Hospital

PENN HIGHLANDS TYRONE

Tyrone, PA · CCN 391307 · Rates published

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This facility hasn’t published a payer-negotiated rate for this exact code. See its full rate list below.

138 distinct procedures filed

52 distinct payers

6,743 rate rows

2025-08-01 last MRF observed · ⚠ 12 mo old

Data quality

815 of 6,743 rate rows are consumer-grade (12.1%)

5,928 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	5,330
professional (physician) fee — not the facility price	598

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 12 months old. CMS requires hospitals to refresh these files at least annually, so newer rates may exist that we haven't ingested yet. The prices below are exactly as last filed.

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

Source MRF file	https://www.phhealthcare.org/data/uploads/contentblock/PHT%20Charge%20Master%20072021.csv
Found on page	https://www.phhealthcare.org/patients-visitors/patient-billing-services
Discovered via	Discovered by HANK
Last fetch	not_modified · 2026-08-03

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 $19,527 outlier · 3.6×
91 MS_DRG	Other Disorders Of Nervous System With Mcc	1	$56,476.96	$56,476.96	$56,476.96	nat. median $17,843 outlier · 3.2×
561 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc	3	$23,510.62	$63,728.28	$49,420.00	nat. median $9,110 outlier · 5.4×
559 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Mcc	4	$20,352.60	$91,040.40	$41,588.07	nat. median $18,860 outlier · 2.2×
948 MS_DRG	Signs And Symptoms Without Mcc	7	$19,420.70	$45,520.20	$31,938.45	nat. median $8,463 outlier · 3.8×
999 MS_DRG	Ungroupable	1	$31,768.29	$31,768.29	$31,768.29	nat. median $7,940 outlier · 4.0×
947 MS_DRG	Signs And Symptoms With Mcc	7	$21,180.00	$60,010.00	$31,302.14	nat. median $12,594 outlier · 2.5×
560 MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Cc	3	$22,480.26	$31,864.14	$23,509.22	nat. median $12,112 1.9× median
432 MS_DRG	Cirrhosis And Alcoholic Hepatitis With Mcc	1	$23,460.86	$23,460.86	$23,460.86	nat. median $19,576 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 $12,590 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 $10,827 1.9× median
557 MS_DRG	Tendonitis, Myositis And Bursitis With Mcc	1	$19,962.88	$19,962.88	$19,962.88	nat. median $15,170 1.3× median
689 MS_DRG	Kidney And Urinary Tract Infections With Mcc	2	$8,643.18	$27,948.82	$18,296.00	nat. median $12,008 1.5× median
690 MS_DRG	Kidney And Urinary Tract Infections Without Mcc	1	$16,755.08	$16,755.08	$16,755.08	nat. median $8,869 1.9× median
69 MS_DRG	Transient Ischemia Without Thrombolytic	2	$11,906.43	$13,656.06	$12,781.24	nat. median $8,926 1.4× median
638 MS_DRG	Diabetes With Cc	1	$11,889.01	$11,889.01	$11,889.01	nat. median $9,750 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 $9,456 1.3× median
9013 OTHER	Inj Risankizumab-rzaa?1 Mg	1	$11,286.38	$11,286.38	$11,286.38	nat. median $15 outlier · 736.2×
639 MS_DRG	Diabetes Without Cc/Mcc	1	$11,173.92	$11,173.92	$11,173.92	nat. median $7,159 1.6× median
189 MS_DRG	Pulmonary Edema And Respiratory Failure	2	$10,334.59	$11,796.00	$11,065.30	nat. median $12,892 0.9× median
552 MS_DRG	Medical Back Problems Without Mcc	2	$6,511.34	$14,742.35	$10,626.85	nat. median $10,356 1.0× median
291 MS_DRG	Heart Failure And Shock With Mcc	4	$5,898.00	$28,850.95	$10,553.31	nat. median $13,359 0.8× 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 $9,097 1.1× median
392 MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	2	$8,784.83	$9,987.46	$9,386.15	nat. median $8,659 1.1× median
554 MS_DRG	Bone Diseases And Arthropathies Without Mcc	1	$9,297.35	$9,297.35	$9,297.35	nat. median $9,200 1.0× 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	$6,325.96	$11,583.97	$8,954.97	nat. median $16,167 0.6× median
190 MS_DRG	Chronic Obstructive Pulmonary Disease With Mcc	1	$8,853.18	$8,853.18	$8,853.18	nat. median $11,661 0.8× median
5093 OTHER	Level 3 Breast/Lymphatic Surgery And Related Procedures	2	$8,227.88	$9,100.67	$8,664.27	nat. median $8,962 1.0× median
145 MS_DRG	Other Ear, Nose, Mouth And Throat O.r. Procedures Without Cc/Mcc	2	$6,938.21	$10,361.70	$8,649.95	nat. median $12,568 0.7× median
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 $8,661 0.9× median
871 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	8	$3,010.56	$27,921.20	$7,762.11	nat. median $19,136 outlier · 0.4×
195 MS_DRG	Simple Pneumonia And Pleurisy Without Cc/Mcc	1	$7,761.36	$7,761.36	$7,761.36	nat. median $7,228 1.1× median
0764 OTHER	Ketorolac Tromethamine Inj	2	$3,890.21	$11,004.53	$7,447.37	nat. median $6,727 1.1× median
5115 OTHER	Level 5 Musculoskeletal Procedures	16	$275.00	$15,874.59	$7,256.05	nat. median $13,671 0.5× median
0792 OTHER	Inj, Glycopyrrolate, 0.1 Mg	1	$6,848.17	$6,848.17	$6,848.17	nat. median $3,441 2.0× median
682 MS_DRG	Renal Failure With Mcc	2	$5,827.12	$7,791.88	$6,809.50	nat. median $15,088 outlier · 0.5×
9132 OTHER	Prothrombin Complex Kcentra	2	$6,579.88	$6,858.34	$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 $20,032 outlier · 0.3×
866 MS_DRG	Viral Illness Without Mcc	1	$6,052.12	$6,052.12	$6,052.12	nat. median $9,395 0.6× median
872 MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	7	$1,595.36	$15,719.00	$6,021.12	nat. median $11,029 0.5× median
683 MS_DRG	Renal Failure With Cc	3	$1,459.00	$16,782.70	$6,021.12	nat. median $9,596 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 $8,588 0.7× median
9367 OTHER	Inj Ruxience, 10 Mg	4	$1,588.12	$6,192.22	$5,786.74	nat. median $20 outlier · 290.6×
5361 OTHER	Level 1 Laparoscopy And Related Services	5	$853.60	$8,066.29	$5,634.16	nat. median $6,478 0.9× median
184 MS_DRG	Major Chest Trauma With Cc	1	$5,629.35	$5,629.35	$5,629.35	nat. median $11,192 0.5× median
467 MS_DRG	Revision Of Hip Or Knee Replacement With Cc	1	$5,616.58	$5,616.58	$5,616.58	nat. median $34,366 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 $8,425 0.7× median
603 MS_DRG	Cellulitis Without Mcc	3	$1,063.00	$36,943.06	$5,326.20	nat. median $9,525 0.6× median
5153 OTHER	Level 3 Airway Endoscopy	5	$1,393.20	$10,290.70	$5,236.30	nat. median $1,877 outlier · 2.8×

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
561	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc	3	3	—	—	$23,510.62	$63,728.28	$49,420.00	2025-08-01
559	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Mcc	4	4	—	—	$20,352.60	$91,040.40	$41,588.07	2025-08-01
948	MS_DRG	Signs And Symptoms Without Mcc	7	7	—	—	$19,420.70	$45,520.20	$31,938.45	2025-08-01
999	MS_DRG	Ungroupable	1	1	—	—	$31,768.29	$31,768.29	$31,768.29	2025-08-01
947	MS_DRG	Signs And Symptoms With Mcc	7	7	—	—	$21,180.00	$60,010.00	$31,302.14	2025-08-01
560	MS_DRG	Aftercare, Musculoskeletal System And Connective Tissue With Cc	3	3	—	—	$22,480.26	$31,864.14	$23,509.22	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	—	—	$8,643.18	$27,948.82	$18,296.00	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
69	MS_DRG	Transient Ischemia Without Thrombolytic	2	2	—	—	$11,906.43	$13,656.06	$12,781.24	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	—	—	$10,334.59	$11,796.00	$11,065.30	2025-08-01
552	MS_DRG	Medical Back Problems Without Mcc	2	2	—	—	$6,511.34	$14,742.35	$10,626.85	2025-08-01
291	MS_DRG	Heart Failure And Shock With Mcc	4	4	—	—	$5,898.00	$28,850.95	$10,553.31	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	—	—	$8,784.83	$9,987.46	$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
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	—	—	$6,325.96	$11,583.97	$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	—	—	$8,227.88	$9,100.67	$8,664.27	2025-08-01
145	MS_DRG	Other Ear, Nose, Mouth And Throat O.r. Procedures Without Cc/Mcc	2	2	—	—	$6,938.21	$10,361.70	$8,649.95	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
871	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	8	8	—	—	$3,010.56	$27,921.20	$7,762.11	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	2	2	—	—	$3,890.21	$11,004.53	$7,447.37	2025-08-01
5115	OTHER	Level 5 Musculoskeletal Procedures	16	16	—	—	$275.00	$15,874.59	$7,256.05	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	—	—	$5,827.12	$7,791.88	$6,809.50	2025-08-01
9132	OTHER	Prothrombin Complex Kcentra	2	2	—	—	$6,579.88	$6,858.34	$6,719.11	2025-08-01
866	MS_DRG	Viral Illness Without Mcc	1	1	—	—	$6,052.12	$6,052.12	$6,052.12	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
683	MS_DRG	Renal Failure With Cc	3	3	—	—	$1,459.00	$16,782.70	$6,021.12	2025-08-01
872	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	7	7	—	—	$1,595.36	$15,719.00	$6,021.12	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
9367	OTHER	Inj Ruxience, 10 Mg	4	4	—	—	$1,588.12	$6,192.22	$5,786.74	2025-08-01
5361	OTHER	Level 1 Laparoscopy And Related Services	5	5	—	—	$853.60	$8,066.29	$5,634.16	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
603	MS_DRG	Cellulitis Without Mcc	3	3	—	—	$1,063.00	$36,943.06	$5,326.20	2025-08-01
5153	OTHER	Level 3 Airway Endoscopy	5	5	—	—	$1,393.20	$10,290.70	$5,236.30	2025-08-01
305	MS_DRG	Hypertension Without Mcc	1	1	—	—	$5,079.04	$5,079.04	$5,079.04	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	—	—	$3,375.00	$6,021.12	$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
5116	OTHER	Level 6 Musculoskeletal Procedures	4	4	—	—	$1,293.73	$8,931.37	$4,470.40	2025-08-01
1670	OTHER	Tetanus Immune Globulin Inj	1	1	—	—	$4,382.18	$4,382.18	$4,382.18	2025-08-01
5691	OTHER	Level 1 Drug Administration	6	6	—	—	$851.00	$8,956.72	$4,299.24	2025-08-01
5183	OTHER	Level 3 Vascular Procedures	6	6	—	—	$200.00	$16,853.46	$4,286.40	2025-08-01
313	MS_DRG	Chest Pain	1	1	—	—	$4,227.00	$4,227.00	$4,227.00	2025-08-01
5155	OTHER	Level 5 Airway Endoscopy	9	9	—	—	$853.60	$9,579.07	$4,107.22	2025-08-01
5503	OTHER	Level 3 Extraocular, Repair, And Plastic Eye Procedures	3	3	—	—	$2,482.27	$5,757.20	$3,975.29	2025-08-01
1214	OTHER	Inj Ivig Privigen 500 Mg	5	5	—	—	$521.37	$4,213.02	$3,377.58	2025-08-01
5493	OTHER	Level 3 Intraocular Procedures	5	5	—	—	$1,843.00	$4,320.32	$3,251.34	2025-08-01
5165	OTHER	Level 5 ENT Procedures	19	19	—	—	$513.29	$9,891.84	$2,988.43	2025-08-01
5573	OTHER	Level 3 Imaging With Contrast	3	3	—	—	$1,323.27	$3,095.72	$2,987.87	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
5091	OTHER	Level 1 Breast/Lymphatic Surgery And Related Procedures	1	1	—	—	$2,661.88	$2,661.88	$2,661.88	2025-08-01
5072	OTHER	Level 2 Excision/ Biopsy/ Incision And Drainage	9	9	—	—	$508.14	$20,504.56	$2,583.16	2025-08-01
5492	OTHER	Level 2 Intraocular Procedures	9	9	—	—	$635.57	$6,446.18	$2,580.46	2025-08-01
5491	OTHER	Level 1 Intraocular Procedures	19	19	—	—	$638.00	$5,519.52	$2,535.51	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
5054	OTHER	Level 4 Skin Procedures	9	9	—	—	$750.75	$7,564.46	$2,358.64	2025-08-01
5113	OTHER	Level 3 Musculoskeletal Procedures	12	12	—	—	$474.06	$5,007.20	$2,355.82	2025-08-01
7043	OTHER	Infliximab Not Biosimil 10mg	1	1	—	—	$2,243.98	$2,243.98	$2,243.98	2025-08-01
5673	OTHER	Level 3 Pathology	2	2	—	—	$59.62	$4,190.39	$2,125.01	2025-08-01
5154	OTHER	Level 4 Airway Endoscopy	6	6	—	—	$838.20	$6,950.32	$1,963.55	2025-08-01
5114	OTHER	Level 4 Musculoskeletal Procedures	12	12	—	—	$678.00	$7,124.71	$1,808.51	2025-08-01
5162	OTHER	Level 2 ENT Procedures	3	3	—	—	$1,746.97	$14,113.93	$1,776.00	2025-08-01
5164	OTHER	Level 4 ENT Procedures	13	13	—	—	$694.68	$4,802.94	$1,705.31	2025-08-01
5241	OTHER	Level 1 Blood Product Exchange And Related Services	3	3	—	—	$1,342.92	$2,479.52	$1,699.20	2025-08-01
5163	OTHER	Level 3 ENT Procedures	11	11	—	—	$474.21	$13,731.78	$1,622.46	2025-08-01
5025	OTHER	Level 5 Type A Ed Visits	24	24	—	—	$273.43	$5,851.75	$1,599.14	2025-08-01
9441	OTHER	Inj Ferric Carboxymaltos 1mg	2	2	—	—	$1,347.55	$1,750.88	$1,549.22	2025-08-01
5092	OTHER	Level 2 Breast/Lymphatic Surgery And Related Procedures	2	2	—	—	$300.00	$2,660.08	$1,480.04	2025-08-01
9522	OTHER	Rbc Leukoreduced Irradiated	2	2	—	—	$1,303.83	$1,645.52	$1,474.67	2025-08-01
5112	OTHER	Level 2 Musculoskeletal Procedures	5	5	—	—	$588.81	$3,715.95	$1,457.46	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
5041	OTHER	Critical Care	7	7	—	—	$519.31	$3,195.46	$1,289.31	2025-08-01
5572	OTHER	Level 2 Imaging With Contrast	18	18	—	—	$295.90	$3,188.50	$1,086.33	2025-08-01
5071	OTHER	Level 1 Excision/ Biopsy/ Incision And Drainage	5	5	—	—	$749.10	$3,159.79	$1,041.58	2025-08-01
5524	OTHER	Level 4 Imaging Without Contrast	18	18	—	—	$106.00	$7,459.92	$1,008.88	2025-08-01
0964	RC	Albumin (human), 25%, 20 Ml	1	1	—	—	$976.66	$976.66	$976.66	2025-08-01
5024	OTHER	Level 4 Type A Ed Visits	33	33	—	—	$40.17	$5,271.44	$930.26	2025-08-01
9133	OTHER	Rabies Ig, Im/sc	4	4	—	—	$133.87	$4,067.66	$912.72	2025-08-01
5431	OTHER	Level 1 Nerve Procedures	3	3	—	—	$312.50	$2,979.70	$905.54	2025-08-01
5161	OTHER	Level 1 ENT Procedures	1	1	—	—	$889.62	$889.62	$889.62	2025-08-01
5073	OTHER	Level 3 Excision/ Biopsy/ Incision And Drainage	5	5	—	—	$624.25	$6,892.40	$863.00	2025-08-01
5094	OTHER	Level 4 Breast/Lymphatic Surgery And Related Procedures	1	1	—	—	$853.60	$853.60	$853.60	2025-08-01
5571	OTHER	Level 1 Imaging With Contrast	17	17	—	—	$111.56	$1,950.79	$737.52	2025-08-01
5694	OTHER	Level 4 Drug Administration	6	6	—	—	$223.02	$3,766.26	$676.71	2025-08-01
5672	OTHER	Level 2 Pathology	3	3	—	—	$72.54	$930.14	$659.99	2025-08-01
5523	OTHER	Level 3 Imaging Without Contrast	22	22	—	—	$215.76	$1,587.75	$612.41	2025-08-01
5182	OTHER	Level 2 Vascular Procedures	1	1	—	—	$580.43	$580.43	$580.43	2025-08-01
1822	OTHER	Injection, Zarxio	3	3	—	—	$336.82	$723.54	$560.53	2025-08-01
9097	OTHER	Inj Retacrit Non-esrd Use	1	1	—	—	$559.20	$559.20	$559.20	2025-08-01
5693	OTHER	Level 3 Drug Administration	18	18	—	—	$43.23	$1,431.41	$522.97	2025-08-01
9139	OTHER	Rabies Vaccine, IM	6	6	—	—	$11.00	$1,025.04	$442.62	2025-08-01
5111	OTHER	Level 1 Musculoskeletal Procedures	9	9	—	—	$94.88	$10,166.34	$418.33	2025-08-01
5051	OTHER	Level 1 Skin Procedures	4	4	—	—	$64.35	$1,495.58	$416.77	2025-08-01
5722	OTHER	Level 2 Diagnostic Tests And Related Services	12	12	—	—	$12.54	$1,118.90	$319.75	2025-08-01
5021	OTHER	Level 1 Type A Ed Visits	7	7	—	—	$22.00	$1,066.00	$318.95	2025-08-01
9512	OTHER	Rbc Leukocytes Reduced	1	1	—	—	$315.00	$315.00	$315.00	2025-08-01
5522	OTHER	Level 2 Imaging Without Contrast	25	25	—	—	$48.40	$899.21	$308.00	2025-08-01
5023	OTHER	Level 3 Type A Ed Visits	35	35	—	—	$47.35	$2,024.28	$300.00	2025-08-01
1829	OTHER	Penicillin G Benzathine Inj	1	1	—	—	$289.13	$289.13	$289.13	2025-08-01
N900	OTHER	Non-covered Services	11	11	—	—	$77.86	$284.71	$183.11	2025-08-01
N804	OTHER	Mammography Services	22	22	—	—	$103.58	$528.00	$182.59	2025-08-01
5012	OTHER	Clinic Visits And Related Services	11	11	—	—	$90.46	$1,202.80	$176.71	2025-08-01
5022	OTHER	Level 2 Type A Ed Visits	24	24	—	—	$27.02	$478.28	$174.74	2025-08-01
5734	OTHER	Level 4 Minor Procedures	11	11	—	—	$11.00	$1,197.00	$167.26	2025-08-01
N907	OTHER	Not Billable To Fi	5	5	—	—	$30.58	$1,086.55	$149.00	2025-08-01
5732	OTHER	Level 2 Minor Procedures	3	3	—	—	$58.48	$173.25	$142.12	2025-08-01
5521	OTHER	Level 1 Imaging Without Contrast	28	28	—	—	$12.42	$539.62	$136.91	2025-08-01
5721	OTHER	Level 1 Diagnostic Tests And Related Services	2	2	—	—	$9.90	$258.06	$133.98	2025-08-01
5733	OTHER	Level 3 Minor Procedures	22	22	—	—	$11.51	$396.20	$120.39	2025-08-01
5052	OTHER	Level 2 Skin Procedures	7	7	—	—	$2.02	$1,066.28	$119.29	2025-08-01
5443	OTHER	Level 3 Nerve Injections	1	1	—	—	$116.35	$116.35	$116.35	2025-08-01
N800	OTHER	Clinical Diagnostic Lab Services	37	37	—	—	$16.33	$238.70	$103.62	2025-08-01
7048	OTHER	Alteplase Recombinant	1	1	—	—	$88.49	$88.49	$88.49	2025-08-01
5671	OTHER	Level 1 Pathology	9	9	—	—	$9.90	$395.62	$82.55	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	—	—	$60.48	$66.00	$63.24	2025-08-01
5441	OTHER	Level 1 Nerve Injections	2	2	—	—	$52.80	$73.50	$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
5692	OTHER	Level 2 Drug Administration	3	3	—	—	$13.97	$239.00	$24.34	2025-08-01

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