Q4126 — Hc Shell Q4126, Memoderm, Dermaspan, Tranzgraft Or Integuply, Per Sq Cm
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). HC Shell Q4126, Memoderm, Dermaspan, Tranzgraft or Integuply, per Sq Cm (HCPCS Q4126) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/Q4126?code_type=HCPCS
MLA (9th ed.)
“HC Shell Q4126, Memoderm, Dermaspan, Tranzgraft or Integuply, per Sq Cm (HCPCS Q4126) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/Q4126?code_type=HCPCS. Accessed .
Chicago (notes-bibliography)
“HC Shell Q4126, Memoderm, Dermaspan, Tranzgraft or Integuply, per Sq Cm (HCPCS Q4126) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/Q4126?code_type=HCPCS.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $127–$1,474 (25th–75th percentile) across 1,425 hospitals · 2,055 payers.
“Negotiated” is the hospital’s negotiated facility rate for this HCPCS Q4126 — 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
$127
$209 typical
$1,474
The middle 50% of negotiated facility rates for this procedure, measured across 1,425 hospitals.
What you’ll likely be billed
| Hospital facility Actual median across hospitals The hospital’s negotiated facility rate — from our MRF data. | $209 |
| Likely subtotal | $209 |
Facility charge (no separate professional fee)
$209
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 $127–$1,474.
- 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 | — | — | — | $320.32 | $160.16 | 2024-12-15 | MRF ↗ |
| TEXAS HEALTH HUGULEY HOSPITAL FORT WORTH SOUTH Inpatient | — | — | — | $320.32 | $160.16 | 2024-12-15 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS OutpatientFacility | Cigna (EverNorth) | Behavioral Health | — | $221.40 | $132.84 | 2026-04-21 | MRF ↗ |
| BAXTER HEALTH Outpatient | Aetna | Aetna | — | $56.60 | $33.96 | 2026-07-15 | MRF ↗ |
| BAXTER HEALTH Outpatient | United Healthcare | Uhc | — | $56.60 | $33.96 | 2026-07-15 | MRF ↗ |
| BAXTER HEALTH Outpatient | Web Tpa | Web Tpa | — | $56.60 | $33.96 | 2026-07-15 | MRF ↗ |
| BAXTER HEALTH Outpatient | Va | Va (Mcr) | — | $56.60 | $33.96 | 2026-07-15 | MRF ↗ |
| BAXTER HEALTH Outpatient | Healthlink | Healthlink | — | $56.60 | $33.96 | 2026-07-15 | MRF ↗ |
| BAXTER HEALTH Outpatient | Cigna | Cigna | — | $56.60 | $33.96 | 2026-07-15 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Cigna | Cigna | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER OutpatientFacility | — | — | — | $319.66 | $127.86 | 2026-07-14 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Highlands | Highlands | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Bcbs Of Va | Anthem Blue Cross Ppo | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Bcbs Of Va | Anthem Blue Cross Hmo | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Uhc | Uhc Onenet | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Uhc | Uhc Onenet | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Aetna | Aetna | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Bcbs Of Va | Anthem Blue Cross Hmo | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Four Most | Four Most | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Medcost | Medcost | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | First Health | First Health | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Four Most | Four Most | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Highlands | Highlands | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Bcbs Of Va | Anthem Hix | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Uhc | Uhc All Payer | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | First Health | First Health | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Amps | Amps | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Employee Benefit Consultants | Employee Benefit Consultants | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Optima Health Plan | Sentara (Optima) | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Amps | Amps | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Optima Health Plan | Sentara (Optima) | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Optima Health Plan | Optima | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Bcbs Of Va | Anthem Blue Cross Ppo | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Aetna | Aetna | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Employee Benefit Consultants | Employee Benefit Consultants | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Medcost | Medcost | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Optima Health Plan | Optima | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Gateway | Gateway | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Gateway | Gateway | — | $319.66 | $127.86 | 2026-05-18 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Bcbs Of Va | Anthem Hix | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| CLINCH VALLEY MEDICAL CENTER Outpatient | Cigna | Cigna | — | $319.66 | $127.86 | 2026-05-08 | MRF ↗ |
| TEXAS HEALTH CENTER FOR DIAGNOSTICS & SURGERY OutpatientFacility | Molina | Managed Medicaid | $31.82 | $221.40 | $132.84 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH CENTER FOR DIAGNOSTICS & SURGERY OutpatientFacility | Superior Wellcare | Managed Medicaid | $31.82 | $221.40 | $132.84 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH CENTER FOR DIAGNOSTICS & SURGERY OutpatientFacility | United Healthcare | Managed Medicaid | $31.82 | $221.40 | $132.84 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH CENTER FOR DIAGNOSTICS & SURGERY OutpatientFacility | Parkland | Managed Medicaid | $31.82 | $221.40 | $132.84 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH CENTER FOR DIAGNOSTICS & SURGERY OutpatientFacility | Blue Cross Blue Shield | Managed Medicaid | $31.82 | $221.40 | $132.84 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH CENTER FOR DIAGNOSTICS & SURGERY OutpatientFacility | Amerigroup | Managed Medicaid | $31.82 | $221.40 | $132.84 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH HOSPITAL FRISCO OutpatientFacility | Superior Wellcare | Managed Medicaid | $31.83 | $170.40 | $102.24 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO OutpatientFacility | Molina | Managed Medicaid | $31.86 | $241.00 | $144.60 | 2026-04-21 | MRF ↗ |
| HACKENSACK UNIVERSITY MEDICAL CENTER OutpatientFacility | AETNA | MEDICARE ADVANTAGE | $31.93 | $155.00 | — | 2025-12-31 | MRF ↗ |
| HACKENSACK UNIVERSITY MEDICAL CENTER OutpatientFacility | AETNA | MEDICARE ADVANTAGE | $31.93 | $155.00 | — | 2025-12-31 | MRF ↗ |
| JFK UNIVERSITY MEDICAL CENTER OutpatientFacility | Aetna | Managed Medicare | $31.93 | $155.00 | — | 2024-12-31 | MRF ↗ |
| JFK UNIVERSITY MEDICAL CENTER OutpatientFacility | AETNA | MEDICARE ADVANTAGE | $31.93 | $155.00 | — | 2025-12-31 | MRF ↗ |
| JFK UNIVERSITY MEDICAL CENTER OutpatientFacility | Aetna | Managed Medicare | $31.93 | $155.00 | — | 2024-12-31 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | TriWest | Community Care Network | $32.00 | $246.14 | $147.68 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | TriWest | Community Care Network | $32.01 | $246.25 | $147.75 | 2026-02-21 | MRF ↗ |
| TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHLAKE OutpatientFacility | Molina | Managed Medicaid | $32.01 | $270.60 | $162.36 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE OutpatientFacility | Molina | Managed Medicaid | $32.01 | $270.60 | $162.36 | 2026-04-21 | MRF ↗ |
| HCA FLORIDA FORT WALTON-DESTIN HOSPITAL Outpatient | BCBS | PPO | $32.03 | $215.00 | $215.00 | 2026-03-01 | MRF ↗ |
| HCA FLORIDA FORT WALTON-DESTIN HOSPITAL Outpatient | BCBS | NWB | $32.03 | $215.00 | $215.00 | 2026-03-01 | MRF ↗ |
| BAYLOR SCOTT & WHITE MEDICAL CENTER HILLCREST OutpatientFacility | Superior Health Plan | Medicaid | $32.07 | $267.26 | $160.36 | 2026-02-19 | MRF ↗ |
| TEXAS HEALTH HARRIS METHODIST HOSPITAL ALLIANCE OutpatientFacility | Aetna | Managed Medicaid | $32.15 | $284.54 | $170.73 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH HARRIS METHODIST HURST-EULESS-BEDFORD OutpatientFacility | Aetna | Managed Medicaid | $32.15 | $270.60 | $162.36 | 2026-04-21 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Bcbs Of Tn | Managed Medicare 100% | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Prime Health | Prime Health | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH OutpatientFacility | — | — | — | $201.00 | $65.53 | 2026-07-10 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Bcbs Of Tn | Blue Cross Medicare Advantage | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Veterans Admin - Governmental | Managed Medicare 100% | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Bcbs Of Tn | Blue Cross Preferred | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Bcbs Of Tn | Blue Cross Select | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Healthspring | Managed Medicare 100% | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Amerigroup | Managed Medicare 100% | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Multiplan | Multiplan | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Wellcare | Managed Medicare 100% | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Humana | Managed Medicare 100% | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Managed Medicare 100% | Managed Medicare 100% | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Cigna | Cigna Hmo | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Cigna | Cigna Ppo | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Uhc | Uhc Managed Medicare | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Prime Health | Prime Health Indigent | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Aetna | Managed Medicare 100% | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Aetna | Aetna | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| HIGHPOINT HEALTH-RIVERVIEW WITH ASCENSION SAINT TH Outpatient | Uhc | Uhc | — | $201.00 | $65.53 | 2026-05-18 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO OutpatientFacility | Parkland | Managed Medicaid | $32.17 | $262.85 | $157.71 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO OutpatientFacility | Blue Cross Blue Shield | Managed Medicaid | $32.17 | $262.85 | $157.71 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO OutpatientFacility | Amerigroup | Managed Medicaid | $32.17 | $262.85 | $157.71 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO OutpatientFacility | United Healthcare | Managed Medicaid | $32.17 | $262.85 | $157.71 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH HEART & VASCULAR HOSPITAL ARLINGTON OutpatientFacility | Superior Wellcare | Managed Medicaid | $32.20 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | Baylor Scott & White Health Plan | Medicare Advantage | $32.21 | $260.84 | $156.50 | 2026-02-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON OutpatientFacility | Cook Childrens | Managed Medicaid | $32.24 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN OutpatientFacility | Parkland | Managed Medicaid | $32.24 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON OutpatientFacility | Blue Cross Blue Shield | Managed Medicaid | $32.24 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN OutpatientFacility | United Healthcare | Managed Medicaid | $32.24 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON OutpatientFacility | Amerigroup | Managed Medicaid | $32.24 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON OutpatientFacility | United Healthcare | Managed Medicaid | $32.24 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN OutpatientFacility | Amerigroup | Managed Medicaid | $32.24 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN OutpatientFacility | Blue Cross Blue Shield | Managed Medicaid | $32.24 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS OutpatientFacility | Parkland | Managed Medicaid | $32.24 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS OutpatientFacility | Blue Cross Blue Shield | Managed Medicaid | $32.24 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS OutpatientFacility | United Healthcare | Managed Medicaid | $32.24 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS OutpatientFacility | Amerigroup | Managed Medicaid | $32.24 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH HARRIS METHODIST HURST-EULESS-BEDFORD OutpatientFacility | Superior Wellcare | Managed Medicaid | $32.27 | $284.54 | $170.73 | 2026-04-21 | MRF ↗ |
| BAYLOR SCOTT AND WHITE MEDICAL CENTER MCKINNEY OutpatientFacility | Superior Health Plan | Medicaid | $32.37 | $231.20 | $138.72 | 2026-02-19 | MRF ↗ |
| Baylor Scott & White Medical Center - Frisco at PGA Parkway OutpatientFacility | Superior Health Plan | Medicaid | $32.37 | $231.20 | $138.72 | 2026-02-23 | MRF ↗ |
| SOUTHERN OCEAN MEDICAL CENTER OutpatientFacility | AETNA | MEDICARE ADVANTAGE | $32.40 | $155.00 | — | 2025-12-31 | MRF ↗ |
| SOUTHERN OCEAN MEDICAL CENTER OutpatientFacility | AETNA | MEDICARE ADVANTAGE | $32.40 | $155.00 | — | 2025-12-31 | MRF ↗ |
| BAYLOR SCOTT & WHITE HEART & VASCULAR HOSPITAL - DALLAS OutpatientFacility | Superior Health Plan | Medicaid | $32.43 | $405.41 | $243.25 | 2026-02-21 | MRF ↗ |
| HCA FLORIDA FORT WALTON-DESTIN HOSPITAL Outpatient | BCBS | HMO | $32.47 | $215.00 | $215.00 | 2026-03-01 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | TriWest | Community Care Network | $32.51 | $250.09 | $150.05 | 2026-02-21 | MRF ↗ |
| NORTHSIDE HOSPITAL CHEROKEE Outpatient | Institutional GA Medicaid | Institutional GA Medicaid | $32.52 | $291.00 | $218.25 | 2026-02-14 | MRF ↗ |
| NORTHSIDE HOSPITAL CHEROKEE Outpatient | Centene | Peach State Medicaid | $32.52 | $291.00 | $218.25 | 2026-02-14 | MRF ↗ |
| NORTHSIDE HOSPITAL CHEROKEE Outpatient | Amerigroup | Amerigroup Medicaid | $32.52 | $291.00 | $218.25 | 2026-02-14 | MRF ↗ |
| RIVERVIEW MEDICAL CENTER OutpatientFacility | Aetna | Managed Medicare | $32.55 | $155.00 | — | 2024-12-31 | MRF ↗ |
| RIVERVIEW MEDICAL CENTER OutpatientFacility | AETNA | MEDICARE ADVANTAGE | $32.55 | $155.00 | — | 2025-12-31 | MRF ↗ |
| RIVERVIEW MEDICAL CENTER OutpatientFacility | AETNA | MEDICARE ADVANTAGE | $32.55 | $155.00 | — | 2025-12-31 | MRF ↗ |
| SAN GABRIEL VALLEY MEDICAL CENTER InpatientFacility | — | — | — | $155.00 | $46.50 | 2026-07-01 | MRF ↗ |
| FRANCISCAN HEALTH ORTHOPEDIC HOSPITAL CARMEL Outpatient | BLUE CROSS [1014] | ANTHEM HEALTHSYNC POS-CID- CARMEL ORTHO | $32.57 | $70.00 | $18.41 | 2025-07-01 | MRF ↗ |
| TEXAS HEALTH HOSPITAL FRISCO OutpatientFacility | Superior Wellcare | Managed Medicaid | $32.60 | $174.50 | $104.70 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE OutpatientFacility | Aetna | Managed Medicaid | $32.61 | $270.60 | $162.36 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHLAKE OutpatientFacility | Aetna | Managed Medicaid | $32.61 | $270.60 | $162.36 | 2026-04-21 | MRF ↗ |
| SKY RIDGE MEDICAL CENTER Outpatient | Cigna | Connect-SBPLeanBenefitPlans | $32.64 | $51.00 | $51.00 | 2026-03-01 | MRF ↗ |
| SKY RIDGE MEDICAL CENTER Outpatient | Cigna | SureFitLeanBenefitPlans | $32.64 | $51.00 | $51.00 | 2026-03-01 | MRF ↗ |
| SKY RIDGE MEDICAL CENTER Outpatient | Cigna | Connect-NSBPLeanBenefitPlans | $32.64 | $51.00 | $51.00 | 2026-03-01 | MRF ↗ |
| SKY RIDGE MEDICAL CENTER Outpatient | Cigna | BroadLeanBenefitPlans | $32.64 | $51.00 | $51.00 | 2026-03-01 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN OutpatientFacility | Molina | Managed Medicaid | $32.70 | $262.85 | $157.71 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH HARRIS METHODIST HOSPITAL AZLE OutpatientFacility | Superior Wellcare | Managed Medicaid | $32.72 | $284.54 | $170.73 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHLAKE OutpatientFacility | Superior Wellcare | Managed Medicaid | $32.72 | $284.54 | $170.73 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH HOSPITAL FRISCO OutpatientFacility | Molina | Managed Medicaid | $32.73 | $170.40 | $102.24 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN OutpatientFacility | Superior Wellcare | Managed Medicaid | $32.74 | $270.60 | $162.36 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN OutpatientFacility | Amerigroup | Managed Medicaid | $32.78 | $284.54 | $170.73 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN OutpatientFacility | United Healthcare | Managed Medicaid | $32.78 | $284.54 | $170.73 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN OutpatientFacility | Blue Cross Blue Shield | Managed Medicaid | $32.78 | $284.54 | $170.73 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL ALLEN OutpatientFacility | Parkland | Managed Medicaid | $32.78 | $284.54 | $170.73 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH HARRIS METHODIST FORT WORTH OutpatientFacility | Superior Wellcare | Managed Medicaid | $32.80 | $241.00 | $144.60 | 2026-04-21 | MRF ↗ |
| Northwest Medical Center Houghton Outpatient | Uhc Hix | Uhc Hix | $32.80 | $137.25 | $24.71 | 2026-07-15 | MRF ↗ |
| NORTHWEST MEDICAL CENTER Outpatient | Uhc Health Exchange | Uhc Hix | $32.80 | $137.25 | $32.94 | 2026-07-15 | MRF ↗ |
| DOCTORS HOSPTAL AT RENAISSANCE Outpatient | United Healthcare | Community | $32.82 | $221.79 | $221.79 | 2026-07-16 | MRF ↗ |
| JERSEY SHORE UNIVERSITY MEDICAL CENTER OutpatientFacility | AETNA | MEDICARE ADVANTAGE | $32.86 | $155.00 | — | 2025-12-31 | MRF ↗ |
| JERSEY SHORE UNIVERSITY MEDICAL CENTER OutpatientFacility | Aetna | Managed Medicare | $32.86 | $155.00 | — | 2024-12-31 | MRF ↗ |
| JERSEY SHORE UNIVERSITY MEDICAL CENTER OutpatientFacility | AETNA | MEDICARE ADVANTAGE | $32.86 | $155.00 | — | 2025-12-31 | MRF ↗ |
| TEXAS HEALTH HEART & VASCULAR HOSPITAL ARLINGTON OutpatientFacility | Superior Wellcare | Managed Medicaid | $32.86 | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON OutpatientFacility | Blue Cross Blue Shield | Managed Medicaid | $32.89 | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON OutpatientFacility | Amerigroup | Managed Medicaid | $32.89 | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON OutpatientFacility | United Healthcare | Managed Medicaid | $32.89 | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN OutpatientFacility | Parkland | Managed Medicaid | $32.89 | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN OutpatientFacility | Blue Cross Blue Shield | Managed Medicaid | $32.89 | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DENTON OutpatientFacility | Cook Childrens | Managed Medicaid | $32.89 | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN OutpatientFacility | Amerigroup | Managed Medicaid | $32.89 | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL KAUFMAN OutpatientFacility | United Healthcare | Managed Medicaid | $32.89 | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS OutpatientFacility | Parkland | Managed Medicaid | $32.89 | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS OutpatientFacility | United Behavioral Health | Managed Medicaid | — | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS OutpatientFacility | Blue Cross Blue Shield | Managed Medicaid | $32.89 | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS OutpatientFacility | United Healthcare | Managed Medicaid | $32.89 | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS OutpatientFacility | Amerigroup | Managed Medicaid | $32.89 | $351.41 | $210.85 | 2026-04-21 | MRF ↗ |
| NORTHWEST MEDICAL CENTER Outpatient | Self Pay | Self Pay | $32.94 | $137.25 | $32.94 | 2026-07-15 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL ROCKWALL OutpatientFacility | Blue Cross Blue Shield | Managed Medicaid | $32.99 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL ROCKWALL OutpatientFacility | Parkland | Managed Medicaid | $32.99 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL ROCKWALL OutpatientFacility | Amerigroup | Managed Medicaid | $32.99 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL ROCKWALL OutpatientFacility | United Healthcare | Managed Medicaid | $32.99 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| ADVENTHEALTH DADE CITY Outpatient | Humana | PPO/PFFS_Medicare | $33.00 | $1,325.28 | $530.11 | 2024-12-15 | MRF ↗ |
| ADVENTHEALTH DADE CITY Outpatient | Blue_Cross_&_Blue_Shield_of_Florida | Blue_Select | — | $430.09 | $172.04 | 2024-12-15 | MRF ↗ |
| ADVENTHEALTH DADE CITY Outpatient | Blue_Cross_&_Blue_Shield_of_Florida | PPC | — | $430.09 | $172.04 | 2024-12-15 | MRF ↗ |
| ADVENTHEALTH DADE CITY Outpatient | Blue_Cross_&_Blue_Shield_of_Florida_ | My_Blue | — | $430.09 | $172.04 | 2024-12-15 | MRF ↗ |
| ADVENTHEALTH DADE CITY Outpatient | Blue_Cross_&_Blue_Shield_of_Florida | Network_Blue | — | $430.09 | $172.04 | 2024-12-15 | MRF ↗ |
| ADVENTHEALTH DADE CITY Outpatient | Blue_Cross_&_Blue_Shield_of_Florida | Health_Options | — | $430.09 | $172.04 | 2024-12-15 | MRF ↗ |
| ADVENTHEALTH DADE CITY Outpatient | Blue_Cross_&_Blue_Shield_of_Florida | Traditional | — | $430.09 | $172.04 | 2024-12-15 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | Baylor Scott & White Health Plan | Medicare Advantage | $33.01 | $267.26 | $160.36 | 2026-02-21 | MRF ↗ |
| TEXAS HEALTH HEART & VASCULAR HOSPITAL ARLINGTON OutpatientFacility | Molina | Managed Medicaid | $33.10 | $344.40 | $206.64 | 2026-04-21 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCPreferredBlue | $33.10 | — | — | 2024-12-08 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCBlueChoice | $33.10 | — | — | 2024-12-08 | MRF ↗ |
| HCA FLORIDA FORT WALTON-DESTIN HOSPITAL Outpatient | Simply | MGMCR | $33.11 | $215.00 | $215.00 | 2026-03-01 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO OutpatientFacility | Parkland | Managed Medicaid | $33.12 | $270.60 | $162.36 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO OutpatientFacility | Blue Cross Blue Shield | Managed Medicaid | $33.12 | $270.60 | $162.36 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO OutpatientFacility | Amerigroup | Managed Medicaid | $33.12 | $270.60 | $162.36 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO OutpatientFacility | United Healthcare | Managed Medicaid | $33.12 | $270.60 | $162.36 | 2026-04-21 | MRF ↗ |
| SKY RIDGE MEDICAL CENTER Outpatient | Western Plains Community Health | COMM | $33.15 | $51.00 | $51.00 | 2026-03-01 | MRF ↗ |
| TEXAS HEALTH HARRIS METHODIST HURST-EULESS-BEDFORD OutpatientFacility | Molina | Managed Medicaid | $33.18 | $284.54 | $170.73 | 2026-04-21 | MRF ↗ |
| HCA FLORIDA WEST HOSPITAL Outpatient | BCBS | SBN | $33.32 | $196.00 | $196.00 | 2024-10-01 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL FLOWER MOUND OutpatientFacility | Blue Cross Blue Shield | Managed Medicaid | $33.34 | $221.40 | $132.84 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL FLOWER MOUND OutpatientFacility | Cook Childrens | Managed Medicaid | $33.34 | $221.40 | $132.84 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL FLOWER MOUND OutpatientFacility | Amerigroup | Managed Medicaid | $33.34 | $221.40 | $132.84 | 2026-04-21 | MRF ↗ |
| TEXAS HEALTH PRESBYTERIAN HOSPITAL FLOWER MOUND OutpatientFacility | United Healthcare | Managed Medicaid | $33.34 | $221.40 | $132.84 | 2026-04-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE MEDICAL CENTER HILLCREST OutpatientFacility | Superior Health Plan | Medicaid | $33.41 | $278.39 | $167.03 | 2026-02-19 | MRF ↗ |
| FRANCISCAN HEALTH MOORESVILLE Both | MANAGED CARE [2000] | FRANCISCAN HEALTH PLAN CAP-CIR | $33.48 | $72.00 | $18.29 | 2026-01-01 | MRF ↗ |
| FRANCISCAN HEALTH INDIANAPOLIS Both | MANAGED CARE [2000] | FRANCISCAN HEALTH PLAN CAP-CIR | $33.48 | $72.00 | $16.63 | 2026-01-01 | MRF ↗ |
| NORTHSIDE HOSPITAL CHEROKEE Outpatient | CareSource | CareSource | $33.50 | $291.00 | $218.25 | 2026-02-14 | MRF ↗ |
| TEXAS HEALTH HOSPITAL FRISCO OutpatientFacility | Molina | Managed Medicaid | $33.52 | $174.50 | $104.70 | 2026-04-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | Prime Health Services | Worker's Compensation | $33.52 | $246.14 | $147.68 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | CORVEL | Worker's Compensation | $33.52 | $246.14 | $147.68 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | CORVEL | Worker's Compensation | $33.54 | $246.25 | $147.75 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | Prime Health Services | Worker's Compensation | $33.54 | $246.25 | $147.75 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | HealthSpring | Medicare Advantage | $33.60 | $246.14 | $147.68 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | American Health Plan | Medicare Advantage | $33.60 | $246.14 | $147.68 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | Blue Cross Blue Shield | Medicare Advantage | $33.60 | $246.14 | $147.68 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | ProCare Advantage | Medicare Advantage | $33.60 | $246.14 | $147.68 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | Superior Health Plan | Medicare HMO/Medicare PPO | $33.60 | $246.14 | $147.68 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE HOSPITAL BRENHAM OutpatientFacility | Blue Cross Blue Shield | Medicare Advantage | $33.61 | $246.25 | $147.75 | 2026-02-21 | MRF ↗ |
| METHODIST MANSFIELD MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MMMC | $33.61 | $108.41 | $54.20 | 2026-03-21 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MRMC | $33.61 | $108.41 | $54.20 | 2026-03-21 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MRMC | $33.61 | $108.41 | $54.20 | 2026-03-21 | 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.