Hospital

PENN HIGHLANDS TYRONE

Tyrone, PA · CCN 391307 · Rates published

138 distinct procedures filed

52 distinct payers

6,744 rate rows

2025-08-01 last MRF observed

Data quality

515 of 6,744 rate rows are consumer-grade (7.6%)

6,229 rows are marked excluded from the consumer medians — these stay visible in the raw drill-down with the same reason shown here, so nothing is silently hidden.

Excluded — reason	Rows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians	5,631
professional (physician) fee — not the facility price	598

Data source & audit trail ↓ Download audit trail (JSON)

Source MRF file	https://www.phhealthcare.org/download/?id=15375
Found on page	https://www.phhealthcare.org/patients-visitors/patient-billing-services
Discovered via	Discovered by HANK
Last fetch	success · 2026-05-18
Content fingerprint	c5b3ba50e45b43a2… · 5,103,789 bytes · first seen 2026-05-09

Top 50 most expensive offerings

Outliers are flagged where this hospital's filed rate is ≥2× or ≤0.5× the national median for the same code.

Code	Description	Payers	Min $	Max $	Avg median	vs national
539 MS_DRG	Osteomyelitis With Mcc	1	$69,430.00	$69,430.00	$69,430.00	nat. median $19,718 outlier · 3.5×
91 MS_DRG	Other Disorders Of Nervous System With Mcc	1	$56,476.96	$56,476.96	$56,476.96	nat. median $17,985 outlier · 3.1×
559 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Mcc	4	$55,696.50	$55,696.50	$55,696.50	nat. median $19,047 outlier · 2.9×
561 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc	3	$43,619.45	$43,619.45	$43,619.45	nat. median $9,193 outlier · 4.7×
947 MS_DRG	Signs And Symptoms With Mcc	7	$40,595.00	$40,595.00	$40,595.00	nat. median $12,688 outlier · 3.2×
948 MS_DRG	Signs And Symptoms Without Mcc	7	$32,470.45	$32,470.45	$32,470.45	nat. median $8,515 outlier · 3.8×
999 MS_DRG	Ungroupable	1	$31,768.29	$31,768.29	$31,768.29	nat. median $9,134 outlier · 3.5×
560 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Cc	3	$27,172.20	$27,172.20	$27,172.20	nat. median $12,148 outlier · 2.2×
432 MS_DRG	Cirrhosis And Alcoholic Hepatitis With Mcc	1	$23,460.86	$23,460.86	$23,460.86	nat. median $19,681 1.2× median
308 MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Mcc	1	$20,156.66	$20,156.66	$20,156.66	nat. median $12,751 1.6× median
699 MS_DRG	Other Kidney And Urinary Tract Diagnoses With Cc	1	$20,153.26	$20,153.26	$20,153.26	nat. median $10,935 1.8× median
557 MS_DRG	Tendonitis, Myositis And Bursitis With Mcc	1	$19,962.88	$19,962.88	$19,962.88	nat. median $15,338 1.3× median
689 MS_DRG	Kidney And Urinary Tract Infections With Mcc	2	$18,296.00	$18,296.00	$18,296.00	nat. median $12,152 1.5× median
291 MS_DRG	Heart Failure And Shock With Mcc	4	$17,374.47	$17,374.47	$17,374.47	nat. median $13,521 1.3× median
690 MS_DRG	Kidney And Urinary Tract Infections Without Mcc	1	$16,755.08	$16,755.08	$16,755.08	nat. median $8,979 1.9× median
871 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	8	$15,465.88	$15,465.88	$15,465.88	nat. median $19,634 0.8× median
69 MS_DRG	Transient Ischemia Without Thrombolytic	2	$12,781.25	$12,781.25	$12,781.25	nat. median $8,973 1.4× median
638 MS_DRG	Diabetes With Cc	1	$11,889.01	$11,889.01	$11,889.01	nat. median $9,824 1.2× median
439 MS_DRG	Disorders Of Pancreas Except Malignancy With Cc	1	$11,879.24	$11,879.24	$11,879.24	nat. median $9,521 1.2× median
9013 OTHER	Inj Risankizumab-rzaa?1 Mg	1	$11,286.38	$11,286.38	$11,286.38	nat. median $15 outlier · 741.1×
639 MS_DRG	Diabetes Without Cc/Mcc	1	$11,173.92	$11,173.92	$11,173.92	nat. median $7,254 1.5× median
189 MS_DRG	Pulmonary Edema And Respiratory Failure	2	$11,065.30	$11,065.30	$11,065.30	nat. median $13,017 0.9× median
552 MS_DRG	Medical Back Problems Without Mcc	2	$10,626.84	$10,626.84	$10,626.84	nat. median $10,422 1.0× median
556 MS_DRG	Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc	1	$10,292.25	$10,292.25	$10,292.25	nat. median $9,145 1.1× median
392 MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	2	$9,386.15	$9,386.15	$9,386.15	nat. median $8,728 1.1× median
554 MS_DRG	Bone Diseases And Arthropathies Without Mcc	1	$9,297.35	$9,297.35	$9,297.35	nat. median $9,260 1.0× median
683 MS_DRG	Renal Failure With Cc	3	$9,120.85	$9,120.85	$9,120.85	nat. median $9,664 0.9× median
9213 OTHER	Inj. Pemetrexed Nos 10mg	1	$9,095.27	$9,095.27	$9,095.27	nat. median $4 outlier · 2175.9×
177 MS_DRG	Respiratory Infections And Inflammations With Mcc	2	$8,954.97	$8,954.97	$8,954.97	nat. median $16,234 0.6× median
190 MS_DRG	Chronic Obstructive Pulmonary Disease With Mcc	1	$8,853.18	$8,853.18	$8,853.18	nat. median $11,699 0.8× median
5093 OTHER	Level 3 Breast/Lymphatic Surgery And Related Procedures	2	$8,664.27	$8,664.27	$8,664.27	nat. median $8,902 1.0× median
872 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	7	$8,657.18	$8,657.18	$8,657.18	nat. median $11,103 0.8× median
145 MS_DRG	Other Ear, Nose, Mouth And Throat O.r. Procedures Without Cc/Mcc	2	$8,649.95	$8,649.95	$8,649.95	nat. median $12,673 0.7× median
5162 OTHER	Level 2 ENT Procedures	3	$7,930.45	$7,930.45	$7,930.45	nat. median $562 outlier · 14.1×
897 MS_DRG	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	1	$7,825.40	$7,825.40	$7,825.40	nat. median $8,726 0.9× median
195 MS_DRG	Simple Pneumonia And Pleurisy Without Cc/Mcc	1	$7,761.36	$7,761.36	$7,761.36	nat. median $7,338 1.1× median
0764 OTHER	Ketorolac Tromethamine Inj	3	$7,447.37	$7,447.37	$7,447.37	nat. median $6,884 1.1× median
0792 OTHER	Inj, Glycopyrrolate, 0.1 Mg	1	$6,848.17	$6,848.17	$6,848.17	nat. median $4,134 1.7× median
682 MS_DRG	Renal Failure With Mcc	2	$6,809.50	$6,809.50	$6,809.50	nat. median $15,223 outlier · 0.4×
9132 OTHER	Prothrombin Complex Kcentra	2	$6,719.11	$6,719.11	$6,719.11	nat. median $2 outlier · 2999.6×
64 MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	1	$6,052.12	$6,052.12	$6,052.12	nat. median $20,254 outlier · 0.3×
866 MS_DRG	Viral Illness Without Mcc	1	$6,052.12	$6,052.12	$6,052.12	nat. median $9,533 0.6× median
641 MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…	1	$5,867.91	$5,867.91	$5,867.91	nat. median $8,664 0.7× median
5153 OTHER	Level 3 Airway Endoscopy	5	$5,841.95	$5,841.95	$5,841.95	nat. median $1,878 outlier · 3.1×
184 MS_DRG	Major Chest Trauma With Cc	1	$5,629.35	$5,629.35	$5,629.35	nat. median $11,329 outlier · 0.5×
467 MS_DRG	Revision Of Hip Or Knee Replacement With Cc	1	$5,616.58	$5,616.58	$5,616.58	nat. median $34,720 outlier · 0.2×
282 MS_DRG	Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc	1	$5,588.96	$5,588.96	$5,588.96	nat. median $8,518 0.7× median
5155 OTHER	Level 5 Airway Endoscopy	9	$5,216.34	$5,216.34	$5,216.34	nat. median $7,444 0.7× median
5165 OTHER	Level 5 ENT Procedures	19	$5,202.56	$5,202.56	$5,202.56	nat. median $6,244 0.8× median
5116 OTHER	Level 6 Musculoskeletal Procedures	4	$5,112.55	$5,112.55	$5,112.55	nat. median $18,574 outlier · 0.3×

Other procedures at this hospital

Browse this hospital's 138 published procedures. Use the slice to choose what to show, then sort or filter any column.

Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
Code	Type	Description	Rate rows	Payers	Gross	Cash	Min $	Max $	Avg median	Last observed

539	MS_DRG	Osteomyelitis With Mcc	1	1	—	—	$69,430.00	$69,430.00	$69,430.00	2025-08-01
91	MS_DRG	Other Disorders Of Nervous System With Mcc	1	1	—	—	$56,476.96	$56,476.96	$56,476.96	2025-08-01
559	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Mcc	4	4	—	—	$55,696.50	$55,696.50	$55,696.50	2025-08-01
561	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc	3	3	—	—	$43,619.45	$43,619.45	$43,619.45	2025-08-01
947	MS_DRG	Signs And Symptoms With Mcc	7	7	—	—	$40,595.00	$40,595.00	$40,595.00	2025-08-01
948	MS_DRG	Signs And Symptoms Without Mcc	7	7	—	—	$32,470.45	$32,470.45	$32,470.45	2025-08-01
999	MS_DRG	Ungroupable	1	1	—	—	$31,768.29	$31,768.29	$31,768.29	2025-08-01
560	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Cc	3	3	—	—	$27,172.20	$27,172.20	$27,172.20	2025-08-01
432	MS_DRG	Cirrhosis And Alcoholic Hepatitis With Mcc	1	1	—	—	$23,460.86	$23,460.86	$23,460.86	2025-08-01
308	MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Mcc	1	1	—	—	$20,156.66	$20,156.66	$20,156.66	2025-08-01
699	MS_DRG	Other Kidney And Urinary Tract Diagnoses With Cc	1	1	—	—	$20,153.26	$20,153.26	$20,153.26	2025-08-01
557	MS_DRG	Tendonitis, Myositis And Bursitis With Mcc	1	1	—	—	$19,962.88	$19,962.88	$19,962.88	2025-08-01
689	MS_DRG	Kidney And Urinary Tract Infections With Mcc	2	2	—	—	$18,296.00	$18,296.00	$18,296.00	2025-08-01
291	MS_DRG	Heart Failure And Shock With Mcc	4	4	—	—	$17,374.47	$17,374.47	$17,374.47	2025-08-01
690	MS_DRG	Kidney And Urinary Tract Infections Without Mcc	1	1	—	—	$16,755.08	$16,755.08	$16,755.08	2025-08-01
871	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	8	8	—	—	$15,465.88	$15,465.88	$15,465.88	2025-08-01
69	MS_DRG	Transient Ischemia Without Thrombolytic	2	2	—	—	$12,781.25	$12,781.25	$12,781.25	2025-08-01
638	MS_DRG	Diabetes With Cc	1	1	—	—	$11,889.01	$11,889.01	$11,889.01	2025-08-01
439	MS_DRG	Disorders Of Pancreas Except Malignancy With Cc	1	1	—	—	$11,879.24	$11,879.24	$11,879.24	2025-08-01
9013	OTHER	Inj Risankizumab-rzaa?1 Mg	1	1	—	—	$11,286.38	$11,286.38	$11,286.38	2025-08-01
639	MS_DRG	Diabetes Without Cc/Mcc	1	1	—	—	$11,173.92	$11,173.92	$11,173.92	2025-08-01
189	MS_DRG	Pulmonary Edema And Respiratory Failure	2	2	—	—	$11,065.30	$11,065.30	$11,065.30	2025-08-01
552	MS_DRG	Medical Back Problems Without Mcc	2	2	—	—	$10,626.84	$10,626.84	$10,626.84	2025-08-01
556	MS_DRG	Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc	1	1	—	—	$10,292.25	$10,292.25	$10,292.25	2025-08-01
392	MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	2	2	—	—	$9,386.15	$9,386.15	$9,386.15	2025-08-01
554	MS_DRG	Bone Diseases And Arthropathies Without Mcc	1	1	—	—	$9,297.35	$9,297.35	$9,297.35	2025-08-01
683	MS_DRG	Renal Failure With Cc	3	3	—	—	$9,120.85	$9,120.85	$9,120.85	2025-08-01
9213	OTHER	Inj. Pemetrexed Nos 10mg	1	1	—	—	$9,095.27	$9,095.27	$9,095.27	2025-08-01
177	MS_DRG	Respiratory Infections And Inflammations With Mcc	2	2	—	—	$8,954.97	$8,954.97	$8,954.97	2025-08-01
190	MS_DRG	Chronic Obstructive Pulmonary Disease With Mcc	1	1	—	—	$8,853.18	$8,853.18	$8,853.18	2025-08-01
5093	OTHER	Level 3 Breast/Lymphatic Surgery And Related Procedures	2	2	—	—	$8,664.27	$8,664.27	$8,664.27	2025-08-01
872	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	7	7	—	—	$8,657.18	$8,657.18	$8,657.18	2025-08-01
145	MS_DRG	Other Ear, Nose, Mouth And Throat O.r. Procedures Without Cc/Mcc	2	2	—	—	$8,649.95	$8,649.95	$8,649.95	2025-08-01
5162	OTHER	Level 2 ENT Procedures	3	3	—	—	$7,930.45	$7,930.45	$7,930.45	2025-08-01
897	MS_DRG	Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc	1	1	—	—	$7,825.40	$7,825.40	$7,825.40	2025-08-01
195	MS_DRG	Simple Pneumonia And Pleurisy Without Cc/Mcc	1	1	—	—	$7,761.36	$7,761.36	$7,761.36	2025-08-01
0764	OTHER	Ketorolac Tromethamine Inj	3	3	—	—	$7,447.37	$7,447.37	$7,447.37	2025-08-01
0792	OTHER	Inj, Glycopyrrolate, 0.1 Mg	1	1	—	—	$6,848.17	$6,848.17	$6,848.17	2025-08-01
682	MS_DRG	Renal Failure With Mcc	2	2	—	—	$6,809.50	$6,809.50	$6,809.50	2025-08-01
9132	OTHER	Prothrombin Complex Kcentra	2	2	—	—	$6,719.11	$6,719.11	$6,719.11	2025-08-01
64	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Mcc	1	1	—	—	$6,052.12	$6,052.12	$6,052.12	2025-08-01
866	MS_DRG	Viral Illness Without Mcc	1	1	—	—	$6,052.12	$6,052.12	$6,052.12	2025-08-01
641	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…	1	1	—	—	$5,867.91	$5,867.91	$5,867.91	2025-08-01
5153	OTHER	Level 3 Airway Endoscopy	5	5	—	—	$5,841.95	$5,841.95	$5,841.95	2025-08-01
184	MS_DRG	Major Chest Trauma With Cc	1	1	—	—	$5,629.35	$5,629.35	$5,629.35	2025-08-01
467	MS_DRG	Revision Of Hip Or Knee Replacement With Cc	1	1	—	—	$5,616.58	$5,616.58	$5,616.58	2025-08-01
282	MS_DRG	Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc	1	1	—	—	$5,588.96	$5,588.96	$5,588.96	2025-08-01
5155	OTHER	Level 5 Airway Endoscopy	9	9	—	—	$5,216.34	$5,216.34	$5,216.34	2025-08-01
5165	OTHER	Level 5 ENT Procedures	19	19	—	—	$5,202.56	$5,202.56	$5,202.56	2025-08-01
5116	OTHER	Level 6 Musculoskeletal Procedures	4	4	—	—	$5,112.55	$5,112.55	$5,112.55	2025-08-01
305	MS_DRG	Hypertension Without Mcc	1	1	—	—	$5,079.04	$5,079.04	$5,079.04	2025-08-01
5691	OTHER	Level 1 Drug Administration	6	6	—	—	$4,903.86	$4,903.86	$4,903.86	2025-08-01
9357	OTHER	Inj. Eptinezumab-jjmr 1 Mg	2	2	—	—	$4,776.05	$4,776.05	$4,776.05	2025-08-01
640	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M…	2	2	—	—	$4,698.06	$4,698.06	$4,698.06	2025-08-01
5055	OTHER	Level 5 Skin Procedures	1	1	—	—	$4,552.20	$4,552.20	$4,552.20	2025-08-01
5361	OTHER	Level 1 Laparoscopy And Related Services	5	5	—	—	$4,459.94	$4,459.94	$4,459.94	2025-08-01
1670	OTHER	Tetanus Immune Globulin Inj	1	1	—	—	$4,382.18	$4,382.18	$4,382.18	2025-08-01
313	MS_DRG	Chest Pain	1	1	—	—	$4,227.00	$4,227.00	$4,227.00	2025-08-01
5054	OTHER	Level 4 Skin Procedures	9	9	—	—	$4,157.60	$4,157.60	$4,157.60	2025-08-01
5503	OTHER	Level 3 Extraocular, Repair, And Plastic Eye Procedures	3	3	—	—	$4,119.73	$4,119.73	$4,119.73	2025-08-01
5114	OTHER	Level 4 Musculoskeletal Procedures	12	12	—	—	$3,901.36	$3,901.36	$3,901.36	2025-08-01
5154	OTHER	Level 4 Airway Endoscopy	6	6	—	—	$3,894.26	$3,894.26	$3,894.26	2025-08-01
9367	OTHER	Inj Ruxience, 10 Mg	4	4	—	—	$3,890.17	$3,890.17	$3,890.17	2025-08-01
5073	OTHER	Level 3 Excision/ Biopsy/ Incision And Drainage	5	5	—	—	$3,758.32	$3,758.32	$3,758.32	2025-08-01
5492	OTHER	Level 2 Intraocular Procedures	9	9	—	—	$3,540.88	$3,540.88	$3,540.88	2025-08-01
5493	OTHER	Level 3 Intraocular Procedures	5	5	—	—	$3,081.66	$3,081.66	$3,081.66	2025-08-01
5491	OTHER	Level 1 Intraocular Procedures	19	19	—	—	$3,078.76	$3,078.76	$3,078.76	2025-08-01
544	MS_DRG	Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With…	1	1	—	—	$2,948.47	$2,948.47	$2,948.47	2025-08-01
5164	OTHER	Level 4 ENT Procedures	13	13	—	—	$2,748.81	$2,748.81	$2,748.81	2025-08-01
5113	OTHER	Level 3 Musculoskeletal Procedures	12	12	—	—	$2,740.63	$2,740.63	$2,740.63	2025-08-01
5091	OTHER	Level 1 Breast/Lymphatic Surgery And Related Procedures	1	1	—	—	$2,661.88	$2,661.88	$2,661.88	2025-08-01
192	MS_DRG	Chronic Obstructive Pulmonary Disease Without Cc/Mcc	1	1	—	—	$2,522.00	$2,522.00	$2,522.00	2025-08-01
9173	OTHER	Injection, Fulphila	1	1	—	—	$2,390.39	$2,390.39	$2,390.39	2025-08-01
1214	OTHER	Inj Ivig Privigen 500 Mg	5	5	—	—	$2,367.20	$2,367.20	$2,367.20	2025-08-01
7043	OTHER	Infliximab Not Biosimil 10mg	1	1	—	—	$2,243.98	$2,243.98	$2,243.98	2025-08-01
5573	OTHER	Level 3 Imaging With Contrast	3	3	—	—	$2,209.49	$2,209.49	$2,209.49	2025-08-01
5112	OTHER	Level 2 Musculoskeletal Procedures	5	5	—	—	$2,152.38	$2,152.38	$2,152.38	2025-08-01
5694	OTHER	Level 4 Drug Administration	6	6	—	—	$1,994.64	$1,994.64	$1,994.64	2025-08-01
5071	OTHER	Level 1 Excision/ Biopsy/ Incision And Drainage	5	5	—	—	$1,954.44	$1,954.44	$1,954.44	2025-08-01
5241	OTHER	Level 1 Blood Product Exchange And Related Services	3	3	—	—	$1,911.22	$1,911.22	$1,911.22	2025-08-01
5041	OTHER	Critical Care	7	7	—	—	$1,857.38	$1,857.38	$1,857.38	2025-08-01
5572	OTHER	Level 2 Imaging With Contrast	18	18	—	—	$1,742.20	$1,742.20	$1,742.20	2025-08-01
5431	OTHER	Level 1 Nerve Procedures	3	3	—	—	$1,646.10	$1,646.10	$1,646.10	2025-08-01
9441	OTHER	Inj Ferric Carboxymaltos 1mg	2	2	—	—	$1,549.21	$1,549.21	$1,549.21	2025-08-01
5092	OTHER	Level 2 Breast/Lymphatic Surgery And Related Procedures	2	2	—	—	$1,480.04	$1,480.04	$1,480.04	2025-08-01
9522	OTHER	Rbc Leukoreduced Irradiated	2	2	—	—	$1,474.67	$1,474.67	$1,474.67	2025-08-01
193	MS_DRG	Simple Pneumonia And Pleurisy With Mcc	1	1	—	—	$1,352.00	$1,352.00	$1,352.00	2025-08-01
563	MS_DRG	Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit…	1	1	—	—	$1,352.00	$1,352.00	$1,352.00	2025-08-01
5571	OTHER	Level 1 Imaging With Contrast	17	17	—	—	$1,031.17	$1,031.17	$1,031.17	2025-08-01
0964	OTHER	Albumin (human), 25%, 20 Ml	1	1	—	—	$976.66	$976.66	$976.66	2025-08-01
5523	OTHER	Level 3 Imaging Without Contrast	22	22	—	—	$901.75	$901.75	$901.75	2025-08-01
5161	OTHER	Level 1 ENT Procedures	1	1	—	—	$889.62	$889.62	$889.62	2025-08-01
5094	OTHER	Level 4 Breast/Lymphatic Surgery And Related Procedures	1	1	—	—	$853.60	$853.60	$853.60	2025-08-01
5012	OTHER	Clinic Visits And Related Services	11	11	—	—	$646.63	$646.63	$646.63	2025-08-01
5182	OTHER	Level 2 Vascular Procedures	1	1	—	—	$580.43	$580.43	$580.43	2025-08-01
9097	OTHER	Inj Retacrit Non-esrd Use	1	1	—	—	$559.20	$559.20	$559.20	2025-08-01
1822	OTHER	Injection, Zarxio	3	3	—	—	$530.18	$530.18	$530.18	2025-08-01
5672	OTHER	Level 2 Pathology	3	3	—	—	$501.34	$501.34	$501.34	2025-08-01
5522	OTHER	Level 2 Imaging Without Contrast	25	25	—	—	$473.81	$473.81	$473.81	2025-08-01
N804	OTHER	Mammography Services	22	22	—	—	$315.79	$315.79	$315.79	2025-08-01
9512	OTHER	Rbc Leukocytes Reduced	1	1	—	—	$315.00	$315.00	$315.00	2025-08-01
1829	OTHER	Penicillin G Benzathine Inj	1	1	—	—	$289.13	$289.13	$289.13	2025-08-01
5022	OTHER	Level 2 Type A Ed Visits	24	24	—	—	$252.65	$252.65	$252.65	2025-08-01
N900	OTHER	Non-covered Services	11	11	—	—	$181.28	$181.28	$181.28	2025-08-01
N800	OTHER	Clinical Diagnostic Lab Services	37	37	—	—	$127.52	$127.52	$127.52	2025-08-01
5692	OTHER	Level 2 Drug Administration	3	3	—	—	$126.48	$126.48	$126.48	2025-08-01
5443	OTHER	Level 3 Nerve Injections	1	1	—	—	$116.35	$116.35	$116.35	2025-08-01
5732	OTHER	Level 2 Minor Procedures	3	3	—	—	$115.86	$115.86	$115.86	2025-08-01
7048	OTHER	Alteplase Recombinant	1	1	—	—	$88.49	$88.49	$88.49	2025-08-01
5151	OTHER	Level 1 Airway Endoscopy	1	1	—	—	$69.00	$69.00	$69.00	2025-08-01
N902	OTHER	Packaged Services	2	2	—	—	$63.24	$63.24	$63.24	2025-08-01
5441	OTHER	Level 1 Nerve Injections	2	2	—	—	$63.15	$63.15	$63.15	2025-08-01
5791	OTHER	Pulmonary Treatment	1	1	—	—	$54.19	$54.19	$54.19	2025-08-01
9517	OTHER	Red Blood Cells Unit	1	1	—	—	$33.00	$33.00	$33.00	2025-08-01
N907	OTHER	Not Billable To Fi	0	0	—	—	—	—	—	2025-08-01
5163	OTHER	Level 3 ENT Procedures	0	0	—	—	—	—	—	2025-08-01
5115	OTHER	Level 5 Musculoskeletal Procedures	0	0	—	—	—	—	—	2025-08-01
5111	OTHER	Level 1 Musculoskeletal Procedures	0	0	—	—	—	—	—	2025-08-01
5183	OTHER	Level 3 Vascular Procedures	0	0	—	—	—	—	—	2025-08-01
5072	OTHER	Level 2 Excision/ Biopsy/ Incision And Drainage	0	0	—	—	—	—	—	2025-08-01
5052	OTHER	Level 2 Skin Procedures	0	0	—	—	—	—	—	2025-08-01
5051	OTHER	Level 1 Skin Procedures	0	0	—	—	—	—	—	2025-08-01
5025	OTHER	Level 5 Type A Ed Visits	0	0	—	—	—	—	—	2025-08-01
5521	OTHER	Level 1 Imaging Without Contrast	0	0	—	—	—	—	—	2025-08-01
5524	OTHER	Level 4 Imaging Without Contrast	0	0	—	—	—	—	—	2025-08-01
5024	OTHER	Level 4 Type A Ed Visits	0	0	—	—	—	—	—	2025-08-01
5023	OTHER	Level 3 Type A Ed Visits	0	0	—	—	—	—	—	2025-08-01
5671	OTHER	Level 1 Pathology	0	0	—	—	—	—	—	2025-08-01
5673	OTHER	Level 3 Pathology	0	0	—	—	—	—	—	2025-08-01
5693	OTHER	Level 3 Drug Administration	0	0	—	—	—	—	—	2025-08-01
5021	OTHER	Level 1 Type A Ed Visits	0	0	—	—	—	—	—	2025-08-01
5721	OTHER	Level 1 Diagnostic Tests And Related Services	0	0	—	—	—	—	—	2025-08-01
5722	OTHER	Level 2 Diagnostic Tests And Related Services	0	0	—	—	—	—	—	2025-08-01
5733	OTHER	Level 3 Minor Procedures	0	0	—	—	—	—	—	2025-08-01
5734	OTHER	Level 4 Minor Procedures	0	0	—	—	—	—	—	2025-08-01
9133	OTHER	Rabies Ig, Im/sc	0	0	—	—	—	—	—	2025-08-01
9139	OTHER	Rabies Vaccine, IM	0	0	—	—	—	—	—	2025-08-01
603	MS_DRG	Cellulitis Without Mcc	0	0	—	—	—	—	—	2025-08-01

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