Q4205 — Membrane Graft Or Wrap Sq Cm
Cite this view
APA (7th ed.)
HANK Price Transparency. (n.d.). Membrane graft or wrap sq cm (HCPCS Q4205) negotiated rates. PPMan price-transparency data, derived from CMS-required hospital MRFs. Retrieved , from http://ppman.hank.ai/transparency/code/Q4205?code_type=HCPCS
MLA (9th ed.)
“Membrane graft or wrap sq cm (HCPCS Q4205) negotiated rates.” HANK Price Transparency, http://ppman.hank.ai/transparency/code/Q4205?code_type=HCPCS. Accessed .
Chicago (notes-bibliography)
“Membrane graft or wrap sq cm (HCPCS Q4205) negotiated rates,” HANK Price Transparency, accessed , http://ppman.hank.ai/transparency/code/Q4205?code_type=HCPCS.
Source: PPMan price-transparency data, derived from CMS-required hospital machine-readable files (45 CFR 180). See methodology.
Usually $244–$1,678 (25th–75th percentile) across 1,094 hospitals · 903 payers.
“Negotiated” is the hospital’s negotiated facility rate for this HCPCS Q4205 — 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
$244
$1,160 typical
$1,678
The middle 50% of negotiated facility rates for this procedure, measured across 1,094 hospitals.
What you’ll likely be billed
| Hospital facility Actual median across hospitals The hospital’s negotiated facility rate — from our MRF data. | $1,160 |
| Likely subtotal | $1,160 |
Facility charge (no separate professional fee)
$1,160
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 $244–$1,678.
- 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 |
|---|---|---|---|---|---|---|---|
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Phcs | PPO | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Christus Health | HIX | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | United Healthcare | HIX | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Coventry | First Health | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | United Healthcare | All Payer | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Molina | Star Plus KM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Superior | Star Kids KM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | United Healthcare | Star KM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Amerigroup | Star KM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Naphcare Inc. | RRMB | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Christus Health | Med Adv MM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Molina | Chip KM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Superior | Chip KM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Molina | Healthspring Star Plus KM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Cigna | PPO | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Texas Childrens Health Plan | Star Plus KM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | United Healthcare | VA CCN MM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Aetna | All Plans | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | United Healthcare | Star Kids KM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Triwest | VA MM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Imperial Health Plan | MM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Superior | Star KM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Coventry | First Health PPO | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Amerigroup | MM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Aetna | MM | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Healthsmart | Preferred | — | — | — | 2026-01-12 | MRF ↗ |
| CHRISTUS MOTHER FRANCES HOSPITAL SULPHUR SPRINGS OutpatientFacility | Healthcare Highways | PPO | — | — | — | 2026-01-12 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | PROMED HLTH NTWRK OP ONLY - ALL PLANS | PROMED HLTH NTWRK OP ONLY - ALL PLANS | $32.19 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| MIDLAND MEMORIAL HOSPITAL OutpatientFacility | Bcbs Advantage | Exchange | $33.04 | — | — | 2026-04-01 | MRF ↗ |
| MIDLAND MEMORIAL HOSPITAL OutpatientFacility | Bcbs Advantage | Exchange | $33.04 | — | — | 2026-04-01 | 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 ↗ |
| CASA COLINA HOSPITAL Outpatient | AETNA INDIV EXCH/OFF EXCH | AETNA INDIV EXCH/OFF EXCH | $33.44 | $27.87 | $36.23 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | AETNA INDIV EXCH/OFF EXCH | AETNA INDIV EXCH/OFF EXCH | $33.49 | $27.91 | $36.28 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | EPIC MCR ADV | EPIC MCR ADV | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | KAISER MCR ADV | KAISER MCR ADV | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | EPIC COMM - ALL OTHER PLANS | EPIC COMM - ALL OTHER PLANS | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | EMPIRE HEALTHCARE OP ONLY - ALL PLANS | EMPIRE HEALTHCARE OP ONLY - ALL PLANS | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | HUMANA MCR ADV | HUMANA MCR ADV | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | KAISER MCAL | KAISER MCAL | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | PROSPECT HP MCR ADV | PROSPECT HP MCR ADV | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | TRIWEST - ALL PLANS | TRIWEST - ALL PLANS | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | KAISER COMM - ALL OTHER PLANS | KAISER COMM - ALL OTHER PLANS | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | WELLCARE MCR ADV - ALL PLANS | WELLCARE MCR ADV - ALL PLANS | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | DOCTORS MANAGED OP ONLY - ALL PLANS | DOCTORS MANAGED OP ONLY - ALL PLANS | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | IEHP - ALL OTHER PLANS | IEHP - ALL OTHER PLANS | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | BRAND NEW DAY MCR ADV - ALL PLANS | BRAND NEW DAY MCR ADV - ALL PLANS | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | FOCUS HEALTHCARE WC - ALL PLANS | FOCUS HEALTHCARE WC - ALL PLANS | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | IEHP MCR ADV | IEHP MCR ADV | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | HEALTHCARE PARTNERS MCR | HEALTHCARE PARTNERS MCR | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | IEHP MCAL | IEHP MCAL | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | PRIMECARE MCR ADV | PRIMECARE MCR ADV | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | HEALTHNET MCR ADV | HEALTHNET MCR ADV | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | UHC MCR ADV | UHC MCR ADV | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | MEDI-CAL | MEDI-CAL | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | PREMIERCARE OP ONLY - ALL PLANS | PREMIERCARE OP ONLY - ALL PLANS | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | CENTRAL HLTH PLAN - ALL PLANS | CENTRAL HLTH PLAN - ALL PLANS | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | CAREMORE MCR ADV - ALL PLANS | CAREMORE MCR ADV - ALL PLANS | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | HERITAGE PRVDR NTWRK MCR | HERITAGE PRVDR NTWRK MCR | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | AETNA MCR ADV | AETNA MCR ADV | $33.88 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| MISSION REGIONAL MEDICAL CENTER Outpatient | BCBS | BCBS Traditional | $34.37 | — | — | 2024-12-19 | MRF ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCPreferredBlue | $34.60 | — | — | 2024-12-08 | MRF ↗ |
| EAST COOPER MEDICAL CENTER Outpatient | BCBS-SC | BCBSSCBlueChoice | $34.60 | — | — | 2024-12-08 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | PRIMECARE COMM - ALL OTHER PLANS | PRIMECARE COMM - ALL OTHER PLANS | $34.84 | $27.87 | $36.23 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | PRIMECARE COMM - ALL OTHER PLANS | PRIMECARE COMM - ALL OTHER PLANS | $34.89 | $27.91 | $36.28 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | BLUE SHIELD COMM - ALL OTHER PLANS | BLUE SHIELD COMM - ALL OTHER PLANS | $35.57 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| MIDLAND MEMORIAL HOSPITAL OutpatientFacility | Bcbs Hmo | Hmo | $36.11 | — | — | 2026-04-01 | MRF ↗ |
| MIDLAND MEMORIAL HOSPITAL OutpatientFacility | Bcbs Hmo | Hmo | $36.11 | — | — | 2026-04-01 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | PROSPECT HP COMM - ALL OTHER PLANS | PROSPECT HP COMM - ALL OTHER PLANS | $37.27 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | HEALTHCARE PARTNERS - ALL OTHER PLANS | HEALTHCARE PARTNERS - ALL OTHER PLANS | $37.27 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | PROSPECT MED GRP ALTA - ALL PLANS | PROSPECT MED GRP ALTA - ALL PLANS | $37.27 | $33.88 | $44.04 | 2026-10-05 | 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 ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Caresource | Commercial | $37.56 | — | — | 2026-07-17 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | HEALTHNET COMM - ALL OTHER PLANS | HEALTHNET COMM - ALL OTHER PLANS | $37.90 | $27.87 | $36.23 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | HEALTHNET COMM - ALL OTHER PLANS | HEALTHNET COMM - ALL OTHER PLANS | $37.96 | $27.91 | $36.28 | 2026-10-05 | MRF ↗ |
| MIDLAND MEMORIAL HOSPITAL OutpatientFacility | Bcbs Federal | Traditional | $38.87 | — | — | 2026-04-01 | MRF ↗ |
| MIDLAND MEMORIAL HOSPITAL OutpatientFacility | Bcbs Ppo | Ppo | $38.87 | — | — | 2026-04-01 | MRF ↗ |
| MIDLAND MEMORIAL HOSPITAL OutpatientFacility | Bcbs Ppo | Ppo | $38.87 | — | — | 2026-04-01 | MRF ↗ |
| MIDLAND MEMORIAL HOSPITAL OutpatientFacility | Bcbs Federal | Traditional | $38.87 | — | — | 2026-04-01 | MRF ↗ |
| CHRISTUS SANTA ROSA HOSPITAL-SAN MARCOS OutpatientFacility | Blue Cross Blue Shield Of Texas | HMO | $39.28 | — | — | 2026-01-13 | MRF ↗ |
| INDEPENDENCE HEALTH SYSTEM BUTLER MEMORIAL HOSPITA Outpatient | Ccbh - Behavioral Health | Behavioral | — | — | — | 2026-07-19 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | AETNA INDIV EXCH/OFF EXCH | AETNA INDIV EXCH/OFF EXCH | $40.66 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | PRIMECARE COMM - ALL OTHER PLANS | PRIMECARE COMM - ALL OTHER PLANS | $42.35 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| CHRISTUS SANTA ROSA HOSPITAL-SAN MARCOS OutpatientFacility | Blue Cross Blue Shield Of Texas | PPO | $42.97 | — | — | 2026-01-13 | MRF ↗ |
| CASA COLINA HOSPITAL Outpatient | HEALTHNET COMM - ALL OTHER PLANS | HEALTHNET COMM - ALL OTHER PLANS | $46.08 | $33.88 | $44.04 | 2026-10-05 | MRF ↗ |
| REID HEALTH OutpatientFacility | MHS | Managed Medicaid | $47.71 | — | — | 2025-07-21 | MRF ↗ |
| REID HEALTH OutpatientFacility | Anthem Blue Cross Blue Shield | 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 ↗ |
| NORTON SCOTT HOSPITAL OutpatientFacility | Managed Health Services (MHS) | Managed Medicaid | $47.71 | — | — | 2026-06-03 | MRF ↗ |
| MEMORIAL HOSPITAL AND HEALTH CARE CENTER OutpatientFacility | Anthem | Managed Medicaid | $47.71 | — | — | 2026-02-13 | MRF ↗ |
| UOFL HEALTH - SHELBYVILLE HOSPITAL Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-07-15 | MRF ↗ |
| UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-08-01 | MRF ↗ |
| UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-05-22 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Mhs | In Medicaid Hcc | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| NORTON CLARK HOSPITAL OutpatientFacility | Managed Health Services (MHS) Hoosier Care Connect | Managed Medicaid | $47.71 | — | — | 2025-04-24 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Mhs | In Medicaid Hhw | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Mhs | In Medicaid Hip | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Uhc | Pathways For Aging | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Mdwise | In Medicaid Hhw | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Caresource | In Medicaid Hip | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Humana | Pathways For Aging | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| NORTON CLARK HOSPITAL OutpatientFacility | Humana | Managed Medicaid | $47.71 | — | — | 2025-04-24 | MRF ↗ |
| MEMORIAL HOSPITAL AND HEALTH CARE CENTER OutpatientFacility | MHS Hoosier Care Connect | Managed Medicaid | $47.71 | — | — | 2026-02-13 | MRF ↗ |
| NORTON CLARK HOSPITAL OutpatientFacility | CareSource Indiana Healthy Indiana Plan (HIP) | Managed Medicaid | $47.71 | — | — | 2025-04-24 | MRF ↗ |
| REID HEALTH OutpatientFacility | Anthem Blue Cross Blue Shield | Pathways for Aging/Managed Medicaid | $47.71 | — | — | 2025-07-21 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Mdwise | In Medicaid Hip | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| UofL Health - Medical Center Northeast Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-07-15 | 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 Hhw | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Anthem | In Medicaid Hhw | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Anthem | In Medicaid Hip | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| NORTON SCOTT HOSPITAL OutpatientFacility | Managed Health Services (MHS) Hoosier Care Connect | Managed Medicaid | $47.71 | — | — | 2026-06-03 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Anthem | Pathways For Aging | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| MEMORIAL HOSPITAL AND HEALTH CARE CENTER OutpatientFacility | MDWise | Managed Medicaid | $47.71 | — | — | 2026-02-13 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Anthem | In Medicaid Hcc | $47.71 | — | — | 2026-09-21 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Uhc | Pathways For Aging | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Mdwise | In Medicaid Hip | $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 | Humana | Pathways For Aging | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Mdwise | In Medicaid Hhw | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-05-14 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Mhs | In Medicaid Hhw | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| REID HEALTH OutpatientFacility | Humana of Indiana | Pathways for Aging/Managed Medicaid | $47.71 | — | — | 2025-07-21 | MRF ↗ |
| UofL Health - South Hospital Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-07-15 | MRF ↗ |
| REID HEALTH OutpatientFacility | Caresource of Indiana | Managed Medicaid | $47.71 | — | — | 2025-07-21 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Anthem | In Medicaid Hcc | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| NORTON CLARK HOSPITAL OutpatientFacility | Anthem Blue Cross Blue Shield | Managed Medicaid | $47.71 | — | — | 2025-04-24 | MRF ↗ |
| REID HEALTH OutpatientFacility | MDWise | Managed Medicaid | $47.71 | — | — | 2025-07-21 | MRF ↗ |
| NORTON SCOTT HOSPITAL OutpatientFacility | United Healthcare of Indiana | Managed Medicaid | $47.71 | — | — | 2026-06-03 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Mhs | In Medicaid Hip | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Mdwise | In Medicaid Hhw | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Anthem | In Medicaid Hip | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Mhs | In Medicaid Hip | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Anthem | In Medicaid Hhw | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Anthem | Pathways For Aging | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| UofL Health - Medical Center East Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-08-01 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Humana | Pathways For Aging | $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 Hip Bh | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Mdwise | In Medicaid Hip | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Uhc | Pathways For Aging | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| UofL Health - Medical Center Southwest Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-07-15 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Caresource | In Medicaid Hhw | $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 Hhw | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Caresource | In Medicaid Hip | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Mhs | In Medicaid Hcc Bh | $47.71 | — | — | 2026-05-13 | MRF ↗ |
| UofL Health - Peace Hospital Outpatient | Anthem | In Medicaid | $47.71 | — | — | 2026-07-15 | MRF ↗ |
| NORTON CLARK HOSPITAL OutpatientFacility | Managed Health Services (MHS) Hoosier Healthwise (HHW) | Managed Medicaid | $47.71 | — | — | 2025-04-24 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Anthem | In Medicaid Hip | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Anthem | Exchange | $47.71 | — | — | 2026-09-16 | MRF ↗ |
| NORTON SCOTT HOSPITAL OutpatientFacility | CareSource Indiana Hoosier Healthwise (HHW) | Managed Medicaid | $48.19 | — | — | 2026-06-03 | MRF ↗ |
| REID HEALTH OutpatientFacility | United Healthcare | Pathways for Aging/Managed Medicaid | $48.66 | — | — | 2025-07-21 | MRF ↗ |
| REID HEALTH OutpatientFacility | United Healthcare | Managed Medicaid | $48.66 | — | — | 2025-07-21 | MRF ↗ |
| PIONEERS MEMORIAL HEALTHCARE DISTRICT Outpatient | UNITED HEALTHCARE | UNITED HEALTH CARE-ALL PLANS | $48.67 | $139.05 | $34.76 | 2026-02-01 | MRF ↗ |
| UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital Outpatient | Anthem | In Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Mhs | In Medicaid Hip | $48.68 | — | — | 2026-07-15 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Uhc Pathways | Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Mdwise Bhmi | Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Mhs | In Medicaid Hhw | $48.68 | — | — | 2026-07-15 | MRF ↗ |
| NORTON-KING'S DAUGHTERS' HEALTH OutpatientFacility | Anthem of Indiana | Managed Medicaid | $48.68 | — | — | 2026-05-05 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Anthem Indiana | Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Caresource Hip | Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Bcbs | Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| UOFL HEALTH - SHELBYVILLE HOSPITAL Outpatient | Anthem | In Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital Outpatient | Anthem | In Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Meridian | Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Anthem | Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| UNIVERSITY OF LOUISVILLE HOSPITAL Outpatient | Anthem | In Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Aetna | Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Mdwise | In Medicaid Hip | $48.68 | — | — | 2026-07-15 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Uhc | Pathways For Aging | $48.68 | — | — | 2026-07-15 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Mdwise | In Medicaid Hhw | $48.68 | — | — | 2026-07-15 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Anthem | In Medicaid Hcc | $48.68 | — | — | 2026-07-15 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Caresource | In Medicaid Hip | $48.68 | — | — | 2026-07-15 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Caresource | In Medicaid Hhw | $48.68 | — | — | 2026-07-15 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Molina | Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Caresource Hhw | Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Humana | Pathways For Aging | $48.68 | — | — | 2026-07-15 | MRF ↗ |
| MEMORIAL HOSPITAL OF SOUTH BEND Outpatient | Uhc | In Medicaid Hcc | $48.68 | — | — | 2026-09-21 | MRF ↗ |
| THE WOMEN'S HOSPITAL OutpatientFacility | MHS Behavioral | Managed Medicaid | $48.68 | — | — | 2026-02-13 | MRF ↗ |
| THE WOMEN'S HOSPITAL OutpatientFacility | United Healthcare IN | Managed Medicaid | $48.68 | — | — | 2026-02-13 | MRF ↗ |
| THE WOMEN'S HOSPITAL OutpatientFacility | MDWise HIP | Managed Medicaid | $48.68 | — | — | 2026-02-13 | MRF ↗ |
| THE WOMEN'S HOSPITAL OutpatientFacility | Anthem HIP | Managed Medicaid | $48.68 | — | — | 2026-02-13 | MRF ↗ |
| THE WOMEN'S HOSPITAL OutpatientFacility | Anthem IN | Managed Medicaid | $48.68 | — | — | 2026-02-13 | MRF ↗ |
| THE WOMEN'S HOSPITAL OutpatientFacility | Anthem IN Pathways for Aging | Managed Medicaid | $48.68 | — | — | 2026-02-13 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Anthem | In Medicaid Hip | $48.68 | — | — | 2026-07-15 | MRF ↗ |
| THE WOMEN'S HOSPITAL OutpatientFacility | Caresource IN | Managed Medicaid | $48.68 | — | — | 2026-02-13 | MRF ↗ |
| THE WOMEN'S HOSPITAL OutpatientFacility | Caresource HIP | Managed Medicaid | $48.68 | — | — | 2026-02-13 | MRF ↗ |
| TERRE HAUTE REGIONAL HOSPITAL Outpatient | Hospice of Bloomington Hospital | MCR | $48.68 | — | — | 2024-10-01 | MRF ↗ |
| COMMUNITY HOSPITAL OF BREMEN INC Outpatient | Anthem | Pathways For Aging | $48.68 | — | — | 2026-07-15 | MRF ↗ |
| GOOD SAMARITAN HOSPITAL Outpatient | Uhc | Medicaid | $48.68 | — | — | 2026-07-17 | MRF ↗ |
| ELKHART GENERAL HOSPITAL Outpatient | Mhs | In Medicaid Hhw Bh | $48.68 | — | — | 2026-05-13 | MRF ↗ |
| TERRE HAUTE REGIONAL HOSPITAL Outpatient | Hospice of Bloomington Hospital | MCR | $48.68 | — | — | 2024-10-01 | MRF ↗ |
| NORTON CLARK HOSPITAL OutpatientFacility | CareSource Indiana Hoosier Healthwise (HHW) | Managed Medicaid | $49.14 | — | — | 2025-04-24 | MRF ↗ |
| NORTON CLARK HOSPITAL OutpatientFacility | United Healthcare | Managed Medicaid | $49.14 | — | — | 2025-04-24 | MRF ↗ |
| UNIVERSITY OF LOUISVILLE HOSPITAL Outpatient | Anthem | In Medicaid | $49.24 | — | — | 2026-05-14 | MRF ↗ |
| UNIVERSITY OF LOUISVILLE HOSPITAL Outpatient | Anthem | In Medicaid | $49.24 | — | — | 2026-05-22 | 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.