Q4105 — Integra Drt Or Omnigraft
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). Integra drt or omnigraft (CPT Q4105) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/Q4105?code_type=CPT
MLA (9th ed.)
“Integra drt or omnigraft (CPT Q4105) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/Q4105?code_type=CPT. Accessed .
Chicago (notes-bibliography)
“Integra drt or omnigraft (CPT Q4105) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/Q4105?code_type=CPT.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $82–$1,187 (25th–75th percentile) across 1,394 hospitals · 2,740 payers.
“Negotiated” is the hospital’s negotiated facility rate for this CPT/HCPCS Q4105 — 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 this costs at this hospital
The hospital facility charge for this code — an actual negotiated rate from our data. A separate professional fee isn’t separately estimable for this code (see the note below).
What hospitals actually negotiate
Measured
$82
$168 typical
$1,187
The middle 50% of negotiated facility rates for this procedure, measured across 1,394 hospitals.
What you’ll likely be billed
| Hospital facility Actual median across hospitals The hospital’s negotiated facility rate — from our MRF data. | $168 |
| Likely subtotal | $168 |
Facility charge (no separate professional fee)
$168
Not included in this estimate:
- Rehab, physical therapy, and other post-acute care after discharge
- Complications, revisions, or readmissions
- Out-of-network provider choices you make yourself (the No Surprises Act only covers providers you can't choose)
The biggest swing: which insurer's rate applies — negotiated prices here run $82–$1,187.
- This is a drug/supply code billed by the facility; there is no separate professional fee to estimate — the figure above is the facility charge only.
How each figure is sourced
- Hospital facility (actual)
- source: Hospital MRF (45 CFR 180)
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 HOSPITAL MANSFIELD Inpatient | — | — | — | $773.18 | $386.59 | 2024-12-15 | MRF ↗ |
| TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH Inpatient | — | — | — | $773.18 | $386.59 | 2024-12-15 | MRF ↗ |
| OCEAN MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $0.20 | $111.35 | — | 2024-12-31 | MRF ↗ |
| OCEAN MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $0.28 | $155.15 | — | 2024-12-31 | MRF ↗ |
| OCEAN MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $0.31 | $171.00 | — | 2024-12-31 | MRF ↗ |
| BAYSHORE MEDICAL CENTER OutpatientFacility | CLOVER | MEDICARE ADVANTAGE | $0.31 | $171.00 | — | 2025-12-31 | MRF ↗ |
| FOOTHILL REGIONAL MEDICAL CENTER OutpatientFacility | Blue Shield of California | EPO/PPO/Out of State | $0.33 | — | — | 2026-03-18 | MRF ↗ |
| OCEAN MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $0.48 | $265.01 | — | 2024-12-31 | MRF ↗ |
| BAYSHORE MEDICAL CENTER OutpatientFacility | CLOVER | MEDICARE ADVANTAGE | $0.48 | $264.00 | — | 2025-12-31 | MRF ↗ |
| OCEAN MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $0.48 | $264.00 | — | 2024-12-31 | MRF ↗ |
| BAYSHORE MEDICAL CENTER OutpatientFacility | CLOVER | MEDICARE ADVANTAGE | $0.55 | $302.86 | — | 2025-12-31 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $0.65 | $176.02 | $167.22 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $0.65 | $176.02 | $167.22 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Point Comfort Underwriters | Organizational | $0.70 | $176.02 | $167.22 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $0.84 | $176.02 | $167.22 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $0.84 | $176.02 | $167.22 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $0.86 | $176.02 | $167.22 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $0.86 | $176.02 | $167.22 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $0.86 | $176.02 | $167.22 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Point Comfort Underwriters | Organizational | $0.86 | $176.02 | $167.22 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $0.90 | $176.02 | $167.22 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Point Comfort Underwriters | Organizational | $0.95 | $176.02 | $167.22 | 2026-02-20 | MRF ↗ |
| ESSENTIA HEALTH ST JOSEPH'S MEDICAL CENTER OutpatientFacility | MN BCBS Commercial | BCBS MN | $1.00 | — | — | 2026-01-01 | MRF ↗ |
| ESSENTIA HEALTH OutpatientFacility | BCBS PLUS PMAP PCC PRIME | Medicaid | $1.00 | — | — | 2026-01-01 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $1.00 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | UnitedHealth Group of WI | Medicare Advantage | $1.00 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| ESSENTIA HEALTH OutpatientFacility | MN BCBS Commercial | BCBS MN | $1.00 | — | — | 2026-01-01 | MRF ↗ |
| ESSENTIA HEALTH ST JOSEPH'S MEDICAL CENTER OutpatientFacility | BLUE PLUS PMAP PCC PRIME | Medicaid | $1.00 | — | — | 2026-01-01 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $1.00 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| ESSENTIA HEALTH DULUTH OutpatientFacility | MN BCBS Commercial | BCBS MN | $1.00 | — | — | 2026-01-01 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $1.02 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Point Comfort Underwriters | Organizational | $1.08 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $1.29 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $1.29 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $1.32 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Point Comfort Underwriters | Organizational | $1.32 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $1.32 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $1.32 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $1.35 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $1.37 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $1.40 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Point Comfort Underwriters | Organizational | $1.46 | $269.53 | $256.05 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $1.68 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | UnitedHealth Group of WI | Medicare Advantage | $1.68 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $1.68 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $1.73 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $1.78 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| FLAMBEAU HOSPITAL OutpatientFacility | Point Comfort Underwriters | Organizational | $1.82 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $2.19 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $2.19 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Veteran's Administration (VA CCN) | VA Network | $2.23 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $2.23 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Security Health Plan (SHP) | Medicare Advantage | $2.23 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Point Comfort Underwriters | Organizational | $2.23 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Anthem BCBS of WI | Medicare Advantage | $2.28 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - LADYSMITH OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $2.32 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Group Health Cooperative of Eau Claire | Medicare Advantage | $2.37 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| MARSHFIELD MEDICAL CENTER - NEILLSVILLE OutpatientFacility | Point Comfort Underwriters | Organizational | $2.46 | $455.36 | $432.59 | 2026-02-20 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Aetna | MGMCR | $3.30 | $22.00 | $22.00 | 2026-03-01 | MRF ↗ |
| MEMORIAL HEALTH MEADOWS HOSPITAL Outpatient | Peach State | MGMCD | $3.45 | — | — | 2024-10-01 | MRF ↗ |
| SAVANNAH HEALTH SERVICES LLC DBA MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER Outpatient | Peach State | MGMCD | $3.45 | — | — | 2024-10-01 | MRF ↗ |
| DOCTORS HOSPITAL OF MANTECA Outpatient | Amerigroup | MCD | $3.94 | $27.75 | $27.75 | 2026-03-01 | MRF ↗ |
| Lake City Medical Center Suwannee Campus Outpatient | BCBS | MCRPPO | $4.00 | $71.50 | $71.50 | 2026-03-01 | MRF ↗ |
| Lake City Medical Center Suwannee Campus Outpatient | BCBS | MCRHMO | $4.02 | $71.50 | $71.50 | 2026-03-01 | MRF ↗ |
| DOCTORS HOSPITAL OF MANTECA Outpatient | Aetna | MCR | $4.16 | $27.75 | $27.75 | 2026-03-01 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | HEALTHPARTNERS | COMMERCIAL | $4.19 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| DOCTORS HOSPITAL OF MANTECA Outpatient | United | OptionsPPO | $4.33 | $27.75 | $27.75 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | United | OptionsPPO | $4.58 | $22.00 | $22.00 | 2026-03-01 | MRF ↗ |
| Lake City Medical Center Suwannee Campus Outpatient | Aetna | MCR | $4.93 | $71.50 | $71.50 | 2026-03-01 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | MEDICA | MINNESOTACARE-MANAGED MEDICAID | $4.97 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | MEDICA | MSC+ Dual | $5.13 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | MEDICA | MSHO | $5.15 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | MEDICA | ACCESSABILITY SOLUTION-Dual | $5.25 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| DOCTORS HOSPITAL OF MANTECA Outpatient | Peach State | MGMCD | $5.55 | $27.75 | $27.75 | 2026-03-01 | MRF ↗ |
| DOCTORS HOSPITAL OF MANTECA Outpatient | Wellcare | MCD | $5.55 | $27.75 | $27.75 | 2026-03-01 | MRF ↗ |
| VOLUNTEER COMMUNITY HOSPITAL OutpatientFacility | River Valley Plan | TennCare | $5.57 | $8,427.00 | $5,898.90 | 2026-02-05 | MRF ↗ |
| METHODIST HOSPITALS OF MEMPHIS Both | TRANSPLANT OPTUM TENNCARE [350013] | HB MEDICAID TN - UHC TENNCARE (AMERICHOICE) - MUH-MNH-MSH-MGH-MHM-MCI | $5.57 | $1,923.94 | $423.27 | 2026-03-19 | MRF ↗ |
| METHODIST HOSPITALS OF MEMPHIS Both | UHC MEDICAID [350006] | HB MEDICAID TN - UHC TENNCARE (AMERICHOICE) - MUH-MNH-MSH-MGH-MHM-MCI | $5.57 | $1,923.94 | $423.27 | 2026-03-19 | MRF ↗ |
| METHODIST HOSPITALS OF MEMPHIS Both | TRANSPLANT OPTUM TENNCARE [350013] | HB MEDICAID TN - UHC TENNCARE (AMERICHOICE) - MUH-MNH-MSH-MGH-MHM-MCI | $5.57 | $1,923.94 | $423.27 | 2026-03-19 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | TRANSPLANT OPTUM TENNCARE [350013] | HB MEDICAID TN - UHC TENNCARE (AMERICHOICE) - MUH-MNH-MSH-MGH-MHM-MCI | $5.57 | $1,923.94 | $423.27 | 2026-03-19 | MRF ↗ |
| METHODIST HEALTHCARE - OLIVE BRANCH HOSPITAL Both | UHC MEDICAID [350006] | HB MEDICAID TN - UHC TENNCARE (AMERICHOICE) - MUH-MNH-MSH-MGH-MHM-MCI | $5.57 | $1,923.94 | $423.27 | 2026-03-19 | MRF ↗ |
| METHODIST HEALTHCARE - OLIVE BRANCH HOSPITAL Both | TRANSPLANT OPTUM TENNCARE [350013] | HB MEDICAID TN - UHC TENNCARE (AMERICHOICE) - MUH-MNH-MSH-MGH-MHM-MCI | $5.57 | $1,923.94 | $423.27 | 2026-03-19 | MRF ↗ |
| DYERSBURG REGIONAL MEDICAL CENTER OutpatientFacility | River Valley Plan | TennCare | $5.57 | $8,427.00 | $5,898.90 | 2026-02-06 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | UHC MEDICAID [350006] | HB MEDICAID TN - UHC TENNCARE (AMERICHOICE) - MUH-MNH-MSH-MGH-MHM-MCI | $5.57 | $1,923.94 | $423.27 | 2026-03-19 | MRF ↗ |
| METHODIST HOSPITALS OF MEMPHIS Both | UHC MEDICAID [350006] | HB MEDICAID TN - UHC TENNCARE (AMERICHOICE) - MUH-MNH-MSH-MGH-MHM-MCI | $5.57 | $1,923.94 | $423.27 | 2026-03-19 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | HUM Healthcare Systems Inc. (HHS)/Partners Health Plan | Medicare Advantage | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Cigna/MVP | Essential Medicaid 3-4 | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | HUM Healthcare Systems Inc. (HHS)/Partners Health Plan | Commercial | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Prime Health Services | Medicare Advantage | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Fidelis | Medicare Advantage | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | United Healthcare | Medicare Advantage | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Cigna/MVP | Essential Medicaid 1-2/5-6 | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Cigna/MVP | Individual Commercial | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | HUM Healthcare Systems Inc. (HHS)/Partners Health Plan | Managed Medicaid | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Coventry | Commercial | $5.62 | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Humana ChoiceCare | Medicare Advantage | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Humana ChoiceCare | Commercial | $5.62 | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Blue Cross Blue Shield/Excellus | Medicare Advantage | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Fidelis | Managed Medicaid | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Cigna/MVP | Medicare Advantage | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Beacon Health Options | Behavioral Health/All Products | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Logistic Health Inc. | Commercial | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Prime Health Services | Telemedicine Program | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Nascentia/VNA Homecare Options Inc. | Medicare Advantage/Medicaid Long Term Care | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| DOCTORS HOSPITAL OF MANTECA Outpatient | Aetna | QualifiedHealthPlan | $5.94 | $27.75 | $27.75 | 2026-03-01 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | UCARE | MSHO | $6.00 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | UCARE | MINNESOTACARE-MANAGED MEDICAID | $6.00 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| Claxton-hepburn Medical Center InpatientFacility | Humana ChoiceCare | Commercial | $6.19 | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center InpatientFacility | Blue Cross Blue Shield/Excellus | Commercial | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center InpatientFacility | Blue Cross Blue Shield/Excellus | Managed Medicaid | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center InpatientFacility | St. Lawrence-Lewis Program/STLLC | School Employee Program | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center InpatientFacility | Cigna/MVP | Group Commercial | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center InpatientFacility | Wellcare | Medicare Advantage | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center InpatientFacility | Department of Correctional Services DOCCCS | Managed Medicaid | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center InpatientFacility | Emblem/GHI | Commercial | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center InpatientFacility | United Healthcare | Commercial | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Claxton-hepburn Medical Center InpatientFacility | United Healthcare | Managed Medicaid | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS OutpatientFacility | Independence BC (IBC) ACA Tiered | HMO/PPO | $6.23 | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| RANGE REGIONAL HEALTH SERVICES OutpatientFacility | Blue Cross of Minnesota | PMAP | $6.32 | — | — | 2026-01-29 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS OutpatientFacility | Independence BC (IBC) | Indemnity/Traditional | $6.46 | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS OutpatientFacility | Independence BC (IBC) | HMO/PPO | $6.77 | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS OutpatientFacility | Blue Cross Out of Area Plans | HMO/PPO | $6.77 | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | BCBS | MHCP-Managed Medicaid | $6.78 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | MEDICA | ACCESSABILITY SOLUTION-Managed Medicaid | $6.78 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | HEALTHPARTNERS | Managed Medicaid | $6.78 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | UBH | COMMERCIAL/Managed Medicaid | $6.78 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | HENNEPIN HEALTH | PMAP-Managed Medicaid | $6.78 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | UCARE | Managed Medicaid | $6.78 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | MEDICA | PMAP-Managed Medicaid | $6.78 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS OutpatientFacility | Cigna | HMO/PPO | $7.00 | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| Lake City Medical Center Suwannee Campus Outpatient | BCBS | MCRPPO | $7.03 | $125.50 | $125.50 | 2026-03-01 | MRF ↗ |
| Lake City Medical Center Suwannee Campus Outpatient | BCBS | MCRHMO | $7.05 | $125.50 | $125.50 | 2026-03-01 | MRF ↗ |
| HUDSON REGIONAL HOSPITAL Outpatient | AETNA - ALL PLANS | AETNA - ALL PLANS | $7.15 | $22.00 | $22.00 | 2026-01-19 | MRF ↗ |
| HUDSON REGIONAL HOSPITAL Outpatient | AETNA - ALL PLANS | AETNA - ALL PLANS | $7.15 | $22.00 | $22.00 | 2026-01-19 | MRF ↗ |
| WEST TENNESSEE HEALTHCARE CAMDEN HOSPITAL OutpatientFacility | River Valley Plan | TennCare | $7.23 | $8,427.00 | $5,898.90 | 2026-02-06 | MRF ↗ |
| WEST TENNESSEE HEALTHCARE CAMDEN HOSPITAL OutpatientFacility | River Valley Plan | TennCare | $7.23 | $8,427.00 | $5,898.90 | 2026-02-06 | MRF ↗ |
| JACKSON-MADISON COUNTY GENERAL HOSPITAL OutpatientFacility | River Valley Plan | TennCare | $7.23 | $8,427.00 | $5,898.90 | 2026-02-06 | MRF ↗ |
| WEST TENNESSEE HEALTHCARE MILAN HOSPITAL OutpatientFacility | River Valley Plan | TennCare | $7.23 | $8,427.00 | $5,898.90 | 2026-02-05 | MRF ↗ |
| WEST TENNESSEE HEALTHCARE BOLIVAR HOSPITAL OutpatientFacility | River Valley Plan | TennCare | $7.23 | $8,427.00 | $5,898.90 | 2026-02-05 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | UCARE | COMMERCIAL | $7.50 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | MEDICA | CLEAR VALUE ACO FI | $7.55 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | MEDICA | MEDICA CHOICE/MEDICA FOCUS Employee | $7.55 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | MEDICA | IFB CHOICE | $7.55 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | HEALTHPARTNERS | MSHO | $7.61 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| DOCTORS HOSPITAL OF MANTECA Outpatient | Centurion | PRISN | $7.68 | $27.75 | $27.75 | 2026-03-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | Virginia Health Network | ULTRA | $7.70 | $22.00 | $22.00 | 2026-03-01 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | MEDICA | CLEAR VALUE ACO SI | $7.80 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| Lake City Medical Center Suwannee Campus Outpatient | BCBS | SBN | $7.87 | $71.50 | $71.50 | 2026-03-01 | MRF ↗ |
| Lake City Medical Center Suwannee Campus Outpatient | BCBS | BSL | $7.87 | $71.50 | $71.50 | 2026-03-01 | MRF ↗ |
| Lake City Medical Center Suwannee Campus Outpatient | BCBS | MBN | $7.87 | $71.50 | $71.50 | 2026-03-01 | MRF ↗ |
| DOCTORS HOSPITAL OF MANTECA Outpatient | Aetna | PPO | $7.94 | $27.75 | $27.75 | 2026-03-01 | MRF ↗ |
| DOCTORS HOSPITAL OF MANTECA Outpatient | Aetna | POS | $7.94 | $27.75 | $27.75 | 2026-03-01 | MRF ↗ |
| DOCTORS HOSPITAL OF MANTECA Outpatient | Aetna | OpenAccess | $7.94 | $27.75 | $27.75 | 2026-03-01 | MRF ↗ |
| DOCTORS HOSPITAL OF MANTECA Outpatient | Aetna | HMO | $7.94 | $27.75 | $27.75 | 2026-03-01 | MRF ↗ |
| MONMOUTH MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $7.95 | $4,417.50 | — | 2024-12-31 | MRF ↗ |
| OCEAN MEDICAL CENTER OutpatientFacility | Clover | Managed Medicare | $7.95 | $4,417.50 | — | 2024-12-31 | MRF ↗ |
| BAYSHORE MEDICAL CENTER OutpatientFacility | CLOVER | MEDICARE ADVANTAGE | $7.95 | $4,417.50 | — | 2025-12-31 | MRF ↗ |
| NATIONAL PARK MEDICAL CENTER Outpatient | Health Net | All Medi-cal Plans | $8.28 | $13,368.28 | $6,684.14 | 2026-03-27 | MRF ↗ |
| NATIONAL PARK MEDICAL CENTER Outpatient | Health Net | All Medi-cal Plans | $8.28 | $13,368.28 | $6,684.14 | 2025-12-31 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | BCN HURLEY EMPLOYEE [6007] | BCN HURLEY EMPLOYEE [600701] | $8.31 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | BLUE CARE NETWORK [6005] | BLUE CARE NETWORK [600501] | $8.31 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | BLUE CARE NETWORK [6005] | BLUE CARE NETWORK BEHAVIORAL HEALTH [600504] | $8.31 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | BLUE CARE NETWORK [6005] | BLUE CARE NETWORK CAPITATION [600502] | $8.31 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | BLUE CARE NETWORK [6005] | BLUE CARE NETWORK AWAY FROM HOME [600503] | $8.31 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | MEDICA | ELECT-ESSENTIAL | $8.39 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| HENNEPIN COUNTY MEDICAL CENTER OutpatientFacility | MEDICA | MEDICA CHOICE/MEDICA FOCUS Non-Employee | $8.39 | $15.00 | $6.75 | 2025-12-17 | MRF ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Blue Cross Blue Shield/Excellus | Managed Medicaid | $8.44 | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| Lake City Medical Center Suwannee Campus Outpatient | Aetna | MCR | $8.66 | $125.50 | $125.50 | 2026-03-01 | MRF ↗ |
| ST JUDE CHILDRENS RESEARCH HOSPITAL OutpatientFacility | UnitedHealthcare of TN Community Plan | MANAGED MEDICAID | $8.67 | $2,095.00 | — | 2025-07-01 | MRF ↗ |
| HELEN NEWBERRY JOY HOSPITAL Outpatient | BCBS - ALL OTHER PLANS | BCBS - ALL OTHER PLANS | $8.75 | $26.09 | $16.44 | 2026-01-27 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS OutpatientFacility | UPMC For You | Managed Medicaid | $9.29 | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS OutpatientFacility | PA Health & Wellness Community Health Choices | Dual Plan Managed Medicaid | $9.29 | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| HELEN NEWBERRY JOY HOSPITAL Outpatient | MI WC - ALL PLANS | MI WC - ALL PLANS | $9.39 | $26.09 | $16.44 | 2026-01-27 | MRF ↗ |
| BAYLOR SCOTT & WHITE HEART & VASCULAR HOSPITAL - DALLAS OutpatientFacility | Superior Health Plan | Medicaid | $9.43 | $117.90 | $70.74 | 2026-02-21 | MRF ↗ |
| ASCENSION ST VINCENT KOKOMO Both | ANTHEM CARE CONNECT | 8255_ANTHEM CONNECT MEDICAID REPLACEMENT OUTPATIENT 20240101 | $9.73 | $15,171.00 | $9,102.60 | 2026-01-01 | MRF ↗ |
| CJW MEDICAL CENTER Outpatient | United | GlobalBenefitPlan | $9.90 | $22.00 | $22.00 | 2026-03-01 | MRF ↗ |
| MERCY HOSPITAL SOUTH OutpatientFacility | MOLINA HEALTHCARE MEDICAID CONTRACTED [320265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $10.08 | $155.00 | $100.75 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL SOUTH OutpatientFacility | MOLINA HEALTHCARE MEDICAID [20265] | HB WASH JEFN LINC SAMC MOLINA HEALTHCHOICE OF IL MEDICAID NEW 040125 | $10.08 | $155.00 | $100.75 | 2026-03-12 | MRF ↗ |
| MERCY HOSPITAL SOUTH OutpatientFacility | MERIDIAN MEDICAID CONTRACTED [320430] | HB WASH JEFN LINC SAMC MERIDIAN HEALTH PLAN OF IL MEDICAID 103% | $10.08 | $155.00 | $100.75 | 2026-03-12 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | OUT OF STATE BCBS [6001] | OUT OF STATE BLUE CROSS GEORGIA [600107] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | OUT OF STATE BCBS [6001] | OUT OF STATE BLUE CROSS ILLINOIS [600108] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | OUT OF STATE BCBS [6001] | OUT OF STATE BLUE CROSS ARKANSAS [600104] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | OUT OF STATE BCBS [6001] | OUT OF STATE BCBS [600101] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | OUT OF STATE BCBS [6001] | OUT OF STATE BLUE CROSS PENNSYLVANIA [600110] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | OUT OF STATE BCBS [6001] | OUT OF STATE BLUE CROSS ALABAMA [600103] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | OUT OF STATE BCBS [6001] | OUT OF STATE BLUE CROSS CALIFORNIA [600105] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | OUT OF STATE BCBS [6001] | OUT OF STATE BLUE CROSS OHIO [600109] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | OUT OF STATE BCBS [6001] | OUT OF STATE BLUE CROSS RHODE ISLAND [600111] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | OUT OF STATE BCBS [6001] | OUT OF STATE BLUE CROSS TEXAS [600112] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | OUT OF STATE BCBS [6001] | OUT OF STATE BLUE CROSS WASHINGTON [600113] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | OUT OF STATE BCBS [6001] | OUT OF STATE BLUE CROSS COLORADO [600106] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | BCBS HURLEY EMPLOYEE [6002] | BCBS HURLEY EMPLOYEE [600201] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | BCBS FEDERAL EMPLOYEE FEP [6003] | BCBS FEDERAL EMPLOYEE FEP [600301] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | BCBS OF MICHIGAN [6000] | BCBS MEDICARE SUPPLEMENTAL [600004] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | BCBS OF MICHIGAN [6000] | BLUE HIGH PERFORMANCE NETWORK [600003] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | BCBS OF MICHIGAN [6000] | BCBS OF MICHIGAN [600001] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| HURLEY MEDICAL CENTER Both | BCBS OF MICHIGAN [6000] | BCBS GM RETIREES [600002] | $10.14 | $21.00 | $21.00 | 2026-03-23 | MRF ↗ |
| ALTRU HOSPITAL OutpatientFacility | Medica | Medicaid Managed Care Plan – Hmo | $10.30 | — | — | 2026-03-01 | MRF ↗ |
| ALTRU HOSPITAL OutpatientFacility | Medica | Medicaid Managed Care Plan | $10.30 | — | — | 2026-03-01 | MRF ↗ |
| SURGICAL INSTITUTE OF READING BothFacility | HIGHMARK | All Plans | $10.36 | $1,344.00 | $179.54 | 2026-04-08 | 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.