A9604 — Sm 153 Lexidronam
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). Sm 153 lexidronam (OTHER A9604) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/A9604?code_type=OTHER
MLA (9th ed.)
“Sm 153 lexidronam (OTHER A9604) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/A9604?code_type=OTHER. Accessed .
Chicago (notes-bibliography)
“Sm 153 lexidronam (OTHER A9604) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/A9604?code_type=OTHER.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $4,315–$17,778 (25th–75th percentile) across 150 hospitals · 326 payers.
“Negotiated” is the hospital’s negotiated facility rate for this OTHER 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 |
|---|---|---|---|---|---|---|---|
| INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL Outpatient | United Healthcare | Uhc Charter/Navigate | — | — | — | 2026-05-22 | MRF ↗ |
| LUTHERAN MEDICAL CENTER Outpatient | United Healthcare | Medica | — | — | — | 2026-05-14 | MRF ↗ |
| LUTHERAN MEDICAL CENTER Outpatient | United Healthcare | Uhc Charter/Navigate | — | — | — | 2026-05-14 | MRF ↗ |
| SAINT JOSEPH HOSPITAL Outpatient | United Healthcare | All Savers Alternative Funding | — | — | — | 2026-05-14 | MRF ↗ |
| INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL Outpatient | United Healthcare | Uhc Exchange Plan | — | — | — | 2026-05-22 | MRF ↗ |
| LUTHERAN MEDICAL CENTER Outpatient | United Healthcare | United Healthcare | — | — | — | 2026-05-14 | MRF ↗ |
| INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL Outpatient | United Healthcare | United Healthcare | — | — | — | 2026-05-22 | MRF ↗ |
| INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL Outpatient | United Healthcare | All Savers Alternative Funding | — | — | — | 2026-05-17 | MRF ↗ |
| INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL Outpatient | Geha | Geha | — | — | — | 2026-05-22 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Selectcolorado | — | — | — | 2026-05-22 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | Geha | Geha | — | — | — | 2026-05-18 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Uhc Exchange Plan | — | — | — | 2026-05-22 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | United Healthcare | — | — | — | 2026-05-22 | MRF ↗ |
| INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL Outpatient | United Healthcare | Medica | — | — | — | 2026-05-22 | MRF ↗ |
| INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL Outpatient | Geha | Geha Mcr Supplemental | — | — | — | 2026-05-17 | MRF ↗ |
| INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL Outpatient | United Healthcare | Surest | — | — | — | 2026-05-17 | MRF ↗ |
| INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL Outpatient | United Healthcare | Uhc Exchange Plan | — | — | — | 2026-05-17 | MRF ↗ |
| INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL Outpatient | United Healthcare | Selectcolorado | — | — | — | 2026-05-17 | MRF ↗ |
| INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL Outpatient | United Healthcare | Umr-United Med Resources | — | — | — | 2026-05-22 | MRF ↗ |
| INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL Outpatient | Geha | Geha Mcr Supplemental | — | — | — | 2026-05-22 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Umr-United Med Resources | — | — | — | 2026-05-22 | MRF ↗ |
| SAINT JOSEPH HOSPITAL Outpatient | United Healthcare | United Healthcare | — | — | — | 2026-05-14 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Golden Rule Ins | — | — | — | 2026-05-22 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | All Savers Alternative Funding | — | — | — | 2026-05-18 | MRF ↗ |
| SAINT JOSEPH HOSPITAL Outpatient | United Healthcare | Medica | — | — | — | 2026-05-14 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | Geha | Geha Mcr Supplemental | — | — | — | 2026-05-18 | MRF ↗ |
| INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL Outpatient | Geha | Geha | — | — | — | 2026-05-17 | MRF ↗ |
| SAINT JOSEPH HOSPITAL Outpatient | Geha | Geha Mcr Supplemental | — | — | — | 2026-05-14 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Medica | — | — | — | 2026-05-18 | MRF ↗ |
| INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL Outpatient | United Healthcare | Uhc Other/Supplemental | — | — | — | 2026-05-17 | MRF ↗ |
| INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL Outpatient | United Healthcare | Uhc Charter/Navigate | — | — | — | 2026-05-17 | MRF ↗ |
| LUTHERAN MEDICAL CENTER Outpatient | Geha | Geha Mcr Supplemental | — | — | — | 2026-05-14 | MRF ↗ |
| LUTHERAN MEDICAL CENTER Outpatient | United Healthcare | Uhc Other/Supplemental | — | — | — | 2026-05-14 | MRF ↗ |
| INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL Outpatient | United Healthcare | Selectcolorado | — | — | — | 2026-05-22 | MRF ↗ |
| LUTHERAN MEDICAL CENTER Outpatient | United Healthcare | Umr-United Med Resources | — | — | — | 2026-05-14 | MRF ↗ |
| SAINT JOSEPH HOSPITAL Outpatient | United Healthcare | Surest | — | — | — | 2026-05-14 | MRF ↗ |
| LUTHERAN MEDICAL CENTER Outpatient | United Healthcare | All Savers Alternative Funding | — | — | — | 2026-05-14 | MRF ↗ |
| LUTHERAN MEDICAL CENTER Outpatient | United Healthcare | Surest | — | — | — | 2026-05-14 | MRF ↗ |
| LUTHERAN MEDICAL CENTER Outpatient | United Healthcare | Golden Rule Ins | — | — | — | 2026-05-14 | MRF ↗ |
| SAINT JOSEPH HOSPITAL Outpatient | United Healthcare | Uhc Other/Supplemental | — | — | — | 2026-05-14 | MRF ↗ |
| LUTHERAN MEDICAL CENTER Outpatient | United Healthcare | Uhc Exchange Plan | — | — | — | 2026-05-14 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Umr-United Med Resources | — | — | — | 2026-05-18 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | Geha | Geha Mcr Supplemental | — | — | — | 2026-05-22 | MRF ↗ |
| SAINT JOSEPH HOSPITAL Outpatient | United Healthcare | Uhc Charter/Navigate | — | — | — | 2026-05-14 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Healthscope | — | — | — | 2026-05-18 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Uhc Exchange Plan | — | — | — | 2026-05-18 | MRF ↗ |
| SAINT JOSEPH HOSPITAL Outpatient | United Healthcare | Uhc Exchange Plan | — | — | — | 2026-05-14 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | All Savers Alternative Funding | — | — | — | 2026-05-22 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | United Healthcare | — | — | — | 2026-05-18 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Healthscope | — | — | — | 2026-05-22 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Selectcolorado | — | — | — | 2026-05-18 | MRF ↗ |
| SAINT JOSEPH HOSPITAL Outpatient | United Healthcare | Golden Rule Ins | — | — | — | 2026-05-14 | MRF ↗ |
| INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL Outpatient | United Healthcare | Umr-United Med Resources | — | — | — | 2026-05-17 | MRF ↗ |
| INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL Outpatient | United Healthcare | Healthscope | — | — | — | 2026-05-17 | MRF ↗ |
| SAINT JOSEPH HOSPITAL Outpatient | United Healthcare | Umr-United Med Resources | — | — | — | 2026-05-14 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Surest | — | — | — | 2026-05-22 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Uhc Charter/Navigate | — | — | — | 2026-05-18 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Surest | — | — | — | 2026-05-18 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | Geha | Geha | — | — | — | 2026-05-22 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Golden Rule Ins | — | — | — | 2026-05-18 | MRF ↗ |
| INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL Outpatient | United Healthcare | All Savers Alternative Funding | — | — | — | 2026-05-22 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Medica | — | — | — | 2026-05-22 | MRF ↗ |
| INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL Outpatient | United Healthcare | United Healthcare | — | — | — | 2026-05-17 | MRF ↗ |
| SAINT JOSEPH HOSPITAL Outpatient | Geha | Geha | — | — | — | 2026-05-14 | MRF ↗ |
| LUTHERAN MEDICAL CENTER Outpatient | Geha | Geha | — | — | — | 2026-05-14 | MRF ↗ |
| INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL Outpatient | United Healthcare | Uhc Other/Supplemental | — | — | — | 2026-05-22 | MRF ↗ |
| INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL Outpatient | United Healthcare | Surest | — | — | — | 2026-05-22 | MRF ↗ |
| INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL Outpatient | United Healthcare | Golden Rule Ins | — | — | — | 2026-05-22 | MRF ↗ |
| INTERMOUNTAIN HEALTH PLATTE VALLEY HOSPITAL Outpatient | United Healthcare | Healthscope | — | — | — | 2026-05-22 | MRF ↗ |
| LUTHERAN MEDICAL CENTER Outpatient | United Healthcare | Healthscope | — | — | — | 2026-05-14 | MRF ↗ |
| SAINT JOSEPH HOSPITAL Outpatient | United Healthcare | Selectcolorado | — | — | — | 2026-05-14 | MRF ↗ |
| INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL Outpatient | United Healthcare | Medica | — | — | — | 2026-05-17 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER LLC Outpatient | United Healthcare | Uhc Charter/Navigate | — | — | — | 2026-05-22 | MRF ↗ |
| LUTHERAN MEDICAL CENTER Outpatient | United Healthcare | Selectcolorado | — | — | — | 2026-05-14 | MRF ↗ |
| INTERMOUNTAIN HEALTH ST. MARY'S REGIONAL HOSPITAL Outpatient | United Healthcare | Golden Rule Ins | — | — | — | 2026-05-17 | MRF ↗ |
| PROVIDENT HOSPITAL OF CHICAGO Both | Uhc | Hmo | $158.46 | $7,900.00 | $5,530.00 | 2026-05-22 | MRF ↗ |
| PROVIDENT HOSPITAL OF CHICAGO Both | Uhc | Ppo | $158.46 | $7,900.00 | $5,530.00 | 2026-05-22 | MRF ↗ |
| JOHN H STROGER JR HOSPITAL Both | Uhc | Ppo | $158.46 | $7,900.00 | $5,530.00 | 2026-05-14 | MRF ↗ |
| JOHN H STROGER JR HOSPITAL Both | Uhc | Hmo | $158.46 | $7,900.00 | $5,530.00 | 2026-05-14 | MRF ↗ |
| UNIONTOWN HOSPITAL Outpatient | University Of Pittsburgh Medical Ctr Health Plan | University Of Pittsburgh Medical Ctr Health Plan | $171.55 | $18,865.00 | $9,432.50 | 2026-05-13 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Both | Blue Cross Blue Shield Of Fl | Hmo | $238.00 | $40,888.00 | $30,666.00 | 2026-05-07 | MRF ↗ |
| The Queen's Medical Center Outpatient | Alohacare | Medicaid | $257.71 | $26,627.00 | $18,638.90 | 2026-05-08 | MRF ↗ |
| Wahiawa General Hospital Outpatient | Alohacare | Medicaid | $257.71 | $26,627.00 | $18,638.90 | 2026-05-08 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Both | Blue Cross Blue Shield Of Fl | Nwb | $269.00 | $40,888.00 | $30,666.00 | 2026-05-07 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Both | Blue Cross Blue Shield Of Fl | Mbn | $277.00 | $40,888.00 | $30,666.00 | 2026-05-07 | MRF ↗ |
| LONG ISLAND COMMUNITY HOSPITAL Both | Cigna | Hmo Network - Open Access - All Other | $300.00 | $145,107.21 | $18,863.94 | 2026-05-06 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Both | Blue Cross Blue Shield Of Fl | Preferred | $362.00 | $40,888.00 | $30,666.00 | 2026-05-07 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Both | Blue Cross Blue Shield Of Fl | Ppo | $414.00 | $40,888.00 | $30,666.00 | 2026-05-07 | MRF ↗ |
| GILLETTE CHILDRENS SPECIALTY HOSPITAL Outpatient | Bcbs | Commercial | $1,073.69 | — | — | 2026-05-09 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Both | Aetna | Managed Care | $1,588.00 | $40,888.00 | $30,666.00 | 2026-05-07 | MRF ↗ |
| WELLINGTON REGIONAL MEDICAL CENTER Both | Aetna | Qhp | $1,588.00 | $40,888.00 | $30,666.00 | 2026-05-07 | MRF ↗ |
| VALLEY HOSPITAL MEDICAL CENTER Both | Aetna | Firsthealth | $1,980.00 | $37,470.00 | $14,988.00 | 2026-05-06 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Buckeye Oh | Managed Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Amerihealth Caritas Pa | Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Amerihealth Caritas Oh | Managed Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Aetna | Better Health | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Multiplan | Multiplan | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Cigna | Cigna | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Cigna | Cigna | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Highmark Wholecare Pennsylvania Medicaid | Highmark Wholecare Pennsylvania Medicaid | $2,053.87 | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Buckeye | Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Caresource | Caresource | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Molina Oh | Managed Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Humana | Managed Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | 4 Most Zelis Stratose | 4 Most Zelis Stratose | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Buckeye | Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Multiplan | Multiplan | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | United Mine Workers Of America | United Mine Workers Of America | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Caresource Oh | Managed Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Aetna Rental | First Health | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Humana | Managed Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | University Of Pennsylvania Health Plan | University Of Pennsylvania Health Plan | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Aetna | Aetna | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Geisinger Pa Medicaid | Geisinger Pa Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Peak Health | Peak Health | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Blue Cross Blue Shield Traditional | Blue Cross Blue Shield Traditional | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Blue Cross Blue Shield Ppo | Blue Cross Blue Shield Ppo | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Health Partners Pennsylvania Medicaid | Health Partners Pennsylvania Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | University Of Pennsylvania Health Plan | University Of Pennsylvania Health Plan | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Aetna Rental | First Health | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Blue Cross Blue Shield Traditional | Blue Cross Blue Shield Traditional | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Health Plan Of The Upper Ohio Valley | Health Plan Of The Upper Ohio Valley | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Health Plan Of The Upper Ohio Valley | Health Plan Of The Upper Ohio Valley | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Aetna | Student Health | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Cigna | Cigna | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Molina Oh | Managed Medicaid | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | 4 Most Zelis Stratose | 4 Most Zelis Stratose | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Geisinger Pa Medicaid | Geisinger Pa Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Aetna Rental | First Health | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Caresource | Caresource | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Blue Cross Blue Shield Traditional | Blue Cross Blue Shield Traditional | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Caresource | Caresource | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Geisinger Pennsylvania | Mgd Medicaid | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Highmark Wholecare Pennsylvania Medicaid | Highmark Wholecare Pennsylvania Medicaid | $2,053.87 | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | 4 Most Zelis Stratose | 4 Most Zelis Stratose | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | University Of Pittsburgh Medical Ctr Health Plan | University Of Pittsburgh Medical Ctr Health Plan | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Multiplan | Multiplan | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Aetna | Aetna | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Aetna | Better Health | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Amerihealth Caritas Pa | Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Caresource Oh | Managed Medicaid | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Peak Health | Peak Health | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Blue Cross Blue Shield Ppo | Blue Cross Blue Shield Ppo | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Maryland Physician Care | Maryland Physician Care | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Aetna | Better Health | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Amerihealth Caritas Oh | Managed Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Molina Oh | Managed Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Caresource Oh | Managed Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | United Mine Workers Of America | United Mine Workers Of America | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Buckeye Oh | Managed Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Highmark Wholecare Pennsylvania Medicaid | Highmark Wholecare Pennsylvania Medicaid | $2,053.87 | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Health Partners Pennsylvania Medicaid | Health Partners Pennsylvania Medicaid | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Health Plan Of The Upper Ohio Valley | Health Plan Of The Upper Ohio Valley | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Amerihealth Caritas Oh | Managed Medicaid | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Aetna | Aetna | — | $33,194.00 | $16,597.00 | 2026-05-14 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Humana | Managed Medicaid | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Maryland Physician Care | Maryland Physician Care | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| WHEELING HOSPITAL, INC Outpatient | Aetna | Student | — | $11,270.00 | $5,635.00 | 2026-05-13 | MRF ↗ |
| WEST VIRGINIA UNIVERSITY HOSPITALS, INC Outpatient | Aetna | Student Health | — | $33,194.00 | $16,597.00 | 2026-05-24 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Mclaren (Mi | Mi Medicaid | $2,312.79 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Uhc | Mi Medicaid | $2,312.79 | — | — | 2026-05-13 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Uhc | Mi Medicaid | $2,312.79 | — | — | 2026-05-13 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Mclaren | Mi Medicaid | $2,312.79 | — | — | 2026-05-13 | MRF ↗ |
| THREE RIVERS HEALTH Outpatient | Aetna | Mi Medicaid | $2,312.79 | — | — | 2026-05-13 | MRF ↗ |
| THREE RIVERS HEALTH Outpatient | Uhc | Mi Medicaid | $2,312.79 | — | — | 2026-05-13 | MRF ↗ |
| THREE RIVERS HEALTH Outpatient | Priority Health | Mi Medicaid | $2,312.79 | — | — | 2026-05-13 | MRF ↗ |
| THREE RIVERS HEALTH Outpatient | Mclaren | Mi Medicaid | $2,312.79 | — | — | 2026-05-13 | MRF ↗ |
| THREE RIVERS HEALTH Outpatient | Molina | Mi Medicaid | $2,312.79 | — | — | 2026-05-13 | MRF ↗ |
| BOTHWELL REGIONAL HEALTH CENTER Outpatient | Tri West | Tri West | — | $81,241.00 | $60,930.75 | 2026-05-14 | MRF ↗ |
| BOTHWELL REGIONAL HEALTH CENTER Outpatient | Tricare Health Net | Tricare Health Net | — | $81,241.00 | $60,930.75 | 2026-05-14 | MRF ↗ |
| BOTHWELL REGIONAL HEALTH CENTER Outpatient | United Healthcare | Medicaid | — | $81,241.00 | $60,930.75 | 2026-05-14 | MRF ↗ |
| BOTHWELL REGIONAL HEALTH CENTER Outpatient | Oha Workers Comp | Oha Workers Comp | — | $81,241.00 | $60,930.75 | 2026-05-14 | MRF ↗ |
| BOTHWELL REGIONAL HEALTH CENTER Outpatient | Aetna | All Plans | — | $81,241.00 | $60,930.75 | 2026-05-14 | MRF ↗ |
| BOTHWELL REGIONAL HEALTH CENTER Outpatient | Blue Cross Blue Shield | Preferred, Ppo, Trad, Net | $2,527.84 | $81,241.00 | $60,930.75 | 2026-05-14 | MRF ↗ |
| BOTHWELL REGIONAL HEALTH CENTER Outpatient | Corvel | All Plans | — | $81,241.00 | $60,930.75 | 2026-05-14 | MRF ↗ |
| BOTHWELL REGIONAL HEALTH CENTER Outpatient | Coventry | Workers Comp | — | $81,241.00 | $60,930.75 | 2026-05-14 | MRF ↗ |
| BOTHWELL REGIONAL HEALTH CENTER Outpatient | Cigna | All Plans | — | $81,241.00 | $60,930.75 | 2026-05-14 | MRF ↗ |
| BOTHWELL REGIONAL HEALTH CENTER Outpatient | Home State | Medicaid | — | $81,241.00 | $60,930.75 | 2026-05-14 | MRF ↗ |
| SEVIER VALLEY HOSPITAL Outpatient | Selecthealth | Medicaid | $2,614.73 | — | — | 2026-05-14 | MRF ↗ |
| RIVERTON HOSPITAL Outpatient | Selecthealth | Medicaid | $2,614.73 | — | — | 2026-05-22 | MRF ↗ |
| SEVIER VALLEY HOSPITAL Outpatient | Healthy U | Medicaid | $2,614.73 | — | — | 2026-05-14 | MRF ↗ |
| INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL Outpatient | Molina | Medicaid | $2,614.73 | — | — | 2026-05-22 | MRF ↗ |
| SEVIER VALLEY HOSPITAL Outpatient | Molina | Medicaid | $2,614.73 | — | — | 2026-05-14 | MRF ↗ |
| INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL Outpatient | Selecthealth | Medicaid | $2,614.73 | — | — | 2026-05-22 | MRF ↗ |
| INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL Outpatient | Health Plan Of Nevada | Medicaid | $2,614.73 | — | — | 2026-05-22 | MRF ↗ |
| SEVIER VALLEY HOSPITAL Outpatient | Health Plan Of Nevada | Medicaid | $2,614.73 | — | — | 2026-05-14 | MRF ↗ |
| INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL Outpatient | Healthy U | Medicaid | $2,614.73 | — | — | 2026-05-22 | MRF ↗ |
| RIVERTON HOSPITAL Outpatient | Healthy U | Medicaid | $2,614.73 | — | — | 2026-05-18 | MRF ↗ |
| INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL Outpatient | Healthy U | Medicaid | $2,614.73 | — | — | 2026-05-18 | MRF ↗ |
| RIVERTON HOSPITAL Outpatient | Selecthealth | Medicaid | $2,614.73 | — | — | 2026-05-18 | MRF ↗ |
| RIVERTON HOSPITAL Outpatient | Health Plan Of Nevada | Medicaid | $2,614.73 | — | — | 2026-05-18 | MRF ↗ |
| INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL Outpatient | Molina | Medicaid | $2,614.73 | — | — | 2026-05-18 | MRF ↗ |
| INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL Outpatient | Selecthealth | Medicaid | $2,614.73 | — | — | 2026-05-18 | MRF ↗ |
| INTERMOUNTAIN HEALTH UTAH VALLEY HOSPITAL Outpatient | Health Plan Of Nevada | Medicaid | $2,614.73 | — | — | 2026-05-18 | MRF ↗ |
| BEAR RIVER VALLEY HOSPITAL Outpatient | Molina | Medicaid | $2,614.73 | — | — | 2026-05-09 | MRF ↗ |
| BEAR RIVER VALLEY HOSPITAL Outpatient | Selecthealth | Medicaid | $2,614.73 | — | — | 2026-05-09 | MRF ↗ |
| CEDAR CITY HOSPITAL Outpatient | Molina | Medicaid | $2,614.73 | — | — | 2026-05-09 | MRF ↗ |
| BEAR RIVER VALLEY HOSPITAL Outpatient | Healthy U | Medicaid | $2,614.73 | — | — | 2026-05-09 | MRF ↗ |
| CEDAR CITY HOSPITAL Outpatient | Health Plan Of Nevada | Medicaid | $2,614.73 | — | — | 2026-05-09 | MRF ↗ |
| CEDAR CITY HOSPITAL Outpatient | Healthy U | Medicaid | $2,614.73 | — | — | 2026-05-09 | 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.