Q4105 — Integra Drt Or Omnigraft
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). Integra drt or omnigraft (HCPCS Q4105) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/Q4105?code_type=HCPCS
MLA (9th ed.)
“Integra drt or omnigraft (HCPCS Q4105) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/Q4105?code_type=HCPCS. Accessed .
Chicago (notes-bibliography)
“Integra drt or omnigraft (HCPCS Q4105) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/Q4105?code_type=HCPCS.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $103–$1,659 (25th–75th percentile) across 1,556 hospitals · 2,537 payers.
“Negotiated” is the hospital’s negotiated facility rate for this 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
$103
$198 typical
$1,659
The middle 50% of negotiated facility rates for this procedure, measured across 1,556 hospitals.
What you’ll likely be billed
| Hospital facility Actual median across hospitals The hospital’s negotiated facility rate — from our MRF data. | $198 |
| Likely subtotal | $198 |
Facility charge (no separate professional fee)
$198
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 $103–$1,659.
- 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 ↗ |
| 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 | Telemedicine Program | — | $28.12 | $22.50 | 2025-01-28 | 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 | Fidelis | Managed Medicaid | — | $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 ↗ |
| Claxton-hepburn Medical Center OutpatientFacility | Humana ChoiceCare | Medicare Advantage | — | $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 | Logistic Health Inc. | 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 | Blue Cross Blue Shield/Excellus | 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 | Beacon Health Options | Behavioral Health/All Products | — | $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 | Cigna/MVP | Medicare Advantage | — | $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 | Cigna/MVP | Essential Medicaid 3-4 | — | $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 InpatientFacility | St. Lawrence-Lewis Program/STLLC | School Employee Program | — | $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 | Blue Cross Blue Shield/Excellus | Managed Medicaid | — | $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 ↗ |
| Claxton-hepburn Medical Center InpatientFacility | Cigna/MVP | Group Commercial | — | $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 | Wellcare | Medicare Advantage | — | $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 | Blue Cross Blue Shield/Excellus | Commercial | — | $28.12 | $22.50 | 2025-01-28 | MRF ↗ |
| NORTHSHORE UNIVERSITY HEALTHSYSTEM - EVANSTON HOSPITAL Inpatient | — | — | — | $42.00 | $27.30 | 2025-01-01 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Health Partners | Medicare Advantage | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Health America/Health Assurance | Commercial | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Independence BC (IBC) | HMO/PPO | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Keystone First | Managed Medicaid | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Multiplan | Commercial | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Highmark Direct Plan (ACA) | Commercial | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | UPMC For Life | Medicare Advantage | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | PA Health & Wellness (Allwell) | Medicare Advantage | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | United Healthcare | HMO/PPO | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | PA Health & Wellness Community Health Choices | Dual Plan Managed Medicaid | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Advantra | Medicare Advantage | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Health Partners | Managed Medicaid | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Cigna | HMO/PPO | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | WellNet Administrators (TPA) | Commercial | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Cigna | Medicare Advantage | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Devon | Commercial | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Devoted | Medicare Advantage | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | United Healthcare Medicare | Medicare Advantage | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | PA Health & Wellness Ambetter (ACA) | Commercial | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Keystone First VIP | Medicare Advantage | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | United Healthcare Community | Managed Medicaid | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Highmark Blue Shield | HMO/PPO | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Independence BC (IBC) | Indemnity/Traditional | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Independence BC (IBC) | Medicare Advantage | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Keystone First Community Health Choices | Dual Plan Managed Medicaid | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Aetna | HMO/PPO | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Highmark Medicare | Medicare Advantage | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Highmark Broad Plan (ACA) | Commercial | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Blue Cross Out of Area Plans | HMO/PPO | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Aetna | Medicare Advantage | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Jefferson Plan (ACA) | Commercial | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Humana | Medicare Advantage | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | OSCAR | Commercial | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | PHCS | Commercial | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Lucent Health (TPA) Broad Network | Commercial | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | UPMC For You | Managed Medicaid | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Independence BC (IBC) ACA Tiered | HMO/PPO | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Independence BC (IBC) Focus | Medicare Advantage | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Highmark Blue Shield Out of Area Plans | HMO/PPO | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | Lucent Health (TPA) Narrow Network | Commercial | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| ST LUKE'S HOSPITAL - GRAND VIEW CAMPUS InpatientFacility | UPMC Community Health Choices | Dual Plan Managed Medicaid | — | $35.00 | $31.50 | 2024-12-31 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL-SAN JOSE Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-17 | MRF ↗ |
| MT SAN RAFAEL HOSPITAL Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-17 | MRF ↗ |
| SANTA ROSA MEDICAL CENTER Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-18 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - REDWOOD CITY Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - FRESNO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - SACRAMENTO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL MANTECA Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-18 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - OAKLAND/RICHMOND Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - SOUTH SAN FRANCISCO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - ANTIOCH Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - VACAVILLE Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - OAKLAND/RICHMOND Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| SAN FRANCISCO VA MEDICAL CENTER Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - WALNUT CREEK Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSP SO SACRAMENTO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL MODESTO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - FREMONT Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - ROSEVILLE Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| San Leandro Hospital Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL-SANTA CLARA Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL AND REHAB CENTER Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $63.00 | $35.28 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL MANTECA Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-18 | MRF ↗ |
| SANTA ROSA MEDICAL CENTER Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-18 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - REDWOOD CITY Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - SACRAMENTO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - FRESNO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - WALNUT CREEK Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - SOUTH SAN FRANCISCO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - OAKLAND/RICHMOND Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| MT SAN RAFAEL HOSPITAL Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - ANTIOCH Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL-SANTA CLARA Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - OAKLAND/RICHMOND Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| San Leandro Hospital Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - VACAVILLE Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-17 | MRF ↗ |
| SAN FRANCISCO VA MEDICAL CENTER Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - FREMONT Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL AND REHAB CENTER Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSP SO SACRAMENTO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL-SAN JOSE Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-17 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - ROSEVILLE Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL MODESTO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicare] | — | $63.00 | $35.28 | 2026-07-15 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | United Healthcare | Star KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | HealthSmart | Accel PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | QualChoice | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | United Healthcare | Star Kid KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Provider Select | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | HealthSmart | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | United Healthcare | Star Plus KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Blue Cross Blue Shield of Texas | Blue Advantage HMO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Health Management Network | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Cigna | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Multiplan | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | United Healthcare | Chip KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Summit Community Care | KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Triwest | VA MM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Five Point Credit Union | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Christus Health | Med Adv MM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Amerigroup | Star KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Christus Health | HIX | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Amerigroup | MM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Molina | Star KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | First Health | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Texas Children's Health Plan | Chip KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Molina | Chip KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Imperial Health Plan | MM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Texas Children's Health Plan | Star Kids KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Superior | Star Plus KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Superior | Star Kids KM | — | — | — | 2026-01-13 | MRF ↗ |
| BRADLEY COUNTY MEDICAL CENTER OutpatientFacility | Ambetter Exchange | All Plans | — | — | — | 2026-04-08 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | PHCS | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| BRADLEY COUNTY MEDICAL CENTER OutpatientFacility | Tricare | All Plans | — | — | — | 2026-04-08 | MRF ↗ |
| BRADLEY COUNTY MEDICAL CENTER OutpatientFacility | Vantage | Medicare | — | — | — | 2026-04-08 | MRF ↗ |
| BRADLEY COUNTY MEDICAL CENTER OutpatientFacility | Humana | Medicare | — | — | — | 2026-04-08 | MRF ↗ |
| BRADLEY COUNTY MEDICAL CENTER OutpatientFacility | United Healthcare | UMR | — | — | — | 2026-04-08 | MRF ↗ |
| BRADLEY COUNTY MEDICAL CENTER OutpatientFacility | Municipal Health Benefit Fund | All Plans | — | — | — | 2026-04-08 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Blue Cross Blue Shield of Texas | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| BRADLEY COUNTY MEDICAL CENTER OutpatientFacility | United Healthcare | Care Improvement Plus | — | — | — | 2026-04-08 | MRF ↗ |
| BRADLEY COUNTY MEDICAL CENTER OutpatientFacility | United Healthcare | VA CCN | — | — | — | 2026-04-08 | MRF ↗ |
| BRADLEY COUNTY MEDICAL CENTER OutpatientFacility | Arkansas Superior Select Tribute | All Plans | — | — | — | 2026-04-08 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Blue Cross Blue Shield of Texas | HEB | — | — | — | 2026-01-13 | MRF ↗ |
| BRADLEY COUNTY MEDICAL CENTER OutpatientFacility | Corvel | Workers Comp | — | — | — | 2026-04-08 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Healthcare Highways | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | ProCare Advantage | MM | — | — | — | 2026-01-13 | MRF ↗ |
| BRADLEY COUNTY MEDICAL CENTER OutpatientFacility | Aetna | All Plans | — | — | — | 2026-04-08 | MRF ↗ |
| BRADLEY COUNTY MEDICAL CENTER OutpatientFacility | Wellcare | Medicare | — | — | — | 2026-04-08 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Texas True Choice | Chip KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Molina | Healthspring Star Plus KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Zelis | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | PPOplus Llc | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Superior | Chip KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Aetna | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Beechstreet | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Molina | Star Plus KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Superior | Star KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Blue Cross Blue Shield of Texas | Traditional | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Blue Cross Blue Shield of Texas | HMO | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Texas Children's Health Plan | Star Plus KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Municipal Health Benefit Fund | PPO | — | — | — | 2026-01-13 | MRF ↗ |
| VALLEY CHILDREN'S HOSPITAL OutpatientFacility | Health Net | All Commercial Products | — | — | — | 2026-04-01 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Superior | Foster Care KM | — | — | — | 2026-01-13 | MRF ↗ |
| Christus St Michael Rehab Hospital OutpatientFacility | Naphcare Inc. | RRMB | — | — | — | 2026-01-13 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH OutpatientFacility | — | — | — | $74.98 | $24.44 | 2026-07-10 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Uhc | Uhc Managed Medicare | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Humana | Managed Medicare 100% | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Amerigroup | Managed Medicare 100% | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Uhc | Uhc | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Healthspring | Managed Medicare 100% | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| ADVENTHEALTH REDMOND Outpatient | Peach_State_Health_Plan_Ambetter_Exchange | HMO | — | $112.36 | $56.18 | 2024-12-15 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Wellcare | Managed Medicare 100% | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Cigna | Cigna Hmo | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| ADVENTHEALTH REDMOND Outpatient | Aetna | HMO_PPO | — | $112.36 | $56.18 | 2024-12-15 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Cigna | Cigna Ppo | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Bcbs Of Tn | Managed Medicare 100% | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Prime Health | Prime Health | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| ADVENTHEALTH REDMOND Outpatient | Aetna | Exchange | — | $112.36 | $56.18 | 2024-12-15 | MRF ↗ |
| ADVENTHEALTH REDMOND Outpatient | Oscar | HMO | — | $112.36 | $56.18 | 2024-12-15 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Bcbs Of Tn | Blue Cross Select | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Multiplan | Multiplan | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Bcbs Of Tn | Blue Cross Preferred | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Managed Medicare 100% | Managed Medicare 100% | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Aetna | Managed Medicare 100% | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Aetna | Aetna | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Prime Health | Prime Health Indigent | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Veterans Admin - Governmental | Managed Medicare 100% | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Bcbs Of Tn | Blue Cross Medicare Advantage | — | $74.98 | $24.44 | 2026-05-18 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - REDWOOD CITY Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $74.00 | $41.44 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - OAKLAND/RICHMOND Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $74.00 | $41.44 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - SACRAMENTO Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $74.00 | $41.44 | 2026-07-15 | MRF ↗ |
| KAISER FOUNDATION HOSPITAL - OAKLAND/RICHMOND Both | [Kaiser Foundation Health Plan, Inc.] | [Medicaid] | — | $74.00 | $41.44 | 2026-07-15 | 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.