D4212 — Gingivectomy/plasty Rest
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). Gingivectomy/plasty rest (HCPCS D4212) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/D4212?code_type=HCPCS
MLA (9th ed.)
“Gingivectomy/plasty rest (HCPCS D4212) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/D4212?code_type=HCPCS. Accessed .
Chicago (notes-bibliography)
“Gingivectomy/plasty rest (HCPCS D4212) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/D4212?code_type=HCPCS.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $2,819–$4,674 (25th–75th percentile) across 887 hospitals · 934 payers.
“Negotiated” is the hospital’s negotiated facility rate for this HCPCS D4212 — 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 |
|---|---|---|---|---|---|---|---|
| SIERRA MEDICAL CENTER OutpatientFacility | UNITED HEALTHCARE | UNITED HEALTHCARE NEW MEXICO MEDICAID | $1.00 | — | — | 2026-09-01 | MRF ↗ |
| THE HOSPITALS OF PROVIDENCE - MEMORIAL CAMPUS OutpatientFacility | UNITED HEALTHCARE | UNITED HEALTHCARE NEW MEXICO MEDICAID | $1.00 | — | — | 2026-09-01 | MRF ↗ |
| THE HOSPITALS OF PROVIDENCE - MEMORIAL CAMPUS OutpatientFacility | BLUE CROSS/BLUE SHIELD | BLUECROSS AND BLUESHIELD OF NEW MEXICO BLUE SALUD | $1.00 | — | — | 2026-09-01 | MRF ↗ |
| SIERRA MEDICAL CENTER OutpatientFacility | BLUE CROSS/BLUE SHIELD | BLUECROSS AND BLUESHIELD OF NEW MEXICO BLUE SALUD | $1.00 | — | — | 2026-09-01 | MRF ↗ |
| ST CATHERINE OF SIENA HOSPITAL OutpatientFacility | Beacon Health Options | Medicare | $3.94 | $672.00 | — | 2026-02-19 | MRF ↗ |
| RARITAN BAY MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $7.60 | $4,223.00 | — | 2024-12-31 | MRF ↗ |
| TRINITAS REGIONAL MEDICAL CENTER OutpatientFacility | Wellpoint | NJ Family Care | $9.18 | — | — | 2026-03-04 | MRF ↗ |
| NEWARK BETH ISRAEL MEDICAL CENTER OutpatientFacility | United Healthcare | Community Plan | $9.45 | — | — | 2026-03-04 | MRF ↗ |
| ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL - SOMERSET OutpatientFacility | Wellpoint | NJ Family Care | $9.72 | — | — | 2026-03-04 | MRF ↗ |
| JERSEY CITY MEDICAL CENTER OutpatientFacility | Wellpoint | NJ Family Care | $11.88 | — | — | 2026-03-04 | MRF ↗ |
| VANDERBILT TULLAHOMA-HARTON HOSPITAL Both | United | United DBP | $22.44 | $299.00 | $86.71 | 2025-10-01 | MRF ↗ |
| VANDERBILT BEDFORD HOSPITAL Both | United | United DBP | $22.44 | $299.00 | $86.71 | 2025-10-01 | MRF ↗ |
| VANDERBILT WILSON COUNTY HOSPITAL Both | United | United DBP | $22.44 | $299.00 | $86.71 | 2025-10-01 | MRF ↗ |
| VANDERBILT UNIVERSITY MEDICAL CENTER Both | United | United DBP | $22.44 | $299.00 | $161.46 | 2025-10-01 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - OAKLAND/RICHMOND Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - ANTIOCH Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - ROSEVILLE Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - SOUTH SAN FRANCISCO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - REDWOOD CITY Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL-SAN JOSE Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSP SO SACRAMENTO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL MANTECA Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-18 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL AND REHAB CENTER Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - FREMONT Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| SANTA ROSA MEDICAL CENTER Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-18 | MRF ↗ |
| San Leandro Hospital Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-17 | MRF ↗ |
| SAN FRANCISCO VA MEDICAL CENTER Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL MODESTO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| MT SAN RAFAEL HOSPITAL Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - VACAVILLE Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - FRESNO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - OAKLAND/RICHMOND Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - WALNUT CREEK Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL-SANTA CLARA Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - ROSEVILLE Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - FRESNO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - FREMONT Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - OAKLAND/RICHMOND Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL-SANTA CLARA Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL AND REHAB CENTER Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-17 | MRF ↗ |
| SAN FRANCISCO VA MEDICAL CENTER Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - SOUTH SAN FRANCISCO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - WALNUT CREEK Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| SANTA ROSA MEDICAL CENTER Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-18 | MRF ↗ |
| San Leandro Hospital Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL MANTECA Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-18 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - REDWOOD CITY Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - ANTIOCH Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| MT SAN RAFAEL HOSPITAL Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL MODESTO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL-SAN JOSE Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - VACAVILLE Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - OAKLAND/RICHMOND Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSP SO SACRAMENTO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $191.00 | $106.96 | 2026-07-15 | MRF ↗ |
| ALTRU HOSPITAL OutpatientFacility | Medica | Medicaid Managed Care Plan – Hmo | $26.06 | — | — | 2026-03-01 | MRF ↗ |
| ALTRU HOSPITAL OutpatientFacility | Medica | Medicaid Managed Care Plan | $26.06 | — | — | 2026-03-01 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO OutpatientFacility | Anthem Centers for Medical Excellence | Transplant (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO OutpatientFacility | Blue Cross Blue Shield Association BDCT | Transplant (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO OutpatientFacility | Interlink National | Transplant Commercial (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO OutpatientFacility | Kaiser National | Transplant (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO OutpatientFacility | Interlink National | Transplant Medicaid (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO OutpatientFacility | CCHA Behavioral Health | Medicaid (All Contracted Plans) | $26.60 | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO OutpatientFacility | Optum Health | Transplant Government (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO OutpatientFacility | Optum Health | Transplant Commercial (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO OutpatientFacility | Humana National | Transplant (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO OutpatientFacility | Life Trac National | Transplant (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| Roswell Park Cancer Institute OutpatientFacility | Univera | Special Programs Medicaid Managed Care Plan | $32.20 | — | — | 2026-04-01 | MRF ↗ |
| CHILDREN'S HOSPITALS & CLINICS OF MN Outpatient | Medica | Medica Pmap | $33.12 | $197.00 | $197.00 | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Amerihealth Caritas Nh | Amerihealth Caritas - Nh Managed Medicaid | $34.01 | — | — | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Wellsense Health Plan | Wellsense - Nh Managed Medicaid | $34.01 | — | — | 2026-07-18 | MRF ↗ |
| CHESHIRE MEDICAL CENTER Outpatient | First Health/Hcvm | First Health/Hcvm | — | — | — | 2026-07-15 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Beacon Health Strategies/Carelon | Wellsense - Nh Managed Medicaid Beh Health | $34.01 | — | — | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Phcs | Phcs - Ppo | — | — | — | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Ccmsi | Ccmsi - Workers Comp | — | — | — | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | First Health/Hcvm | First Health/Hcvm - Dhp | — | — | — | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Corvel | Corvel - Workers Comp | — | — | — | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Maine Community Health Options | Mcho Indiv - Exchange | — | — | — | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Granite State Health Plan | New Hampshire Healthy Families - Nh Managed Medicaid Beh Health | $34.01 | — | — | 2026-07-18 | MRF ↗ |
| CHESHIRE MEDICAL CENTER Outpatient | Amerihealth Caritas Nh | Amerihealth Caritas - Nh Managed Medicaid | $34.01 | — | — | 2026-07-15 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Coventry | Coventry- Workers Comp | — | — | — | 2026-07-18 | MRF ↗ |
| CHESHIRE MEDICAL CENTER Outpatient | Granite State Health Plan | New Hampshire Healthy Families - Nh Managed Medicaid | $34.01 | — | — | 2026-07-15 | MRF ↗ |
| CHESHIRE MEDICAL CENTER Outpatient | Phcs | Phcs | — | — | — | 2026-07-15 | MRF ↗ |
| CHESHIRE MEDICAL CENTER Outpatient | Wellsense Health Plan | Wellsense - Nh Managed Medicaid | $34.01 | — | — | 2026-07-15 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Beacon Health Strategies/Carelon | Wellsense - Nh Managed Medicaid Beh Health - Dhp | $35.03 | — | — | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Granite State Health Plan | New Hampshire Healthy Families - Nh Managed Medicaid - Dhp | $36.08 | — | — | 2026-07-18 | MRF ↗ |
| NEW LONDON HOSPITAL Outpatient | Granite State Health Plan | New Hampshire Healthy Families - Nh Managed Medicaid | $36.08 | — | — | 2026-05-23 | MRF ↗ |
| NEW LONDON HOSPITAL Outpatient | Wellsense Health Plan | Wellsense - Nh Managed Medicaid | $36.08 | — | — | 2026-05-23 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Amerihealth Caritas Nh | Amerihealth Caritas - Nh Managed Medicaid - Dhp | $36.08 | — | — | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Wellsense Health Plan | Wellsense - Nh Managed Medicaid - Dhp | $36.08 | — | — | 2026-07-18 | MRF ↗ |
| MONROE REGIONAL HOSPITAL Both | Magnolia Health Plan Mcd Rep | Medicaid Replacement | — | $100.00 | $100.00 | 2026-05-22 | MRF ↗ |
| MONROE REGIONAL HOSPITAL Both | Medicaid Mississippi | Federal | — | $100.00 | $100.00 | 2026-05-22 | MRF ↗ |
| MONROE REGIONAL HOSPITAL Both | Medicare A Ms Jh | Default | $36.26 | $100.00 | $100.00 | 2026-05-22 | MRF ↗ |
| MONROE REGIONAL HOSPITAL Both | Medicare B Ms Jh | Federal | — | $100.00 | $100.00 | 2026-05-22 | MRF ↗ |
| MONROE REGIONAL HOSPITAL Both | Medicare B Ms Jh | Federal | — | $100.00 | $100.00 | 2026-05-13 | MRF ↗ |
| MONROE REGIONAL HOSPITAL Both | Medicaid Mississippi | Federal | — | $100.00 | $100.00 | 2026-05-13 | MRF ↗ |
| MONROE REGIONAL HOSPITAL Both | Magnolia Health Plan Mcd Rep | Medicaid Replacement | — | $100.00 | $100.00 | 2026-05-13 | MRF ↗ |
| MONROE REGIONAL HOSPITAL Both | Medicare A Ms Jh | Default | $36.26 | $100.00 | $100.00 | 2026-05-13 | MRF ↗ |
| FORT SANDERS REGIONAL MEDICAL CENTER OutpatientFacility | Aetna | Commercial | $36.35 | — | — | 2026-04-27 | MRF ↗ |
| PARKWEST MEDICAL CENTER OutpatientFacility | Aetna | Commercial | $36.35 | — | — | 2026-04-27 | MRF ↗ |
| NEW LONDON HOSPITAL Outpatient | Amerihealth Caritas Nh | Amerihealth Caritas - Nh Managed Medicaid | $36.43 | — | — | 2026-05-23 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Granite State Health Plan | New Hampshire Healthy Families - Nh Managed Medicaid Beh Health - Dhp | $36.78 | — | — | 2026-07-18 | MRF ↗ |
| MONROE REGIONAL HOSPITAL Both | Ambetter | Default | $37.00 | $100.00 | $100.00 | 2026-05-22 | MRF ↗ |
| MONROE REGIONAL HOSPITAL Both | Ambetter | Default | $37.00 | $100.00 | $100.00 | 2026-05-13 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Granite State Health Plan | New Hampshire Healthy Families - Nh Managed Medicaid | $37.13 | — | — | 2026-07-18 | MRF ↗ |
| HASKELL REGIONAL HOSPITAL, INC Both | Aetna Medicare Advantage | Medicare Advantage | $39.20 | $100.00 | $100.00 | 2026-07-15 | MRF ↗ |
| HASKELL REGIONAL HOSPITAL, INC Both | Medicare B Ok Jh | Default | — | $100.00 | $100.00 | 2026-07-15 | MRF ↗ |
| HASKELL REGIONAL HOSPITAL, INC Both | Medicare A Ok Jh | Default | $39.20 | $100.00 | $100.00 | 2026-07-15 | MRF ↗ |
| HASKELL REGIONAL HOSPITAL, INC Both | Aetna Better Health Ok | Medicaid Replacement | — | $100.00 | $100.00 | 2026-07-15 | MRF ↗ |
| HASKELL REGIONAL HOSPITAL, INC Both | Humana Mcd Rep | Medicaid Replacement | — | $100.00 | $100.00 | 2026-07-15 | MRF ↗ |
| HASKELL REGIONAL HOSPITAL, INC Both | Medicaid Oklahoma | Default | — | $100.00 | $100.00 | 2026-07-15 | MRF ↗ |
| HASKELL REGIONAL HOSPITAL, INC Both | Oklahoma Complete Health Mcd Rep | Medicaid Replacement | — | $100.00 | $100.00 | 2026-07-15 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | Cigna | Commercial (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | Aetna Institute of Excellence | Transplant (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | United Healthcare | Commercial (Select CO) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | Cigna Lifesource | Transplant (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | United Healthcare | Commercial (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | Select Health | Commercial (EPO/HMO/POS/PPO) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | Colorado Medicaid | FFS (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | United Behavioral Health/Optum | Commercial (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | Denver Health Medical Plan | Medicaid Choice | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | Department of Corrections | Commercial (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | CCHA Behavioral Health | Medicaid (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | Colorado Access | CHP+ | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | ValueOptions Colorado | Medicaid (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | Colorado Access Behavioral Health | Medicaid (All Contracted Plans) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | Rocky Mountain Health Plan | Medicaid Prime | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO OutpatientFacility | Integrated Health Plan | Commercial (PPO) | $39.90 | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| CHILDREN'S HOSPITAL COLORADO InpatientFacility | MotivHealth/Denver Public Schools | Commercial (PPO) | — | $266.00 | $172.90 | 2026-04-17 | MRF ↗ |
| INDEPENDENCE HEALTH SYSTEM BUTLER MEMORIAL HOSPITA Outpatient | Ccbh - Behavioral Health | Behavioral | — | — | — | 2026-07-19 | MRF ↗ |
| HASKELL REGIONAL HOSPITAL, INC Both | Uhc Medicare Solution | Medicare Advantage | $40.00 | $100.00 | $100.00 | 2026-07-15 | MRF ↗ |
| Pam Specialty Hospital Of San Antonio Medical Cen InpatientFacility | Aetna | All Plans | $42.01 | — | — | 2025-09-11 | MRF ↗ |
| Pam Specialty Hospital Of San Antonio Medical Cen InpatientFacility | Aetna | All Plans | $42.01 | — | — | 2025-09-11 | MRF ↗ |
| PEARL RIVER COUNTY HOSPITAL OutpatientFacility | Aetna | Commercial | $43.07 | — | — | 2026-01-30 | MRF ↗ |
| PENN HIGHLANDS MON VALLEY Outpatient | Aetna | Coventry | $45.87 | — | — | 2026-05-14 | MRF ↗ |
| PENN HIGHLANDS MON VALLEY Outpatient | Aetna | Coventry | $45.87 | — | — | 2026-05-23 | MRF ↗ |
| SUMMIT MEDICAL CENTER Outpatient | Aetna 6/1/ | Aetna 6/1/ | $46.31 | — | — | 2026-08-30 | MRF ↗ |
| SUMMIT MEDICAL CENTER Outpatient | Aetna | Aetna | $46.31 | — | — | 2026-08-30 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER OutpatientFacility | HUMANA | HUMANA MEDICARE- MIDTOWN IMAGING | $46.94 | — | — | 2026-09-01 | MRF ↗ |
| ALTRU HOSPITAL OutpatientFacility | Medica | Medicare Managed Care Plan | $47.07 | — | — | 2026-03-01 | MRF ↗ |
| VALLEYWISE HEALTH MEDICAL CENTER OutpatientFacility | AETNA | MEDICARE ADVANTAGE | $48.21 | — | — | 2025-06-28 | MRF ↗ |
| Pam Health Rehabilitation Hospital Of Surprise OutpatientFacility | Aetna | PPO/HMO/EPO | $48.21 | — | — | 2025-09-11 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Aetna | Aetna Medicare Advantage - Dhp | $49.00 | — | — | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Bcbs Of Vermont | Bcbs Of Vermont - The Vermont Health Plan | $49.00 | — | — | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Aetna | Aetna Hmo/Pos/Ppo - Arnb | $49.00 | — | — | 2026-07-18 | MRF ↗ |
| CHESHIRE MEDICAL CENTER Outpatient | Aetna | Aetna Hmo/Pos/Ppo | $49.00 | — | — | 2026-07-15 | MRF ↗ |
| SARASOTA MEMORIAL HOSPITAL Outpatient | Aetna Oncology UPW | Medicare Advantage | $49.00 | — | — | 2026-06-30 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Wellsense Health Plan | Wellsense - Medicare Advantage | $49.00 | — | — | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Aetna | Aetna Hmo/Pos/Ppo | $49.00 | — | — | 2026-07-18 | MRF ↗ |
| SARASOTA MEMORIAL HOSPITAL Outpatient | Aetna Oncology | Medicare Advantage | $49.00 | — | — | 2025-08-01 | MRF ↗ |
| H Lee Moffitt Cancer Center & Research Institute I Outpatient | Aetna | HMO/PPO (MMG) | $49.00 | — | — | 2025-10-24 | MRF ↗ |
| SIGNATURE HEALTHCARE BROCKTON HOSPITAL OutpatientFacility | Aetna | All Plans | $49.00 | — | — | 2026-01-28 | MRF ↗ |
| OUR LADY OF FATIMA HOSPITAL OutpatientFacility | Aetna | Commercial | $49.00 | — | — | 2026-01-01 | MRF ↗ |
| CHESHIRE MEDICAL CENTER Outpatient | Aetna | Aetna Medicare Advantage | $49.00 | — | — | 2026-07-15 | MRF ↗ |
| CHESHIRE MEDICAL CENTER Outpatient | Cigna | Cigna Hmo-Pos | $49.42 | — | — | 2026-07-15 | MRF ↗ |
| CHESHIRE MEDICAL CENTER Outpatient | Mvp | Mvp - Hmo/Pos/Ppo | $49.42 | — | — | 2026-07-15 | MRF ↗ |
| CHESHIRE MEDICAL CENTER Outpatient | Cigna | Cigna Ppo | $49.42 | — | — | 2026-07-15 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Cigna | Cigna Ppo | $49.53 | — | — | 2026-07-18 | MRF ↗ |
| MARY HITCHCOCK MEMORIAL HOSPITAL Outpatient | Cigna | Cigna Hmo-Pos | $49.53 | — | — | 2026-07-18 | MRF ↗ |
| FILLMORE COUNTY HOSPITAL OutpatientFacility | Aetna | Commercial | $50.14 | — | — | 2026-04-23 | MRF ↗ |
| FILLMORE COUNTY HOSPITAL OutpatientFacility | Medica | Commercial | $50.14 | — | — | 2026-04-23 | MRF ↗ |
| FILLMORE COUNTY HOSPITAL OutpatientFacility | Medica | Commercial | $50.14 | — | — | 2026-04-23 | MRF ↗ |
| FILLMORE COUNTY HOSPITAL OutpatientFacility | Aetna | Commercial | $50.14 | — | — | 2026-04-23 | MRF ↗ |
| Post Acute Medical Specialty Hospital Of Texarkana InpatientFacility | Aetna | Commercial | $50.42 | — | — | 2025-09-11 | MRF ↗ |
| CARLE FOUNDATION HOSPITAL OutpatientFacility | Aetna | Medicare Advantage HMO | $51.34 | — | — | 2026-04-15 | MRF ↗ |
| CARLE FOUNDATION HOSPITAL OutpatientFacility | Aetna | Medicare Advantage PPO | $51.34 | — | — | 2026-04-15 | MRF ↗ |
| FORT MEMORIAL HOSPITAL OutpatientFacility | Humana | All Products | $52.53 | — | — | 2025-07-22 | MRF ↗ |
| HENRY COUNTY HEALTH CENTER OutpatientFacility | AETNA | ALL PRODUCTS | $52.69 | — | — | 2025-06-04 | MRF ↗ |
| HENRY COUNTY HEALTH CENTER OutpatientFacility | AETNA | ALL PRODUCTS | $52.69 | — | — | 2025-06-04 | MRF ↗ |
| MEMORIAL HOSPITAL AND HEALTH CARE CENTER OutpatientFacility | Aetna | Medicare Advantage | $52.74 | — | — | 2026-02-13 | MRF ↗ |
| HEYWOOD HOSPITAL - Outpatient | Fallon | MedicarePlusHMO | $52.92 | — | — | 2025-04-16 | MRF ↗ |
| HEYWOOD HOSPITAL - Outpatient | Fallon | MedicarePlusCentralHMO | $52.92 | — | — | 2025-04-16 | MRF ↗ |
| HEYWOOD HOSPITAL - Outpatient | Fallon | MedicarePlusCentralHMO | $52.92 | — | — | 2025-04-16 | MRF ↗ |
| HEYWOOD HOSPITAL - Outpatient | Fallon | MedicarePlusHMO | $52.92 | — | — | 2025-04-16 | MRF ↗ |
| GOOD SAMARITAN MEDICAL CENTER OutpatientFacility | HUMANA | HUMANA- MIDTOWN IMAGING | $53.46 | — | — | 2026-09-01 | MRF ↗ |
| Bradford Regional Medical Center OutpatientFacility | Univera | Medicare Managed Care Plan | $53.67 | — | — | 2026-04-01 | MRF ↗ |
| Roswell Park Cancer Institute OutpatientFacility | Univera | Access All Commercial Plans | $53.67 | — | — | 2026-04-01 | MRF ↗ |
| Roswell Park Cancer Institute OutpatientFacility | Univera | Medicare Managed Care Plan | $53.67 | — | — | 2026-04-01 | MRF ↗ |
| BROOKS-TLC HOSPITAL SYSTEM, INC OutpatientFacility | Univera | Medicare Managed Care Plan | $53.67 | — | — | 2026-04-01 | MRF ↗ |
| Bradford Regional Medical Center OutpatientFacility | Univera | All Commercial Plans | $53.67 | — | — | 2026-04-01 | MRF ↗ |
| Roswell Park Cancer Institute OutpatientFacility | Univera | All Commercial Plans | $53.67 | — | — | 2026-04-01 | MRF ↗ |
| BROOKS-TLC HOSPITAL SYSTEM, INC OutpatientFacility | Univera | All Commercial Plans | $53.67 | — | — | 2026-04-01 | MRF ↗ |
| Bradford Regional Medical Center OutpatientFacility | Univera | Essential Other Commercial Plan | $53.67 | — | — | 2026-04-01 | MRF ↗ |
| MONROE REGIONAL HOSPITAL Both | Medicare A Ms Jh | Default | $54.88 | $100.00 | $100.00 | 2026-09-21 | MRF ↗ |
| SARASOTA MEMORIAL HOSPITAL Outpatient | Aetna Oncology | Commercial | $54.88 | — | — | 2025-08-01 | MRF ↗ |
| SARASOTA MEMORIAL HOSPITAL Outpatient | Aetna Oncology UPW | Commercial | $54.88 | — | — | 2026-06-30 | MRF ↗ |
| MONROE REGIONAL HOSPITAL Both | — | — | — | $100.00 | $100.00 | 2026-03-30 | MRF ↗ |
| NORTH CADDO MEDICAL CENTER BothFacility | United Healthcare | Commercial | $55.34 | — | — | 2026-04-01 | MRF ↗ |
| NORTH CADDO MEDICAL CENTER BothFacility | United Healthcare | Commercial | $55.34 | — | — | 2026-04-01 | MRF ↗ |
| PRISMA HEALTH TUOMEY HOSPITAL | Aetna Medicare | — | $55.89 | $50,000.00 | $32,500.00 | 2026-07-05 | MRF ↗ |
| PRISMA HEALTH BAPTIST PARKRIDGE | Aetna Medicare | — | $55.89 | $50,000.00 | $32,500.00 | 2026-07-05 | MRF ↗ |
| PRISMA HEALTH RICHLAND HOSPITAL | Aetna Medicare | — | $55.89 | $50,000.00 | $32,500.00 | 2026-07-05 | MRF ↗ |
| MONROE REGIONAL HOSPITAL Both | Ambetter | Default | $56.00 | $100.00 | $100.00 | 2026-09-21 | MRF ↗ |
| VANDERBILT WILSON COUNTY HOSPITAL Both | Met Life | Met Life Dental | $57.00 | $299.00 | $86.71 | 2025-10-01 | MRF ↗ |
| VANDERBILT BEDFORD HOSPITAL Both | Met Life | Met Life Dental | $57.00 | $299.00 | $86.71 | 2025-10-01 | MRF ↗ |
| VANDERBILT UNIVERSITY MEDICAL CENTER Both | Met Life | Met Life Dental | $57.00 | $299.00 | $161.46 | 2025-10-01 | MRF ↗ |
| VANDERBILT TULLAHOMA-HARTON HOSPITAL Both | Met Life | Met Life Dental | $57.00 | $299.00 | $86.71 | 2025-10-01 | MRF ↗ |
| MARION GENERAL HOSPITAL OutpatientFacility | Aetna | Commercial | $57.43 | — | — | 2026-01-30 | MRF ↗ |
| FORT MEMORIAL HOSPITAL OutpatientFacility | Molina | Managed Medicaid | $59.79 | — | — | 2025-07-22 | MRF ↗ |
| ST VINCENT GENERAL HOSPITAL DISTRICT OutpatientFacility | First Health | All | — | — | — | 2026-03-29 | MRF ↗ |
| ST VINCENT GENERAL HOSPITAL DISTRICT OutpatientFacility | Cigna | All | — | — | — | 2026-03-29 | 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.