-01 | MRF ↗ |
| HCA HOUSTON HEALTHCARE CLEAR LAKE Outpatient | Texas Athletic Network | Premier | $300.00 | $30,877.91 | $30,877.91 | 2026-03-01 | MRF ↗ |
| BANNER MCKEE MEDICAL CENTER InpatientFacility | Hue Health, Inc | Medicare Advantage | $303.80 | $434.00 | $197.04 | 2026-03-02 | MRF ↗ |
| LMH Both | BLUE CROSS BLUE SHIELD | BLUE CROSS BLUE SHIELD KANSAS CAP | $309.25 | $16,461.00 | $4,115.25 | 2026-03-23 | MRF ↗ |
| LMH Both | BLUE CROSS BLUE SHIELD | BLUE CROSS BLUE SHIELD KANSAS CAP | $309.25 | $16,461.00 | $4,115.25 | 2026-03-23 | MRF ↗ |
| HOLY CROSS HOSPITAL OutpatientFacility | AvMed | All Products | $323.00 | $153,216.00 | $99,590.40 | 2025-01-01 | MRF ↗ |
| HOLY CROSS HOSPITAL OutpatientFacility | AvMed | All Products | $323.00 | $153,216.00 | $99,590.40 | 2025-01-01 | MRF ↗ |
| CHELSEA HOSPITAL OutpatientFacility | Magellan Behavioral Health | Summit_Pinnacle_Navigator | $331.00 | $95,760.00 | $62,244.00 | 2025-01-01 | MRF ↗ |
| SAINT ALPHONSUS MEDICAL CENTER ONTARIO OutpatientFacility | UHC | Medicare Advantage | $350.00 | $95,760.00 | $67,032.00 | 2025-01-01 | MRF ↗ |
| SAINT ALPHONSUS MEDICAL CENTER ONTARIO OutpatientFacility | UHC | Medicare Advantage | $350.00 | $95,760.00 | $67,032.00 | 2025-01-01 | MRF ↗ |
| BANNER MCKEE MEDICAL CENTER OutpatientFacility | Medica | Commercial | $361.52 | $434.00 | $197.04 | 2026-03-02 | MRF ↗ |
| BANNER MCKEE MEDICAL CENTER OutpatientFacility | Cigna Healthcare & Life Insurance Company – WY | HMO Benefit Plan/Network Benefit Plan/Open Access Plus Benefit Plan | $364.56 | $434.00 | $197.04 | 2026-03-02 | MRF ↗ |
| BANNER MCKEE MEDICAL CENTER InpatientFacility | Rocky Mountain Health Plans | Private Plan/Self Insured Plan | $368.90 | $434.00 | $197.04 | 2026-03-02 | MRF ↗ |
| BANNER MCKEE MEDICAL CENTER InpatientFacility | Apostrophe, Inc. | Commercial | $368.90 | $434.00 | $197.04 | 2026-03-02 | MRF ↗ |
| BANNER MCKEE MEDICAL CENTER OutpatientFacility | Decent Health | Commercial | $368.90 | $434.00 | $197.04 | 2026-03-02 | MRF ↗ |
| BANNER MCKEE MEDICAL CENTER InpatientFacility | Cigna Healthcare & Life Insurance Company – WY | HMO Benefit Plan/Network Benefit Plan/Open Access Plus Benefit Plan | $368.90 | $434.00 | $197.04 | 2026-03-02 | MRF ↗ |
| Umc Transplantation Services OutpatientFacility | JW Marriott | All Plans | $372.90 | — | — | 2025-12-27 | MRF ↗ |
| BANNER MCKEE MEDICAL CENTER OutpatientFacility | Aetna | Commercial | $381.49 | $434.00 | $197.04 | 2026-03-02 | MRF ↗ |
| SUNNYVIEW HOSPITAL AND REHABILITATION CENTER OutpatientFacility | MVP | Commercial | $389.00 | $57,456.00 | $48,837.60 | 2025-01-01 | MRF ↗ |
| SUNNYVIEW HOSPITAL AND REHABILITATION CENTER OutpatientFacility | MVP | Individual Plan | $389.00 | $57,456.00 | $48,837.60 | 2025-01-01 | MRF ↗ |
| MERCY MEDICAL CTR BothFacility | TUFTS HEALTH PUBLIC PLANS | TUFTS MEDICAID | $392.00 | $57,456.00 | $57,456.00 | 2026-03-31 | MRF ↗ |
| SAMARITAN HOSPITAL OF TROY, NEW YORK BothFacility | Empire | Medicare Advantage | $402.00 | $57,456.00 | $48,837.60 | 2025-01-01 | MRF ↗ |
| BANNER MCKEE MEDICAL CENTER OutpatientFacility | United Healthcare | UHC Colorado Doctors Plan | $406.00 | $434.00 | $197.04 | 2026-03-02 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Security Health Plan | EPO | $407.03 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Security Health Plan | EPO | $407.03 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BANNER MCKEE MEDICAL CENTER InpatientFacility | Multiplan | Commercial | $407.96 | $434.00 | $197.04 | 2026-03-02 | MRF ↗ |
| BANNER MCKEE MEDICAL CENTER OutpatientFacility | First Choice of the Midwest | Commercial | $412.30 | $434.00 | $197.04 | 2026-03-02 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | The Alliance | Worker's Compensation | $413.10 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | The Alliance | Worker's Compensation | $413.10 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| SUNNYVIEW HOSPITAL AND REHABILITATION CENTER OutpatientFacility | MVP | All Products | $418.00 | $57,456.00 | $48,837.60 | 2025-01-01 | MRF ↗ |
| INTEGRIS MIAMI HOSPITAL OutpatientFacility | Healthchoice | All Commercial Plans | $420.25 | — | — | 2026-04-01 | MRF ↗ |
| INTEGRIS GROVE HOSPITAL OutpatientFacility | Healthchoice | All Commercial Plans | $420.25 | — | — | 2026-04-01 | MRF ↗ |
| INTEGRIS HEALTH EDMOND HOSPITAL OutpatientFacility | Healthchoice | All Commercial Plans | $420.25 | — | — | 2026-04-01 | MRF ↗ |
| INTEGRIS CANADIAN VALLEY HOSPITAL OutpatientFacility | Healthchoice | All Commercial Plans | $420.25 | — | — | 2026-04-01 | MRF ↗ |
| INTEGRIS HEALTH ENID HOSPITAL OutpatientFacility | Healthchoice | All Commercial Plans | $420.25 | — | — | 2026-04-01 | MRF ↗ |
| LAKESIDE WOMEN'S HOSPITAL, A MEMBER OF INTEGRIS HE OutpatientFacility | Healthchoice | All Commercial Plans | $420.25 | — | — | 2026-04-01 | MRF ↗ |
| INTEGRIS MIAMI HOSPITAL OutpatientFacility | Healthchoice | All Commercial Plans | $420.25 | — | — | 2026-04-01 | MRF ↗ |
| ALLIANCEHEALTH WOODWARD OutpatientFacility | Healthchoice | All Commercial Plans | $420.25 | — | — | 2026-04-01 | MRF ↗ |
| INTEGRIS HEALTH PONCA CITY OutpatientFacility | Healthchoice | All Commercial Plans | $420.25 | — | — | 2026-04-01 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Anthem BCBS | Commercial | $427.68 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Anthem BCBS | Commercial | $427.68 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Triology Health Solutions | Health Plan | $437.40 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Triology Health Solutions | Health Plan | $437.40 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Quartz Health Solutions, Inc | Commercial / Self-Insured | $442.26 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Quartz Health Solutions, Inc | Commercial / Self-Insured | $442.26 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Humana | Commercial | $451.98 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | The Alliance | Health Plan | $451.98 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | The Alliance | Health Plan | $451.98 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Humana | Commercial | $451.98 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Security Health Plan | Commercial | $453.92 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Medica | Health Plan | $453.92 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Security Health Plan | Commercial | $453.92 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Medica | Health Plan | $453.92 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | United Health Care | Commercial | $458.30 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | United Health Care | Commercial | $458.30 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Provider Network of America | Health Plan | $461.70 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | First Health Group Corporation | MultiPlan PPC Network | $461.70 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Association Benefits Solution | Health Plan | $461.70 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | First Health Group Corporation | MultiPlan PPC Network | $461.70 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Provider Network of America | Health Plan | $461.70 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL OutpatientFacility | Family Health Center of Marshfield | Health Plan | $461.70 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Triology Health Solutions | Workers Compensation | $461.70 | $486.00 | $437.40 | 2026-01-08 | MRF ↗ |
| BLACK RIVER MEMORIAL HOSPITAL BothFacility | Triology Health Solutions | Workers Compensation | $461.70 | $486.00 | $437.40 | 2026-01-08 | 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.