Hospital

PENN HIGHLANDS BROOKVILLE

Brookville, PA · CCN 391312 · Rates published

186 distinct procedures filed

59 distinct payers

7,101 rate rows

2025-08-01 last MRF observed

Data quality

618 of 7,101 rate rows are consumer-grade (8.7%)

6,483 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	5,885
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=15368
Found on page	https://www.phhealthcare.org/patients-visitors/patient-billing-services
Discovered via	Discovered by HANK
Last fetch	success · 2026-05-19
Content fingerprint	e4e5cadd51eeb327… · 5,301,569 bytes · first seen 2026-05-18

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
0717 OTHER	Instill Adstiladrin, Tx Dose	1	$105,504.93	$105,504.93	$105,504.93	nat. median $63,342 1.7× median
329 MS_DRG	Major Small And Large Bowel Procedures With Mcc	1	$27,561.18	$27,561.18	$27,561.18	nat. median $44,810 0.6× median
57 MS_DRG	Degenerative Nervous System Disorders Without Mcc	4	$21,625.00	$21,625.00	$21,625.00	nat. median $13,201 1.6× median
675 MS_DRG	Other Kidney And Urinary Tract Procedures Without Cc/Mcc	2	$17,372.39	$17,372.39	$17,372.39	nat. median $16,799 1.0× median
885 MS_DRG	Psychoses	5	$17,359.47	$17,359.47	$17,359.47	nat. median $12,884 1.3× median
177 MS_DRG	Respiratory Infections And Inflammations With Mcc	4	$16,803.06	$16,803.06	$16,803.06	nat. median $16,234 1.0× median
91 MS_DRG	Other Disorders Of Nervous System With Mcc	1	$15,592.50	$15,592.50	$15,592.50	nat. median $17,985 0.9× median
41 MS_DRG	Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe…	1	$15,584.66	$15,584.66	$15,584.66	nat. median $22,575 0.7× median
74 MS_DRG	Cranial And Peripheral Nerve Disorders Without Mcc	1	$15,010.56	$15,010.56	$15,010.56	nat. median $11,117 1.4× median
884 MS_DRG	Organic Disturbances And Intellectual Disability	1	$14,606.43	$14,606.43	$14,606.43	nat. median $14,858 1.0× median
637 MS_DRG	Diabetes With Mcc	1	$13,550.00	$13,550.00	$13,550.00	nat. median $14,787 0.9× median
882 MS_DRG	Neuroses Except Depressive	1	$13,475.00	$13,475.00	$13,475.00	nat. median $9,789 1.4× median
356 MS_DRG	Other Digestive System O.r. Procedures With Mcc	1	$13,043.02	$13,043.02	$13,043.02	nat. median $42,444 outlier · 0.3×
56 MS_DRG	Degenerative Nervous System Disorders With Mcc	1	$12,974.52	$12,974.52	$12,974.52	nat. median $22,361 0.6× median
330 MS_DRG	Major Small And Large Bowel Procedures With Cc	3	$12,835.99	$12,835.99	$12,835.99	nat. median $24,346 0.5× median
5094 OTHER	Level 4 Breast/Lymphatic Surgery And Related Procedures	3	$11,593.71	$11,593.71	$11,593.71	nat. median $16,303 0.7× median
385 MS_DRG	Inflammatory Bowel Disease With Mcc	1	$11,300.50	$11,300.50	$11,300.50	nat. median $16,227 0.7× median
331 MS_DRG	Major Small And Large Bowel Procedures Without Cc/Mcc	2	$10,297.74	$10,297.74	$10,297.74	nat. median $17,703 0.6× median
1489 OTHER	Inj Vedolizumab IV 1 Mg	1	$10,022.69	$10,022.69	$10,022.69	nat. median $22 outlier · 446.6×
881 MS_DRG	Depressive Neuroses	1	$9,937.11	$9,937.11	$9,937.11	nat. median $8,971 1.1× median
206 MS_DRG	Other Respiratory System Diagnoses Without Mcc	1	$9,778.35	$9,778.35	$9,778.35	nat. median $10,000 1.0× median
5378 OTHER	Level 8 Urology And Related Services	1	$9,656.62	$9,656.62	$9,656.62	nat. median $20,900 outlier · 0.5×
71 MS_DRG	Other Cerebrovascular Disorders With Cc	2	$9,461.51	$9,461.51	$9,461.51	nat. median $11,209 0.8× median
388 MS_DRG	Gastrointestinal Obstruction With Mcc	1	$9,328.25	$9,328.25	$9,328.25	nat. median $15,091 0.6× median
603 MS_DRG	Cellulitis Without Mcc	5	$9,292.73	$9,292.73	$9,292.73	nat. median $9,571 1.0× median
372 MS_DRG	Major Gastrointestinal Disorders And Peritoneal Infections With Cc	1	$8,678.90	$8,678.90	$8,678.90	nat. median $11,087 0.8× median
9132 OTHER	Prothrombin Complex Kcentra	4	$8,586.07	$8,586.07	$8,586.07	nat. median $2 outlier · 3833.1×
809 MS_DRG	Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co…	1	$8,578.94	$8,578.94	$8,578.94	nat. median $13,226 0.6× median
640 MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M…	2	$8,420.51	$8,420.51	$8,420.51	nat. median $13,400 0.6× median
377 MS_DRG	Gastrointestinal Hemorrhage With Mcc	1	$8,273.26	$8,273.26	$8,273.26	nat. median $18,249 outlier · 0.5×
689 MS_DRG	Kidney And Urinary Tract Infections With Mcc	3	$8,221.50	$8,221.50	$8,221.50	nat. median $12,152 0.7× median
5464 OTHER	Level 4 Neurostimulator And Related Procedures	1	$8,120.28	$8,120.28	$8,120.28	nat. median $20,658 outlier · 0.4×
600 MS_DRG	Non-malignant Breast Disorders With Cc/Mcc	1	$7,883.89	$7,883.89	$7,883.89	nat. median $10,799 0.7× median
189 MS_DRG	Pulmonary Edema And Respiratory Failure	6	$7,769.83	$7,769.83	$7,769.83	nat. median $13,017 0.6× median
948 MS_DRG	Signs And Symptoms Without Mcc	4	$7,324.83	$7,324.83	$7,324.83	nat. median $8,515 0.9× median
391 MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	1	$7,233.50	$7,233.50	$7,233.50	nat. median $13,245 0.5× median
291 MS_DRG	Heart Failure And Shock With Mcc	6	$7,213.00	$7,213.00	$7,213.00	nat. median $13,521 0.5× median
440 MS_DRG	Disorders Of Pancreas Except Malignancy Without Cc/Mcc	2	$7,056.12	$7,056.12	$7,056.12	nat. median $7,343 1.0× median
696 MS_DRG	Kidney And Urinary Tract Signs And Symptoms Without Mcc	1	$6,898.55	$6,898.55	$6,898.55	nat. median $7,849 0.9× median
378 MS_DRG	Gastrointestinal Hemorrhage With Cc	2	$6,836.61	$6,836.61	$6,836.61	nat. median $10,712 0.6× median
638 MS_DRG	Diabetes With Cc	1	$6,820.64	$6,820.64	$6,820.64	nat. median $9,824 0.7× median
947 MS_DRG	Signs And Symptoms With Mcc	4	$6,481.66	$6,481.66	$6,481.66	nat. median $12,688 0.5× median
5041 OTHER	Critical Care	4	$6,398.43	$6,398.43	$6,398.43	nat. median $1,553 outlier · 4.1×
5376 OTHER	Level 6 Urology And Related Services	2	$6,344.85	$6,344.85	$6,344.85	nat. median $9,689 0.7× median
5313 OTHER	Level 3 Lower Gi Procedures	2	$6,265.19	$6,265.19	$6,265.19	nat. median $3,119 outlier · 2.0×
389 MS_DRG	Gastrointestinal Obstruction With Cc	2	$6,262.48	$6,262.48	$6,262.48	nat. median $8,897 0.7× median
5371 OTHER	Level 1 Urology And Related Services	1	$6,045.43	$6,045.43	$6,045.43	nat. median $264 outlier · 22.9×
66 MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc	4	$5,994.56	$5,994.56	$5,994.56	nat. median $8,067 0.7× median
178 MS_DRG	Respiratory Infections And Inflammations With Cc	1	$5,954.71	$5,954.71	$5,954.71	nat. median $10,873 0.5× median
280 MS_DRG	Acute Myocardial Infarction, Discharged Alive With Mcc	2	$5,925.92	$5,925.92	$5,925.92	nat. median $16,529 outlier · 0.4×

Other procedures at this hospital

Browse this hospital's 186 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

0717	OTHER	Instill Adstiladrin, Tx Dose	1	1	—	—	$105,504.93	$105,504.93	$105,504.93	2025-08-01
0792	OTHER	Inj, Glycopyrrolate, 0.1 Mg	1	1	—	—	$4,598.36	$4,598.36	$4,598.36	2025-08-01
100	MS_DRG	Seizures With Mcc	1	1	—	—	$1,780.50	$1,780.50	$1,780.50	2025-08-01
1489	OTHER	Inj Vedolizumab IV 1 Mg	1	1	—	—	$10,022.69	$10,022.69	$10,022.69	2025-08-01
175	MS_DRG	Pulmonary Embolism With Mcc Or Acute Cor Pulmonale	1	1	—	—	$1,260.00	$1,260.00	$1,260.00	2025-08-01
177	MS_DRG	Respiratory Infections And Inflammations With Mcc	4	4	—	—	$16,803.06	$16,803.06	$16,803.06	2025-08-01
178	MS_DRG	Respiratory Infections And Inflammations With Cc	1	1	—	—	$5,954.71	$5,954.71	$5,954.71	2025-08-01
1829	OTHER	Penicillin G Benzathine Inj	2	2	—	—	$1,913.33	$1,913.33	$1,913.33	2025-08-01
184	MS_DRG	Major Chest Trauma With Cc	1	1	—	—	$1,632.00	$1,632.00	$1,632.00	2025-08-01
189	MS_DRG	Pulmonary Edema And Respiratory Failure	6	6	—	—	$7,769.83	$7,769.83	$7,769.83	2025-08-01
190	MS_DRG	Chronic Obstructive Pulmonary Disease With Mcc	1	1	—	—	$1,355.00	$1,355.00	$1,355.00	2025-08-01
192	MS_DRG	Chronic Obstructive Pulmonary Disease Without Cc/Mcc	1	1	—	—	$2,710.00	$2,710.00	$2,710.00	2025-08-01
193	MS_DRG	Simple Pneumonia And Pleurisy With Mcc	9	9	—	—	$5,403.95	$5,403.95	$5,403.95	2025-08-01
194	MS_DRG	Simple Pneumonia And Pleurisy With Cc	2	2	—	—	$5,589.60	$5,589.60	$5,589.60	2025-08-01
195	MS_DRG	Simple Pneumonia And Pleurisy Without Cc/Mcc	1	1	—	—	$4,554.88	$4,554.88	$4,554.88	2025-08-01
206	MS_DRG	Other Respiratory System Diagnoses Without Mcc	1	1	—	—	$9,778.35	$9,778.35	$9,778.35	2025-08-01
280	MS_DRG	Acute Myocardial Infarction, Discharged Alive With Mcc	2	2	—	—	$5,925.92	$5,925.92	$5,925.92	2025-08-01
281	MS_DRG	Acute Myocardial Infarction, Discharged Alive With Cc	1	1	—	—	$2,584.00	$2,584.00	$2,584.00	2025-08-01
282	MS_DRG	Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc	2	2	—	—	$2,185.20	$2,185.20	$2,185.20	2025-08-01
291	MS_DRG	Heart Failure And Shock With Mcc	6	6	—	—	$7,213.00	$7,213.00	$7,213.00	2025-08-01
292	MS_DRG	Heart Failure And Shock With Cc	1	1	—	—	$1,046.00	$1,046.00	$1,046.00	2025-08-01
305	MS_DRG	Hypertension Without Mcc	1	1	—	—	$3,008.00	$3,008.00	$3,008.00	2025-08-01
308	MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Mcc	3	3	—	—	$4,208.20	$4,208.20	$4,208.20	2025-08-01
309	MS_DRG	Cardiac Arrhythmia And Conduction Disorders With Cc	1	1	—	—	$4,024.13	$4,024.13	$4,024.13	2025-08-01
312	MS_DRG	Syncope And Collapse	1	1	—	—	$1,708.00	$1,708.00	$1,708.00	2025-08-01
315	MS_DRG	Other Circulatory System Diagnoses With Cc	1	1	—	—	$1,274.71	$1,274.71	$1,274.71	2025-08-01
329	MS_DRG	Major Small And Large Bowel Procedures With Mcc	1	1	—	—	$27,561.18	$27,561.18	$27,561.18	2025-08-01
330	MS_DRG	Major Small And Large Bowel Procedures With Cc	3	3	—	—	$12,835.99	$12,835.99	$12,835.99	2025-08-01
331	MS_DRG	Major Small And Large Bowel Procedures Without Cc/Mcc	2	2	—	—	$10,297.74	$10,297.74	$10,297.74	2025-08-01
334	MS_DRG	Rectal Resection Without Cc/Mcc	1	1	—	—	$4,536.00	$4,536.00	$4,536.00	2025-08-01
356	MS_DRG	Other Digestive System O.r. Procedures With Mcc	1	1	—	—	$13,043.02	$13,043.02	$13,043.02	2025-08-01
372	MS_DRG	Major Gastrointestinal Disorders And Peritoneal Infections With Cc	1	1	—	—	$8,678.90	$8,678.90	$8,678.90	2025-08-01
377	MS_DRG	Gastrointestinal Hemorrhage With Mcc	1	1	—	—	$8,273.26	$8,273.26	$8,273.26	2025-08-01
378	MS_DRG	Gastrointestinal Hemorrhage With Cc	2	2	—	—	$6,836.61	$6,836.61	$6,836.61	2025-08-01
385	MS_DRG	Inflammatory Bowel Disease With Mcc	1	1	—	—	$11,300.50	$11,300.50	$11,300.50	2025-08-01
388	MS_DRG	Gastrointestinal Obstruction With Mcc	1	1	—	—	$9,328.25	$9,328.25	$9,328.25	2025-08-01
389	MS_DRG	Gastrointestinal Obstruction With Cc	2	2	—	—	$6,262.48	$6,262.48	$6,262.48	2025-08-01
390	MS_DRG	Gastrointestinal Obstruction Without Cc/Mcc	1	1	—	—	$5,734.55	$5,734.55	$5,734.55	2025-08-01
391	MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc	1	1	—	—	$7,233.50	$7,233.50	$7,233.50	2025-08-01
392	MS_DRG	Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc	4	4	—	—	$3,526.00	$3,526.00	$3,526.00	2025-08-01
41	MS_DRG	Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Periphe…	1	1	—	—	$15,584.66	$15,584.66	$15,584.66	2025-08-01
439	MS_DRG	Disorders Of Pancreas Except Malignancy With Cc	2	2	—	—	$3,357.37	$3,357.37	$3,357.37	2025-08-01
440	MS_DRG	Disorders Of Pancreas Except Malignancy Without Cc/Mcc	2	2	—	—	$7,056.12	$7,056.12	$7,056.12	2025-08-01
445	MS_DRG	Disorders Of The Biliary Tract With Cc	1	1	—	—	$1,475.00	$1,475.00	$1,475.00	2025-08-01
5012	OTHER	Clinic Visits And Related Services	20	20	—	—	$205.44	$205.44	$205.44	2025-08-01
5022	OTHER	Level 2 Type A Ed Visits	0	0	—	—	—	—	—	2025-08-01
5023	OTHER	Level 3 Type A Ed Visits	0	0	—	—	—	—	—	2025-08-01
5024	OTHER	Level 4 Type A Ed Visits	0	0	—	—	—	—	—	2025-08-01
5025	OTHER	Level 5 Type A Ed Visits	0	0	—	—	—	—	—	2025-08-01
5041	OTHER	Critical Care	4	4	—	—	$6,398.43	$6,398.43	$6,398.43	2025-08-01
5051	OTHER	Level 1 Skin Procedures	0	0	—	—	—	—	—	2025-08-01
5052	OTHER	Level 2 Skin Procedures	8	8	—	—	$1,567.08	$1,567.08	$1,567.08	2025-08-01
5053	OTHER	Level 3 Skin Procedures	5	5	—	—	$1,286.80	$1,286.80	$1,286.80	2025-08-01
5054	OTHER	Level 4 Skin Procedures	0	0	—	—	—	—	—	2025-08-01
5055	OTHER	Level 5 Skin Procedures	3	3	—	—	$5,795.69	$5,795.69	$5,795.69	2025-08-01
5071	OTHER	Level 1 Excision/ Biopsy/ Incision And Drainage	0	0	—	—	—	—	—	2025-08-01
5072	OTHER	Level 2 Excision/ Biopsy/ Incision And Drainage	0	0	—	—	—	—	—	2025-08-01
5073	OTHER	Level 3 Excision/ Biopsy/ Incision And Drainage	8	8	—	—	$1,807.61	$1,807.61	$1,807.61	2025-08-01
5091	OTHER	Level 1 Breast/Lymphatic Surgery And Related Procedures	0	0	—	—	—	—	—	2025-08-01
5092	OTHER	Level 2 Breast/Lymphatic Surgery And Related Procedures	5	5	—	—	$5,582.71	$5,582.71	$5,582.71	2025-08-01
5093	OTHER	Level 3 Breast/Lymphatic Surgery And Related Procedures	0	0	—	—	—	—	—	2025-08-01
5094	OTHER	Level 4 Breast/Lymphatic Surgery And Related Procedures	3	3	—	—	$11,593.71	$11,593.71	$11,593.71	2025-08-01
5111	OTHER	Level 1 Musculoskeletal Procedures	1	1	—	—	$56.44	$56.44	$56.44	2025-08-01
5112	OTHER	Level 2 Musculoskeletal Procedures	13	13	—	—	$2,451.68	$2,451.68	$2,451.68	2025-08-01
5113	OTHER	Level 3 Musculoskeletal Procedures	0	0	—	—	—	—	—	2025-08-01
5114	OTHER	Level 4 Musculoskeletal Procedures	4	4	—	—	$4,281.94	$4,281.94	$4,281.94	2025-08-01
5163	OTHER	Level 3 ENT Procedures	5	5	—	—	$4,265.46	$4,265.46	$4,265.46	2025-08-01
5164	OTHER	Level 4 ENT Procedures	0	0	—	—	—	—	—	2025-08-01
5165	OTHER	Level 5 ENT Procedures	3	3	—	—	$3,205.07	$3,205.07	$3,205.07	2025-08-01
5182	OTHER	Level 2 Vascular Procedures	2	2	—	—	$2,050.39	$2,050.39	$2,050.39	2025-08-01
5183	OTHER	Level 3 Vascular Procedures	3	3	—	—	$2,524.74	$2,524.74	$2,524.74	2025-08-01
5241	OTHER	Level 1 Blood Product Exchange And Related Services	4	4	—	—	$2,384.11	$2,384.11	$2,384.11	2025-08-01
5301	OTHER	Level 1 Upper Gi Procedures	0	0	—	—	—	—	—	2025-08-01
5311	OTHER	Level 1 Lower Gi Procedures	20	20	—	—	$3,655.67	$3,655.67	$3,655.67	2025-08-01
5312	OTHER	Level 2 Lower Gi Procedures	0	0	—	—	—	—	—	2025-08-01
5313	OTHER	Level 3 Lower Gi Procedures	2	2	—	—	$6,265.19	$6,265.19	$6,265.19	2025-08-01
5341	OTHER	Level 1 Abdominal/Peritoneal/Biliary And Related Procedures	8	8	—	—	$3,869.96	$3,869.96	$3,869.96	2025-08-01
5342	OTHER	Level 2 Abdominal/Peritoneal/Biliary And Related Procedures	2	2	—	—	$3,874.46	$3,874.46	$3,874.46	2025-08-01
5361	OTHER	Level 1 Laparoscopy And Related Services	0	0	—	—	—	—	—	2025-08-01
5362	OTHER	Level 2 Laparoscopy And Related Services	2	2	—	—	$3,227.07	$3,227.07	$3,227.07	2025-08-01
5371	OTHER	Level 1 Urology And Related Services	1	1	—	—	$6,045.43	$6,045.43	$6,045.43	2025-08-01
5372	OTHER	Level 2 Urology And Related Services	0	0	—	—	—	—	—	2025-08-01
5373	OTHER	Level 3 Urology And Related Services	19	19	—	—	$5,315.55	$5,315.55	$5,315.55	2025-08-01
5374	OTHER	Level 4 Urology And Related Services	0	0	—	—	—	—	—	2025-08-01
5375	OTHER	Level 5 Urology And Related Services	0	0	—	—	—	—	—	2025-08-01
5376	OTHER	Level 6 Urology And Related Services	2	2	—	—	$6,344.85	$6,344.85	$6,344.85	2025-08-01
5378	OTHER	Level 8 Urology And Related Services	1	1	—	—	$9,656.62	$9,656.62	$9,656.62	2025-08-01
5414	OTHER	Level 4 Gynecologic Procedures	2	2	—	—	$1,650.49	$1,650.49	$1,650.49	2025-08-01
5415	OTHER	Level 5 Gynecologic Procedures	1	1	—	—	$853.60	$853.60	$853.60	2025-08-01
5431	OTHER	Level 1 Nerve Procedures	0	0	—	—	—	—	—	2025-08-01
5441	OTHER	Level 1 Nerve Injections	6	6	—	—	$246.81	$246.81	$246.81	2025-08-01
5442	OTHER	Level 2 Nerve Injections	2	2	—	—	$270.38	$270.38	$270.38	2025-08-01
5462	OTHER	Level 2 Neurostimulator And Related Procedures	1	1	—	—	$204.86	$204.86	$204.86	2025-08-01
5464	OTHER	Level 4 Neurostimulator And Related Procedures	1	1	—	—	$8,120.28	$8,120.28	$8,120.28	2025-08-01
5491	OTHER	Level 1 Intraocular Procedures	6	6	—	—	$1,548.76	$1,548.76	$1,548.76	2025-08-01
5502	OTHER	Level 2 Extraocular, Repair, And Plastic Eye Procedures	1	1	—	—	$470.97	$470.97	$470.97	2025-08-01
5503	OTHER	Level 3 Extraocular, Repair, And Plastic Eye Procedures	0	0	—	—	—	—	—	2025-08-01
5521	OTHER	Level 1 Imaging Without Contrast	0	0	—	—	—	—	—	2025-08-01
5522	OTHER	Level 2 Imaging Without Contrast	33	33	—	—	$487.87	$487.87	$487.87	2025-08-01
5523	OTHER	Level 3 Imaging Without Contrast	24	24	—	—	$1,565.03	$1,565.03	$1,565.03	2025-08-01
5524	OTHER	Level 4 Imaging Without Contrast	0	0	—	—	—	—	—	2025-08-01
5571	OTHER	Level 1 Imaging With Contrast	0	0	—	—	—	—	—	2025-08-01
5572	OTHER	Level 2 Imaging With Contrast	20	20	—	—	$1,616.36	$1,616.36	$1,616.36	2025-08-01
5573	OTHER	Level 3 Imaging With Contrast	12	12	—	—	$2,598.18	$2,598.18	$2,598.18	2025-08-01
5591	OTHER	Level 1 Nuclear Medicine And Related Services	19	19	—	—	$952.29	$952.29	$952.29	2025-08-01
5592	OTHER	Level 2 Nuclear Medicine And Related Services	15	15	—	—	$1,331.60	$1,331.60	$1,331.60	2025-08-01
5593	OTHER	Level 3 Nuclear Medicine And Related Services	0	0	—	—	—	—	—	2025-08-01
56	MS_DRG	Degenerative Nervous System Disorders With Mcc	1	1	—	—	$12,974.52	$12,974.52	$12,974.52	2025-08-01
564	MS_DRG	Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc	1	1	—	—	$4,065.00	$4,065.00	$4,065.00	2025-08-01
5671	OTHER	Level 1 Pathology	9	9	—	—	$86.36	$86.36	$86.36	2025-08-01
5672	OTHER	Level 2 Pathology	0	0	—	—	—	—	—	2025-08-01
5673	OTHER	Level 3 Pathology	0	0	—	—	—	—	—	2025-08-01
5691	OTHER	Level 1 Drug Administration	0	0	—	—	—	—	—	2025-08-01
5692	OTHER	Level 2 Drug Administration	10	10	—	—	$105.98	$105.98	$105.98	2025-08-01
5693	OTHER	Level 3 Drug Administration	0	0	—	—	—	—	—	2025-08-01
5694	OTHER	Level 4 Drug Administration	1	1	—	—	$1,317.06	$1,317.06	$1,317.06	2025-08-01
57	MS_DRG	Degenerative Nervous System Disorders Without Mcc	4	4	—	—	$21,625.00	$21,625.00	$21,625.00	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
5723	OTHER	Level 3 Diagnostic Tests And Related Services	1	1	—	—	$165.68	$165.68	$165.68	2025-08-01
5731	OTHER	Level 1 Minor Procedures	10	10	—	—	$7.75	$7.75	$7.75	2025-08-01
5732	OTHER	Level 2 Minor Procedures	0	0	—	—	—	—	—	2025-08-01
5733	OTHER	Level 3 Minor Procedures	0	0	—	—	—	—	—	2025-08-01
5734	OTHER	Level 4 Minor Procedures	15	15	—	—	$514.12	$514.12	$514.12	2025-08-01
5771	OTHER	Cardiac Rehabilitation	11	11	—	—	$1,195.95	$1,195.95	$1,195.95	2025-08-01
5781	OTHER	Resuscitation And Cardioversion	2	2	—	—	$1,671.41	$1,671.41	$1,671.41	2025-08-01
5791	OTHER	Pulmonary Treatment	1	1	—	—	$72.50	$72.50	$72.50	2025-08-01
5823	OTHER	Level 3 Health And Behavior Services	4	4	—	—	$396.27	$396.27	$396.27	2025-08-01
5871	OTHER	Dental Procedures	11	11	—	—	$4,177.02	$4,177.02	$4,177.02	2025-08-01
600	MS_DRG	Non-malignant Breast Disorders With Cc/Mcc	1	1	—	—	$7,883.89	$7,883.89	$7,883.89	2025-08-01
602	MS_DRG	Cellulitis With Mcc	1	1	—	—	$1,452.50	$1,452.50	$1,452.50	2025-08-01
603	MS_DRG	Cellulitis Without Mcc	5	5	—	—	$9,292.73	$9,292.73	$9,292.73	2025-08-01
637	MS_DRG	Diabetes With Mcc	1	1	—	—	$13,550.00	$13,550.00	$13,550.00	2025-08-01
638	MS_DRG	Diabetes With Cc	1	1	—	—	$6,820.64	$6,820.64	$6,820.64	2025-08-01
639	MS_DRG	Diabetes Without Cc/Mcc	1	1	—	—	$4,290.90	$4,290.90	$4,290.90	2025-08-01
640	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M…	2	2	—	—	$8,420.51	$8,420.51	$8,420.51	2025-08-01
641	MS_DRG	Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou…	4	4	—	—	$5,092.89	$5,092.89	$5,092.89	2025-08-01
65	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours	1	1	—	—	$1,355.00	$1,355.00	$1,355.00	2025-08-01
66	MS_DRG	Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc	4	4	—	—	$5,994.56	$5,994.56	$5,994.56	2025-08-01
668	MS_DRG	Transurethral Procedures With Mcc	1	1	—	—	$1,512.00	$1,512.00	$1,512.00	2025-08-01
675	MS_DRG	Other Kidney And Urinary Tract Procedures Without Cc/Mcc	2	2	—	—	$17,372.39	$17,372.39	$17,372.39	2025-08-01
682	MS_DRG	Renal Failure With Mcc	1	1	—	—	$4,004.00	$4,004.00	$4,004.00	2025-08-01
683	MS_DRG	Renal Failure With Cc	2	2	—	—	$5,176.98	$5,176.98	$5,176.98	2025-08-01
689	MS_DRG	Kidney And Urinary Tract Infections With Mcc	3	3	—	—	$8,221.50	$8,221.50	$8,221.50	2025-08-01
690	MS_DRG	Kidney And Urinary Tract Infections Without Mcc	3	3	—	—	$3,152.88	$3,152.88	$3,152.88	2025-08-01
694	MS_DRG	Urinary Stones Without Mcc	1	1	—	—	$5,052.62	$5,052.62	$5,052.62	2025-08-01
696	MS_DRG	Kidney And Urinary Tract Signs And Symptoms Without Mcc	1	1	—	—	$6,898.55	$6,898.55	$6,898.55	2025-08-01
70	MS_DRG	Other Cerebrovascular Disorders With Mcc	2	2	—	—	$5,918.00	$5,918.00	$5,918.00	2025-08-01
7043	OTHER	Infliximab Not Biosimil 10mg	2	2	—	—	$4,399.41	$4,399.41	$4,399.41	2025-08-01
71	MS_DRG	Other Cerebrovascular Disorders With Cc	2	2	—	—	$9,461.51	$9,461.51	$9,461.51	2025-08-01
74	MS_DRG	Cranial And Peripheral Nerve Disorders Without Mcc	1	1	—	—	$15,010.56	$15,010.56	$15,010.56	2025-08-01
809	MS_DRG	Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co…	1	1	—	—	$8,578.94	$8,578.94	$8,578.94	2025-08-01
862	MS_DRG	Postoperative And Post-traumatic Infections With Mcc	1	1	—	—	$2,704.00	$2,704.00	$2,704.00	2025-08-01
871	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc	8	8	—	—	$4,890.81	$4,890.81	$4,890.81	2025-08-01
872	MS_DRG	Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc	8	8	—	—	$3,716.15	$3,716.15	$3,716.15	2025-08-01
881	MS_DRG	Depressive Neuroses	1	1	—	—	$9,937.11	$9,937.11	$9,937.11	2025-08-01
882	MS_DRG	Neuroses Except Depressive	1	1	—	—	$13,475.00	$13,475.00	$13,475.00	2025-08-01
884	MS_DRG	Organic Disturbances And Intellectual Disability	1	1	—	—	$14,606.43	$14,606.43	$14,606.43	2025-08-01
885	MS_DRG	Psychoses	5	5	—	—	$17,359.47	$17,359.47	$17,359.47	2025-08-01
89	MS_DRG	Concussion With Cc	1	1	—	—	$1,008.00	$1,008.00	$1,008.00	2025-08-01
91	MS_DRG	Other Disorders Of Nervous System With Mcc	1	1	—	—	$15,592.50	$15,592.50	$15,592.50	2025-08-01
9132	OTHER	Prothrombin Complex Kcentra	4	4	—	—	$8,586.07	$8,586.07	$8,586.07	2025-08-01
9133	OTHER	Rabies Ig, Im/sc	0	0	—	—	—	—	—	2025-08-01
9139	OTHER	Rabies Vaccine, IM	0	0	—	—	—	—	—	2025-08-01
9173	OTHER	Injection, Fulphila	1	1	—	—	$1,419.77	$1,419.77	$1,419.77	2025-08-01
9272	OTHER	Inj, Denosumab	6	6	—	—	$752.86	$752.86	$752.86	2025-08-01
9300	OTHER	Omalizumab Injection	6	6	—	—	$2,275.09	$2,275.09	$2,275.09	2025-08-01
9327	OTHER	Inj. Romosozumab-aqqg 1 Mg	0	0	—	—	—	—	—	2025-08-01
9406	OTHER	Inj, Nyvepria	1	1	—	—	$1,083.11	$1,083.11	$1,083.11	2025-08-01
9441	OTHER	Inj Ferric Carboxymaltos 1mg	7	7	—	—	$1,672.56	$1,672.56	$1,672.56	2025-08-01
9466	OTHER	Inj., Benralizumab, 1 Mg	2	2	—	—	$5,258.56	$5,258.56	$5,258.56	2025-08-01
947	MS_DRG	Signs And Symptoms With Mcc	4	4	—	—	$6,481.66	$6,481.66	$6,481.66	2025-08-01
9473	OTHER	Injection, Mepolizumab, 1mg	0	0	—	—	—	—	—	2025-08-01
948	MS_DRG	Signs And Symptoms Without Mcc	4	4	—	—	$7,324.83	$7,324.83	$7,324.83	2025-08-01
9512	OTHER	Rbc Leukocytes Reduced	1	1	—	—	$3,947.15	$3,947.15	$3,947.15	2025-08-01
9521	OTHER	Platelets Leukoreduced Irrad	1	1	—	—	$4,802.45	$4,802.45	$4,802.45	2025-08-01
N800	OTHER	Clinical Diagnostic Lab Services	0	0	—	—	—	—	—	2025-08-01
N801	OTHER	Therapy Services	0	0	—	—	—	—	—	2025-08-01
N804	OTHER	Mammography Services	19	19	—	—	$339.86	$339.86	$339.86	2025-08-01
N809	OTHER	Other Medicine	6	6	—	—	$303.36	$303.36	$303.36	2025-08-01
N811	OTHER	Observation, Other	2	2	—	—	$1,127.00	$1,127.00	$1,127.00	2025-08-01
N900	OTHER	Non-covered Services	20	20	—	—	$517.54	$517.54	$517.54	2025-08-01
N902	OTHER	Packaged Services	2	2	—	—	$145.73	$145.73	$145.73	2025-08-01
N903	OTHER	Influenza Vaccines & Pneumococcal Pneumonia Vaccines	2	2	—	—	$208.29	$208.29	$208.29	2025-08-01
N905	OTHER	Not Recognized By Opps	0	0	—	—	—	—	—	2025-08-01
N907	OTHER	Not Billable To Fi	7	7	—	—	$366.13	$366.13	$366.13	2025-08-01

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