Q4180 — Revita, Per Sq Cm
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). Revita, per sq cm (HCPCS Q4180) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/Q4180?code_type=HCPCS
MLA (9th ed.)
“Revita, per sq cm (HCPCS Q4180) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/Q4180?code_type=HCPCS. Accessed .
Chicago (notes-bibliography)
“Revita, per sq cm (HCPCS Q4180) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/Q4180?code_type=HCPCS.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $217–$1,845 (25th–75th percentile) across 1,194 hospitals · 1,397 payers.
“Negotiated” is the hospital’s negotiated facility rate for this HCPCS Q4180 — 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
$217
$762 typical
$1,845
The middle 50% of negotiated facility rates for this procedure, measured across 1,194 hospitals.
What you’ll likely be billed
| Hospital facility Actual median across hospitals The hospital’s negotiated facility rate — from our MRF data. | $762 |
| Likely subtotal | $762 |
Facility charge (no separate professional fee)
$762
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 $217–$1,845.
- 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 |
|---|---|---|---|---|---|---|---|
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Colorado Program for Children with Special Needs | HCP | $32.13 | $63.00 | $63.00 | 2026-03-01 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | UNITED HEALTHCARE MEDICAID MANAGED CARE [5015] | MHS HB UNITED MEDICAID STAR PLUS MSMC | $32.33 | $115.62 | $57.81 | 2026-03-23 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | UNITED HEALTHCARE MEDICAID MANAGED CARE [5015] | MHS HB UNITED MEDICAID STAR PLUS MSMC | $32.33 | $115.62 | $57.81 | 2026-03-23 | MRF ↗ |
| METHODIST MANSFIELD MEDICAL CENTER Both | WELLPOINT MEDICAID MANAGED CARE [5001] | MHS HB WELLPOINT MEDICAID STAR MMMC | $32.69 | $101.56 | $50.78 | 2026-03-21 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCBlueChoice | $33.10 | — | — | 2024-12-08 | MRF ↗ |
| HILTON HEAD REGIONAL MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCPreferredBlue | $33.10 | — | — | 2024-12-08 | MRF ↗ |
| THE MEDICAL CENTER OF AURORA & SOUTH HOSPITAL Outpatient | Prime Health | WORKERSCOMP | $33.30 | $37.00 | $37.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Prime Health | WORKERSCOMP | $33.30 | $37.00 | $37.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Multiplan | BeechStreetCOMMPPO | $33.30 | $37.00 | $37.00 | 2026-03-01 | MRF ↗ |
| THE MEDICAL CENTER OF AURORA & SOUTH HOSPITAL Outpatient | Multiplan | BeechStreetCOMMPPO | $33.30 | $37.00 | $37.00 | 2026-03-01 | MRF ↗ |
| METHODIST MIDLOTHIAN MEDICAL CENTER Both | UNITED HEALTHCARE MEDICAID MANAGED CARE [5015] | MHS HB UNITED MEDICAID STAR PLUS MLMC | $33.80 | $200.00 | $100.00 | 2026-03-21 | MRF ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCBlueChoice | $34.60 | — | — | 2024-12-08 | MRF ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCPreferredBlue | $34.60 | — | — | 2024-12-08 | MRF ↗ |
| METHODIST MANSFIELD MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MMMC | $34.78 | $131.25 | $65.62 | 2026-03-21 | MRF ↗ |
| METHODIST MANSFIELD MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MMMC | $34.88 | $112.50 | $56.25 | 2026-03-21 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MSMC | $34.88 | $112.50 | $56.25 | 2026-03-23 | MRF ↗ |
| METHODIST CELINA MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MCEL | $34.88 | $112.50 | $33.75 | 2026-03-23 | MRF ↗ |
| METHODIST DALLAS MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MDMC | $34.88 | $112.50 | $56.25 | 2026-03-20 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MSMC | $34.88 | $112.50 | $56.25 | 2026-03-23 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MRMC | $34.88 | $112.50 | $56.25 | 2026-03-21 | MRF ↗ |
| METHODIST CHARLTON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MCMC | $34.88 | $112.50 | $56.25 | 2026-03-21 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MRMC | $34.88 | $112.50 | $56.25 | 2026-03-21 | MRF ↗ |
| METHODIST CELINA MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MCEL | $35.84 | $115.62 | $34.69 | 2026-03-23 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MRMC | $35.84 | $115.62 | $57.81 | 2026-03-21 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MSMC | $35.84 | $115.62 | $57.81 | 2026-03-23 | MRF ↗ |
| METHODIST DALLAS MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MDMC | $35.84 | $115.62 | $57.81 | 2026-03-20 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MSMC | $35.84 | $115.62 | $57.81 | 2026-03-23 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MRMC | $35.84 | $115.62 | $57.81 | 2026-03-21 | MRF ↗ |
| METHODIST MANSFIELD MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MMMC | $35.84 | $115.62 | $57.81 | 2026-03-21 | MRF ↗ |
| METHODIST CHARLTON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MCMC | $35.84 | $115.62 | $57.81 | 2026-03-21 | MRF ↗ |
| METHODIST DALLAS MEDICAL CENTER Both | SUPERIOR MEDICAID MANAGED CARE [5007] | MHS HB MEDICAID 110% STAR PLUS MDMC | $35.89 | $101.56 | $50.78 | 2026-03-20 | MRF ↗ |
| METHODIST DALLAS MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MDMC | $35.89 | $101.56 | $50.78 | 2026-03-20 | MRF ↗ |
| METHODIST MANSFIELD MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MMMC | $36.02 | $135.94 | $67.97 | 2026-03-21 | MRF ↗ |
| METHODIST MANSFIELD MEDICAL CENTER Both | WELLPOINT MEDICAID MANAGED CARE [5001] | MHS HB WELLPOINT MEDICAID STAR MMMC | $36.21 | $112.50 | $56.25 | 2026-03-21 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | UNITED HEALTHCARE MEDICAID MANAGED CARE [5015] | MHS HB UNITED MEDICAID STAR PLUS MSMC | $36.70 | $131.25 | $65.62 | 2026-03-23 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | UNITED HEALTHCARE MEDICAID MANAGED CARE [5015] | MHS HB UNITED MEDICAID STAR PLUS MSMC | $36.70 | $131.25 | $65.62 | 2026-03-23 | MRF ↗ |
| BAYLOR SCOTT & WHITE HEART & VASCULAR HOSPITAL - DALLAS OutpatientFacility | Superior Health Plan | Medicaid | $36.75 | $459.42 | $275.65 | 2026-02-21 | MRF ↗ |
| METHODIST MIDLOTHIAN MEDICAL CENTER Both | UNITED HEALTHCARE MEDICAID MANAGED CARE [5015] | MHS HB UNITED MEDICAID STAR PLUS MLMC | $36.97 | $218.75 | $109.37 | 2026-03-21 | MRF ↗ |
| METHODIST MANSFIELD MEDICAL CENTER Both | WELLPOINT MEDICAID MANAGED CARE [5001] | MHS HB WELLPOINT MEDICAID STAR MMMC | $37.22 | $115.62 | $57.81 | 2026-03-21 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Caresource | Commercial | $37.56 | — | — | 2026-07-17 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Mdwise | Medicaid | $37.56 | — | — | 2026-07-17 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Mdwise | Hip | $37.56 | — | — | 2026-07-17 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Anthem | Medicaid | $37.56 | — | — | 2026-07-17 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | UNITED HEALTHCARE MEDICAID MANAGED CARE [5015] | MHS HB UNITED MEDICAID STAR PLUS MSMC | $38.01 | $135.94 | $67.97 | 2026-03-23 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | UNITED HEALTHCARE MEDICAID MANAGED CARE [5015] | MHS HB UNITED MEDICAID STAR PLUS MSMC | $38.01 | $135.94 | $67.97 | 2026-03-23 | MRF ↗ |
| PRISMA HEALTH LAURENS COUNTY HOSPITAL Both | BCBS [800] | PHU HB UPSTATE BLUE EXCHANGE REEDY - LMH | $38.58 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| METHODIST CHARLTON MEDICAL CENTER Both | SUPERIOR MEDICAID MANAGED CARE [5007] | MHS HB MEDICAID 110% STAR PLUS MCMC | $38.92 | $101.56 | $50.78 | 2026-03-21 | MRF ↗ |
| METHODIST CHARLTON MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MCMC | $38.92 | $101.56 | $50.78 | 2026-03-21 | MRF ↗ |
| METHODIST DALLAS MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MDMC | $39.76 | $112.50 | $56.25 | 2026-03-20 | MRF ↗ |
| METHODIST DALLAS MEDICAL CENTER Both | SUPERIOR MEDICAID MANAGED CARE [5007] | MHS HB MEDICAID 110% STAR PLUS MDMC | $39.76 | $112.50 | $56.25 | 2026-03-20 | MRF ↗ |
| GLENDALE MEM HOSPITAL & HLTH CENTER Outpatient | SCAN | Medicare|All Plans | $40.00 | $22,940.00 | $7,478.44 | 2026-02-28 | MRF ↗ |
| GLENDALE MEM HOSPITAL & HLTH CENTER Outpatient | SCAN | Medicare|All Plans | $40.00 | $22,940.00 | $7,478.44 | 2026-02-28 | MRF ↗ |
| INDEPENDENCE HEALTH SYSTEM BUTLER MEMORIAL HOSPITA Outpatient | Ccbh - Behavioral Health | Behavioral | — | — | — | 2026-07-19 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Emerging Therapy Solutions | COMM | $40.32 | $63.00 | $63.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Cigna | Connect-SBPLeanBenefitPlans | $40.32 | $63.00 | $63.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Cigna | SureFitLeanBenefitPlans | $40.32 | $63.00 | $63.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Cigna | Connect-NSBPLeanBenefitPlans | $40.32 | $63.00 | $63.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Cigna | BroadLeanBenefitPlans | $40.32 | $63.00 | $63.00 | 2026-03-01 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MSMC | $40.69 | $131.25 | $65.62 | 2026-03-23 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MSMC | $40.69 | $131.25 | $65.62 | 2026-03-23 | MRF ↗ |
| METHODIST CHARLTON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MCMC | $40.69 | $131.25 | $65.62 | 2026-03-21 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MRMC | $40.69 | $131.25 | $65.62 | 2026-03-21 | MRF ↗ |
| METHODIST DALLAS MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MDMC | $40.69 | $131.25 | $65.62 | 2026-03-20 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MRMC | $40.69 | $131.25 | $65.62 | 2026-03-21 | MRF ↗ |
| METHODIST MANSFIELD MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MMMC | $40.69 | $131.25 | $65.62 | 2026-03-21 | MRF ↗ |
| METHODIST CELINA MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MCEL | $40.69 | $131.25 | $39.38 | 2026-03-23 | MRF ↗ |
| METHODIST DALLAS MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MDMC | $40.86 | $115.62 | $57.81 | 2026-03-20 | MRF ↗ |
| METHODIST DALLAS MEDICAL CENTER Both | SUPERIOR MEDICAID MANAGED CARE [5007] | MHS HB MEDICAID 110% STAR PLUS MDMC | $40.86 | $115.62 | $57.81 | 2026-03-20 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Vail Health | COMM | $40.89 | $269.00 | $269.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Western Plains Community Health | COMM | $40.95 | $63.00 | $63.00 | 2026-03-01 | MRF ↗ |
| THE MEDICAL CENTER OF AURORA & SOUTH HOSPITAL Outpatient | Vail Health | COMM | $41.19 | $271.00 | $271.00 | 2026-03-01 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MRMC | $41.89 | $101.56 | $50.78 | 2026-03-21 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | SUPERIOR MEDICAID MANAGED CARE [5007] | MHS HB MEDICAID 110% STAR PLUS MRMC | $41.89 | $101.56 | $50.78 | 2026-03-21 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MRMC | $41.89 | $101.56 | $50.78 | 2026-03-21 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | SUPERIOR MEDICAID MANAGED CARE [5007] | MHS HB MEDICAID 110% STAR PLUS MRMC | $41.89 | $101.56 | $50.78 | 2026-03-21 | MRF ↗ |
| METHODIST MANSFIELD MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MMMC | $42.14 | $135.94 | $67.97 | 2026-03-21 | MRF ↗ |
| METHODIST CHARLTON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MCMC | $42.14 | $135.94 | $67.97 | 2026-03-21 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MSMC | $42.14 | $135.94 | $67.97 | 2026-03-23 | MRF ↗ |
| METHODIST SOUTHLAKE MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MSMC | $42.14 | $135.94 | $67.97 | 2026-03-23 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MRMC | $42.14 | $135.94 | $67.97 | 2026-03-21 | MRF ↗ |
| METHODIST DALLAS MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MDMC | $42.14 | $135.94 | $67.97 | 2026-03-20 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MRMC | $42.14 | $135.94 | $67.97 | 2026-03-21 | MRF ↗ |
| METHODIST CELINA MEDICAL CENTER Both | BCBS [3001] | MHS HB BCBS MY BLUE HEALTH MCEL | $42.14 | $135.94 | $40.78 | 2026-03-23 | MRF ↗ |
| METHODIST MANSFIELD MEDICAL CENTER Both | WELLPOINT MEDICAID MANAGED CARE [5001] | MHS HB WELLPOINT MEDICAID STAR MMMC | $42.25 | $131.25 | $65.62 | 2026-03-21 | MRF ↗ |
| METHODIST CHARLTON MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MCMC | $43.11 | $112.50 | $56.25 | 2026-03-21 | MRF ↗ |
| METHODIST CHARLTON MEDICAL CENTER Both | SUPERIOR MEDICAID MANAGED CARE [5007] | MHS HB MEDICAID 110% STAR PLUS MCMC | $43.11 | $112.50 | $56.25 | 2026-03-21 | MRF ↗ |
| BAYLOR SCOTT AND WHITE MEDICAL CENTER LAKE POINTE OutpatientFacility | Superior Health Plan | Medicaid | $43.49 | $395.38 | $237.23 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT AND WHITE MEDICAL CENTER LAKE POINTE OutpatientFacility | WellPoint (fka Amerigroup) | CHIP/Medicaid | $43.49 | $395.38 | $237.23 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE MEDICAL CENTER AT IRVING OutpatientFacility | Superior Health Plan | Medicaid | $43.49 | $395.38 | $237.23 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE MEDICAL CENTER AT IRVING OutpatientFacility | WellPoint (fka Amerigroup) | CHIP/Medicaid | $43.49 | $395.38 | $237.23 | 2026-02-21 | MRF ↗ |
| BAYLOR SCOTT & WHITE THE HEART HOSPITAL PLANO OutpatientFacility | Superior Health Plan | Medicaid | $43.49 | $395.38 | $237.23 | 2026-02-20 | MRF ↗ |
| METHODIST MANSFIELD MEDICAL CENTER Both | WELLPOINT MEDICAID MANAGED CARE [5001] | MHS HB WELLPOINT MEDICAID STAR MMMC | $43.76 | $135.94 | $67.97 | 2026-03-21 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Multiplan | COMMPPOPRIMARYNETWORK | $44.10 | $63.00 | $63.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Physician Health Partners | MCR | $44.10 | $63.00 | $63.00 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | NorthCare | COMM | $44.10 | $63.00 | $63.00 | 2026-03-01 | MRF ↗ |
| METHODIST CHARLTON MEDICAL CENTER Both | SUPERIOR MEDICAID MANAGED CARE [5007] | MHS HB MEDICAID 110% STAR PLUS MCMC | $44.31 | $115.62 | $57.81 | 2026-03-21 | MRF ↗ |
| METHODIST CHARLTON MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MCMC | $44.31 | $115.62 | $57.81 | 2026-03-21 | MRF ↗ |
| PRISMA HEALTH LAURENS COUNTY HOSPITAL Both | BLUECHOICE [810] | PHU HB BLUES EXCHANGE LAURENS | $46.06 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH LAURENS COUNTY HOSPITAL Both | BCBS [800] | PHU HB BLUES EXCHANGE LAURENS | $46.06 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| METHODIST DALLAS MEDICAL CENTER Both | SUPERIOR MEDICAID MANAGED CARE [5007] | MHS HB MEDICAID 110% STAR PLUS MDMC | $46.38 | $131.25 | $65.62 | 2026-03-20 | MRF ↗ |
| METHODIST DALLAS MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MDMC | $46.38 | $131.25 | $65.62 | 2026-03-20 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MRMC | $46.41 | $112.50 | $56.25 | 2026-03-21 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MRMC | $46.41 | $112.50 | $56.25 | 2026-03-21 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | SUPERIOR MEDICAID MANAGED CARE [5007] | MHS HB MEDICAID 110% STAR PLUS MRMC | $46.41 | $112.50 | $56.25 | 2026-03-21 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | SUPERIOR MEDICAID MANAGED CARE [5007] | MHS HB MEDICAID 110% STAR PLUS MRMC | $46.41 | $112.50 | $56.25 | 2026-03-21 | MRF ↗ |
| NORTHSIDE HOSPITAL CHEROKEE Outpatient | Centene | Peach State Medicaid | $46.50 | $416.00 | $312.00 | 2026-02-14 | MRF ↗ |
| NORTHSIDE HOSPITAL CHEROKEE Outpatient | Amerigroup | Amerigroup Medicaid | $46.50 | $416.00 | $312.00 | 2026-02-14 | MRF ↗ |
| NORTHSIDE HOSPITAL CHEROKEE Outpatient | Institutional GA Medicaid | Institutional GA Medicaid | $46.50 | $416.00 | $312.00 | 2026-02-14 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Anthem | PAR | $46.62 | $63.00 | $63.00 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH TUOMEY HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE-UPSTATE [5200] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH BAPTIST PARKRIDGE Both | PRISMA HEALTH SENIORCARE PACE - MIDLANDS [5400] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH BAPTIST PARKRIDGE Both | PRISMA HEALTH SENIORCARE PACE-UPSTATE [5200] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH BAPTIST EASLEY HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE - MIDLANDS [5400] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH BAPTIST EASLEY HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE-UPSTATE [5200] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH GREENVILLE MEMORIAL HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE - MIDLANDS [5400] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH GREENVILLE MEMORIAL HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE-UPSTATE [5200] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH OCONEE MEMORIAL HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE-UPSTATE [5200] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $62.62 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH OCONEE MEMORIAL HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE - MIDLANDS [5400] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $62.62 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH HILLCREST HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE-UPSTATE [5200] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH RICHLAND HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE - MIDLANDS [5400] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH RICHLAND HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE-UPSTATE [5200] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH OCONEE MEMORIAL HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE - MIDLANDS [5400] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH OCONEE MEMORIAL HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE-UPSTATE [5200] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| Prisma Health North Greenville Ltach Both | PRISMA HEALTH SENIORCARE PACE - MIDLANDS [5400] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| Prisma Health North Greenville Ltach Both | PRISMA HEALTH SENIORCARE PACE-UPSTATE [5200] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH HILLCREST HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE - MIDLANDS [5400] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH BAPTIST Both | PRISMA HEALTH SENIORCARE PACE-UPSTATE [5200] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH TUOMEY HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE - MIDLANDS [5400] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH BAPTIST Both | PRISMA HEALTH SENIORCARE PACE - MIDLANDS [5400] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH LAURENS COUNTY HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE - MIDLANDS [5400] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH LAURENS COUNTY HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE-UPSTATE [5200] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH GREER MEMORIAL HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE-UPSTATE [5200] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH PATEWOOD HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE - MIDLANDS [5400] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH PATEWOOD HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE-UPSTATE [5200] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| PRISMA HEALTH GREER MEMORIAL HOSPITAL Both | PRISMA HEALTH SENIORCARE PACE - MIDLANDS [5400] | PH HB SENIORCARE PACE | $46.86 | $202.00 | $131.30 | 2026-03-01 | MRF ↗ |
| HCA HEALTHONE PRESBYTERIAN ST LUKES Outpatient | Pinnacol Workers Comp | WORKERSCOMP | $47.25 | $63.00 | $63.00 | 2026-03-01 | MRF ↗ |
| BAYLOR SCOTT & WHITE MEDICAL CENTER HILLCREST OutpatientFacility | Superior Health Plan | Medicaid | $47.45 | $395.38 | $237.23 | 2026-02-19 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | SUPERIOR MEDICAID MANAGED CARE [5007] | MHS HB MEDICAID 110% STAR PLUS MRMC | $47.69 | $115.62 | $57.81 | 2026-03-21 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MRMC | $47.69 | $115.62 | $57.81 | 2026-03-21 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | SUPERIOR MEDICAID MANAGED CARE [5007] | MHS HB MEDICAID 110% STAR PLUS MRMC | $47.69 | $115.62 | $57.81 | 2026-03-21 | MRF ↗ |
| METHODIST RICHARDSON MEDICAL CENTER Both | MOLINA MEDICAID MANAGED CARE [5005] | MHS HB MEDICAID 110% STAR PLUS MRMC | $47.69 | $115.62 | $57.81 | 2026-03-21 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Humana | Pathways For Aging | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Mhs | In Medicaid Hcc | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Mhs | In Medicaid Hcc Bh | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Anthem | In Medicaid Hhw | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Mhs | In Medicaid Hip Bh | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Mhs | In Medicaid Hip | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Anthem | In Medicaid Hip | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Caresource | In Medicaid Hip | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Anthem | In Medicaid Hcc | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Mhs | In Medicaid Hhw | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Mdwise | In Medicaid Hip | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Anthem | Pathways For Aging | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Anthem | In Medicaid Hcc | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Anthem | Pathways For Aging | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Mdwise | In Medicaid Hhw | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Caresource | In Medicaid Hhw | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| NORTON SCOTT HOSPITAL OutpatientFacility | Managed Health Services (MHS) | Managed Medicaid | $47.71 | — | — | 2026-06-03 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Anthem | In Medicaid Hhw | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Uhc | Pathways For Aging | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| REID HEALTH OutpatientFacility | MDWise | Managed Medicaid | $47.71 | — | — | 2025-07-21 | MRF ↗ |
| NORTON SCOTT HOSPITAL OutpatientFacility | Managed Health Services (MHS) Hoosier Care Connect | Managed Medicaid | $47.71 | — | — | 2026-06-03 | MRF ↗ |
| UofL Health - Medical Center East Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-08-01 | MRF ↗ |
| UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-08-01 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Mdwise | In Medicaid Hhw | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Mdwise | In Medicaid Hhw | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| MEMORIAL HOSPITAL AND HEALTH CARE CENTER OutpatientFacility | MHS Hoosier Care Connect | Managed Medicaid | $47.71 | — | — | 2026-02-13 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Mhs | In Medicaid Hip | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| MEMORIAL HOSPITAL AND HEALTH CARE CENTER OutpatientFacility | Anthem | Managed Medicaid | $47.71 | — | — | 2026-02-13 | MRF ↗ |
| MEMORIAL HOSPITAL AND HEALTH CARE CENTER OutpatientFacility | MDWise | Managed Medicaid | $47.71 | — | — | 2026-02-13 | MRF ↗ |
| UofL Health - Frazier Rehabilitation Hospital - Brownsboro Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-07-15 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Caresource | In Medicaid Hip | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Anthem | Exchange | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Caresource | In Medicaid Hip | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Anthem | In Medicaid Hcc | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Anthem | In Medicaid Hip | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Humana | Pathways For Aging | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Uhc | Pathways For Aging | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| NORTON CLARK HOSPITAL OutpatientFacility | Managed Health Services (MHS) Hoosier Healthwise (HHW) | Managed Medicaid | $47.71 | — | — | 2025-04-24 | MRF ↗ |
| REID HEALTH OutpatientFacility | Humana of Indiana | Pathways for Aging/Managed Medicaid | $47.71 | — | — | 2025-07-21 | MRF ↗ |
| NORTON SCOTT HOSPITAL OutpatientFacility | CareSource Indiana Healthy Indiana Plan (HIP) | Managed Medicaid | $47.71 | — | — | 2026-06-03 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Mdwise | In Medicaid Hip | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Humana | Pathways For Aging | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| UofL Health - Medical Center Northeast Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-07-15 | MRF ↗ |
| NORTON CLARK HOSPITAL OutpatientFacility | Managed Health Services (MHS) Hoosier Care Connect | Managed Medicaid | $47.71 | — | — | 2025-04-24 | MRF ↗ |
| UofL Health - Medical Center Southwest Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-07-15 | MRF ↗ |
| UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-05-22 | MRF ↗ |
| UOFL HEALTH - SHELBYVILLE HOSPITAL Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-07-15 | MRF ↗ |
| NORTON CLARK HOSPITAL OutpatientFacility | Humana | Managed Medicaid | $47.71 | — | — | 2025-04-24 | MRF ↗ |
| NORTON CLARK HOSPITAL OutpatientFacility | Anthem Blue Cross Blue Shield | Managed Medicaid | $47.71 | — | — | 2025-04-24 | MRF ↗ |
| UofL Health - South Hospital Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-07-15 | MRF ↗ |
| REID HEALTH OutpatientFacility | Anthem Blue Cross Blue Shield | Pathways for Aging/Managed Medicaid | $47.71 | — | — | 2025-07-21 | MRF ↗ |
| REID HEALTH OutpatientFacility | MHS | Managed Medicaid | $47.71 | — | — | 2025-07-21 | MRF ↗ |
| UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-05-14 | MRF ↗ |
| REID HEALTH OutpatientFacility | Caresource of Indiana | Managed Medicaid | $47.71 | — | — | 2025-07-21 | MRF ↗ |
| REID HEALTH OutpatientFacility | Anthem Blue Cross Blue Shield | Managed Medicaid | $47.71 | — | — | 2025-07-21 | MRF ↗ |
| UofL Health - Peace Hospital Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-07-15 | MRF ↗ |
| NORTON CLARK HOSPITAL OutpatientFacility | CareSource Indiana Healthy Indiana Plan (HIP) | Managed Medicaid | $47.71 | — | — | 2025-04-24 | MRF ↗ |
| NORTON SCOTT HOSPITAL OutpatientFacility | United Healthcare of Indiana | Managed Medicaid | $47.71 | — | — | 2026-06-03 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Mhs | In Medicaid Hhw | $47.71 | — | — | 2026-09-16 | 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.