Price Transparencybeta Hospital negotiated rates

Hospital facility prices. What the hospital charges for the facility side of care — the surgeon’s and anesthesiologist’s fees are billed separately and are not included. How we scope prices →

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Hospital

PENN HIGHLANDS ELK

Saint Marys, PA · CCN 391315 · Rates published

231 distinct procedures filed
62 distinct payers
7,386 rate rows
2025-08-01 last MRF observed · ⚠ 12 mo old
Data quality

1,453 of 7,386 rate rows are consumer-grade (19.7%)

5,933 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 — reasonRows
no usable negotiated amount (only an out-of-band fallback) — excluded from medians 5,330
professional (physician) fee — not the facility price 598
below 25% of the Medicare reference for this DRG — likely a mislabeled per-diem; excluded from rankings 5

⚠ Possibly outdated The most recent machine-readable file we have for this hospital is 12 months old.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/download/?id=15372
Found on page https://www.phhealthcare.org/patients-visitors/patient-billing-services
Discovered viaDiscovered by HANK
Last fetch not_modified · 2026-08-14
Content fingerprint 307cbc1ea27362b3… · 5,460,697 bytes · first seen 2026-05-05

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
0944
RC 		Gammagard Liquid Injection 1 $36,845.30 $36,845.30 $36,845.30 nat. median
$194
outlier · 190.1×
264
MS_DRG 		Other Circulatory System O.r. Procedures 1 $22,244.23 $22,244.23 $22,244.23 nat. median
$32,666
0.7× median
9274
OTHER 		Crotalidae Poly Immune Fab 2 $17,186.90 $26,910.42 $22,048.66 nat. median
$1,856
outlier · 11.9×
438
MS_DRG 		Disorders Of Pancreas Except Malignancy With Mcc 1 $16,914.68 $16,914.68 $16,914.68 nat. median
$16,783
1.0× median
623
MS_DRG 		Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 1 $14,984.06 $14,984.06 $14,984.06 nat. median
$18,576
0.8× median
673
MS_DRG 		Other Kidney And Urinary Tract Procedures With Mcc 1 $14,794.71 $14,794.71 $14,794.71 nat. median
$39,775
outlier · 0.4×
629
MS_DRG 		Other Endocrine, Nutritional And Metabolic O.r. Procedures With Cc 1 $14,656.93 $14,656.93 $14,656.93 nat. median
$21,911
0.7× median
5464
OTHER 		Level 4 Neurostimulator And Related Procedures 1 $14,509.26 $14,509.26 $14,509.26 nat. median
$20,895
0.7× median
644
MS_DRG 		Endocrine Disorders With Cc 1 $14,379.72 $14,379.72 $14,379.72 nat. median
$10,989
1.3× median
9002
OTHER 		Tenecteplase Injection 2 $8,833.11 $18,069.32 $13,451.22 nat. median
$187
outlier · 71.9×
560
MS_DRG 		Aftercare, Musculoskeletal System And Connective Tissue With Cc 2 $3,899.60 $22,852.66 $13,376.13 nat. median
$12,112
1.1× median
571
MS_DRG 		Skin Debridement With Cc 2 $10,588.62 $15,156.00 $12,872.31 nat. median
$17,113
0.8× median
57
MS_DRG 		Degenerative Nervous System Disorders Without Mcc 1 $12,840.09 $12,840.09 $12,840.09 nat. median
$13,109
1.0× median
5115
OTHER 		Level 5 Musculoskeletal Procedures 9 $2,805.73 $39,095.28 $12,418.49 nat. median
$13,671
0.9× median
394
MS_DRG 		Other Digestive System Diagnoses With Cc 1 $12,218.99 $12,218.99 $12,218.99 nat. median
$10,183
1.2× median
674
MS_DRG 		Other Kidney And Urinary Tract Procedures With Cc 1 $12,051.36 $12,051.36 $12,051.36 nat. median
$23,243
0.5× median
950
MS_DRG 		Aftercare Without Cc/Mcc 2 $8,310.06 $15,281.26 $11,795.66 nat. median
$7,484
1.6× median
917
MS_DRG 		Poisoning And Toxic Effects Of Drugs With Mcc 1 $11,765.25 $11,765.25 $11,765.25 nat. median
$15,188
0.8× median
95
MS_DRG 		Bacterial And Tuberculous Infections Of Nervous System With Cc 1 $11,635.00 $11,635.00 $11,635.00 nat. median
$24,774
outlier · 0.5×
9013
OTHER 		Inj Risankizumab-rzaa?1 Mg 3 $8,994.00 $19,671.95 $11,466.94 nat. median
$15
outlier · 748.0×
9126
OTHER 		Natalizumab Injection 3 $7,221.00 $13,250.23 $11,108.51 nat. median
$25
outlier · 444.3×
5463
OTHER 		Level 3 Neurostimulator And Related Procedures 1 $11,104.60 $11,104.60 $11,104.60 nat. median
$12,368
0.9× median
694
MS_DRG 		Urinary Stones Without Mcc 1 $11,000.00 $11,000.00 $11,000.00 nat. median
$8,610
1.3× median
617
MS_DRG 		Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 4 $10,307.76 $13,392.96 $10,950.52 nat. median
$19,257
0.6× median
809
MS_DRG 		Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 1 $10,886.23 $10,886.23 $10,886.23 nat. median
$13,098
0.8× median
390
MS_DRG 		Gastrointestinal Obstruction Without Cc/Mcc 1 $10,553.01 $10,553.01 $10,553.01 nat. median
$6,522
1.6× median
501
MS_DRG 		Soft Tissue Procedures With Cc 1 $10,402.91 $10,402.91 $10,402.91 nat. median
$17,709
0.6× median
728
MS_DRG 		Inflammation Of The Male Reproductive System Without Mcc 1 $10,104.00 $10,104.00 $10,104.00 nat. median
$8,946
1.1× median
562
MS_DRG 		Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 1 $10,104.00 $10,104.00 $10,104.00 nat. median
$14,618
0.7× median
348
MS_DRG 		Anal And Stomal Procedures With Cc 1 $10,083.90 $10,083.90 $10,083.90 nat. median
$13,479
0.7× median
920
MS_DRG 		Complications Of Treatment With Cc 1 $10,058.90 $10,058.90 $10,058.90 nat. median
$10,854
0.9× median
553
MS_DRG 		Bone Diseases And Arthropathies With Mcc 1 $10,005.10 $10,005.10 $10,005.10 nat. median
$13,440
0.7× median
56
MS_DRG 		Degenerative Nervous System Disorders With Mcc 1 $9,845.49 $9,845.49 $9,845.49 nat. median
$21,951
outlier · 0.4×
947
MS_DRG 		Signs And Symptoms With Mcc 5 $4,398.00 $14,170.00 $9,695.07 nat. median
$12,594
0.8× median
59
MS_DRG 		Multiple Sclerosis And Cerebellar Ataxia With Cc 1 $9,583.90 $9,583.90 $9,583.90 nat. median
$12,890
0.7× median
742
MS_DRG 		Uterine And Adnexa Procedures For Non-malignancy With Cc/Mcc 1 $9,549.29 $9,549.29 $9,549.29 nat. median
$18,578
0.5× median
64
MS_DRG 		Intracranial Hemorrhage Or Cerebral Infarction With Mcc 4 $1,601.90 $17,175.50 $9,534.62 nat. median
$20,032
outlier · 0.5×
867
MS_DRG 		Other Infectious And Parasitic Diseases Diagnoses With Mcc 1 $9,101.50 $9,101.50 $9,101.50 nat. median
$21,017
outlier · 0.4×
391
MS_DRG 		Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 2 $4,458.00 $13,741.68 $9,099.84 nat. median
$13,072
0.7× median
304
MS_DRG 		Hypertension With Mcc 1 $8,922.92 $8,922.92 $8,922.92 nat. median
$12,433
0.7× median
354
MS_DRG 		Hernia Procedures Except Inguinal And Femoral With Cc 1 $8,880.97 $8,880.97 $8,880.97 nat. median
$17,345
0.5× median
399
MS_DRG 		Appendix Procedures Without Cc/Mcc 1 $8,768.15 $8,768.15 $8,768.15 nat. median
$12,315
0.7× median
643
MS_DRG 		Endocrine Disorders With Mcc 1 $8,732.76 $8,732.76 $8,732.76 nat. median
$16,558
0.5× median
190
MS_DRG 		Chronic Obstructive Pulmonary Disease With Mcc 9 $4,161.77 $16,171.20 $8,718.58 nat. median
$11,661
0.7× median
92
MS_DRG 		Other Disorders Of Nervous System With Cc 1 $8,420.00 $8,420.00 $8,420.00 nat. median
$11,231
0.7× median
616
MS_DRG 		Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 2 $4,904.45 $11,844.33 $8,374.39 nat. median
$35,240
outlier · 0.2×
948
MS_DRG 		Signs And Symptoms Without Mcc 5 $5,484.88 $12,465.09 $8,336.96 nat. median
$8,463
1.0× median
9186
OTHER 		Inj., Rituximab, 10 Mg 5 $7,123.28 $14,200.21 $8,273.96 nat. median
$78
outlier · 105.4×
176
MS_DRG 		Pulmonary Embolism Without Mcc 1 $8,226.87 $8,226.87 $8,226.87 nat. median
$9,073
0.9× median
556
MS_DRG 		Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 1 $8,008.51 $8,008.51 $8,008.51 nat. median
$9,097
0.9× median

Other procedures at this hospital

Browse this hospital's 231 published procedures. Use the slice to choose what to show, then sort or filter any column.

Slice
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
             
0763 OTHER Inj, Bupivacaine Liposome 1 1 — — $2,014.17 $2,014.17 $2,014.17 2025-08-01
0764 OTHER Ketorolac Tromethamine Inj 2 2 — — $50.00 $413.96 $231.98 2025-08-01
0790 RC Inj, Methylpred Acetate 1 Mg 6 6 — — $9.60 $1,418.83 $220.00 2025-08-01
0944 RC Gammagard Liquid Injection 1 1 — — $36,845.30 $36,845.30 $36,845.30 2025-08-01
1214 OTHER Inj Ivig Privigen 500 Mg 2 2 — — $1,921.09 $2,165.89 $2,043.49 2025-08-01
1489 OTHER Inj Vedolizumab IV 1 Mg 5 5 — — $43.23 $10,907.90 $5,702.51 2025-08-01
1670 OTHER Tetanus Immune Globulin Inj 1 1 — — $3,525.42 $3,525.42 $3,525.42 2025-08-01
175 MS_DRG Pulmonary Embolism With Mcc Or Acute Cor Pulmonale 1 1 — — $1,632.00 $1,632.00 $1,632.00 2025-08-01
176 MS_DRG Pulmonary Embolism Without Mcc 1 1 — — $8,226.87 $8,226.87 $8,226.87 2025-08-01
177 MS_DRG Respiratory Infections And Inflammations With Mcc 3 3 — — $1,632.00 $6,013.31 $3,368.00 2025-08-01
1822 OTHER Injection, Zarxio 1 1 — — $379.88 $379.88 $379.88 2025-08-01
1829 OTHER Penicillin G Benzathine Inj 1 1 — — $955.55 $955.55 $955.55 2025-08-01
189 MS_DRG Pulmonary Edema And Respiratory Failure 5 5 — — $1,632.00 $8,165.56 $6,640.13 2025-08-01
190 MS_DRG Chronic Obstructive Pulmonary Disease With Mcc 9 9 — — $4,161.77 $16,171.20 $8,718.58 2025-08-01
191 MS_DRG Chronic Obstructive Pulmonary Disease With Cc 3 3 — — $4,716.34 $6,900.48 $5,167.64 2025-08-01
192 MS_DRG Chronic Obstructive Pulmonary Disease Without Cc/Mcc 4 4 — — $4,419.43 $6,896.00 $5,048.94 2025-08-01
193 MS_DRG Simple Pneumonia And Pleurisy With Mcc 7 7 — — $1,608.74 $9,199.82 $6,650.62 2025-08-01
194 MS_DRG Simple Pneumonia And Pleurisy With Cc 6 6 — — $1,014.20 $8,365.75 $4,737.11 2025-08-01
195 MS_DRG Simple Pneumonia And Pleurisy Without Cc/Mcc 2 2 — — $1,567.00 $3,161.30 $2,364.15 2025-08-01
202 MS_DRG Bronchitis And Asthma With Cc/Mcc 3 3 — — $2,277.72 $6,736.00 $3,441.52 2025-08-01
204 MS_DRG Respiratory Signs And Symptoms 1 1 — — $7,611.86 $7,611.86 $7,611.86 2025-08-01
264 MS_DRG Other Circulatory System O.r. Procedures 1 1 — — $22,244.23 $22,244.23 $22,244.23 2025-08-01
280 MS_DRG Acute Myocardial Infarction, Discharged Alive With Mcc 1 1 — — $1,684.00 $1,684.00 $1,684.00 2025-08-01
282 MS_DRG Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc 1 1 — — $5,156.78 $5,156.78 $5,156.78 2025-08-01
283 MS_DRG Acute Myocardial Infarction, Expired With Mcc 1 1 — — $1,944.00 $1,944.00 $1,944.00 2025-08-01
291 MS_DRG Heart Failure And Shock With Mcc 7 7 — — $1,200.00 $27,136.57 $3,215.15 2025-08-01
292 MS_DRG Heart Failure And Shock With Cc 1 1 — — $6,682.50 $6,682.50 $6,682.50 2025-08-01
299 MS_DRG Peripheral Vascular Disorders With Mcc 1 1 — — $1,829.63 $1,829.63 $1,829.63 2025-08-01
304 MS_DRG Hypertension With Mcc 1 1 — — $8,922.92 $8,922.92 $8,922.92 2025-08-01
305 MS_DRG Hypertension Without Mcc 1 1 — — $5,581.82 $5,581.82 $5,581.82 2025-08-01
308 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Mcc 1 1 — — $3,161.30 $3,161.30 $3,161.30 2025-08-01
309 MS_DRG Cardiac Arrhythmia And Conduction Disorders With Cc 3 3 — — $1,750.72 $10,645.92 $3,154.00 2025-08-01
312 MS_DRG Syncope And Collapse 3 3 — — $5,158.78 $7,195.57 $6,896.00 2025-08-01
316 MS_DRG Other Circulatory System Diagnoses Without Cc/Mcc 1 1 — — $3,146.30 $3,146.30 $3,146.30 2025-08-01
331 MS_DRG Major Small And Large Bowel Procedures Without Cc/Mcc 1 1 — — $6,736.00 $6,736.00 $6,736.00 2025-08-01
348 MS_DRG Anal And Stomal Procedures With Cc 1 1 — — $10,083.90 $10,083.90 $10,083.90 2025-08-01
354 MS_DRG Hernia Procedures Except Inguinal And Femoral With Cc 1 1 — — $8,880.97 $8,880.97 $8,880.97 2025-08-01
372 MS_DRG Major Gastrointestinal Disorders And Peritoneal Infections With Cc 3 3 — — $1,724.00 $5,221.76 $3,441.82 2025-08-01
378 MS_DRG Gastrointestinal Hemorrhage With Cc 1 1 — — $3,146.30 $3,146.30 $3,146.30 2025-08-01
389 MS_DRG Gastrointestinal Obstruction With Cc 4 4 — — $1,712.36 $6,911.64 $5,207.68 2025-08-01
390 MS_DRG Gastrointestinal Obstruction Without Cc/Mcc 1 1 — — $10,553.01 $10,553.01 $10,553.01 2025-08-01
391 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc 2 2 — — $4,458.00 $13,741.68 $9,099.84 2025-08-01
392 MS_DRG Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc 2 2 — — $1,200.00 $8,365.75 $4,782.88 2025-08-01
393 MS_DRG Other Digestive System Diagnoses With Mcc 2 2 — — $4,163.00 $4,731.00 $4,447.00 2025-08-01
394 MS_DRG Other Digestive System Diagnoses With Cc 1 1 — — $12,218.99 $12,218.99 $12,218.99 2025-08-01
399 MS_DRG Appendix Procedures Without Cc/Mcc 1 1 — — $8,768.15 $8,768.15 $8,768.15 2025-08-01
418 MS_DRG Laparoscopic Cholecystectomy Without C.d.e. With Cc 2 2 — — $1,577.00 $2,453.00 $2,015.00 2025-08-01
438 MS_DRG Disorders Of Pancreas Except Malignancy With Mcc 1 1 — — $16,914.68 $16,914.68 $16,914.68 2025-08-01
439 MS_DRG Disorders Of Pancreas Except Malignancy With Cc 5 5 — — $1,684.00 $6,736.00 $5,101.76 2025-08-01
440 MS_DRG Disorders Of Pancreas Except Malignancy Without Cc/Mcc 1 1 — — $4,092.36 $4,092.36 $4,092.36 2025-08-01
442 MS_DRG Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc 1 1 — — $5,174.80 $5,174.80 $5,174.80 2025-08-01
501 MS_DRG Soft Tissue Procedures With Cc 1 1 — — $10,402.91 $10,402.91 $10,402.91 2025-08-01
5012 OTHER Clinic Visits And Related Services 13 13 — — $86.31 $978.00 $104.01 2025-08-01
5021 OTHER Level 1 Type A Ed Visits 4 4 — — $184.21 $513.23 $271.13 2025-08-01
5022 OTHER Level 2 Type A Ed Visits 23 23 — — $38.50 $1,213.86 $148.60 2025-08-01
5023 OTHER Level 3 Type A Ed Visits 31 31 — — $71.44 $976.56 $404.99 2025-08-01
5024 OTHER Level 4 Type A Ed Visits 28 28 — — $167.42 $4,683.56 $1,038.55 2025-08-01
5025 OTHER Level 5 Type A Ed Visits 29 29 — — $197.17 $7,608.30 $1,527.58 2025-08-01
5041 OTHER Critical Care 14 14 — — $479.26 $24,744.67 $2,914.32 2025-08-01
5051 OTHER Level 1 Skin Procedures 15 15 — — $34.69 $1,073.50 $149.09 2025-08-01
5052 OTHER Level 2 Skin Procedures 9 9 — — $423.78 $1,479.01 $595.72 2025-08-01
5053 OTHER Level 3 Skin Procedures 5 5 — — $233.20 $3,957.15 $970.18 2025-08-01
5054 OTHER Level 4 Skin Procedures 5 5 — — $240.62 $7,552.85 $1,237.61 2025-08-01
5071 OTHER Level 1 Excision/ Biopsy/ Incision And Drainage 12 12 — — $39.70 $6,653.05 $982.48 2025-08-01
5072 OTHER Level 2 Excision/ Biopsy/ Incision And Drainage 17 17 — — $175.68 $4,227.33 $1,651.91 2025-08-01
5073 OTHER Level 3 Excision/ Biopsy/ Incision And Drainage 7 7 — — $880.73 $4,946.66 $1,350.00 2025-08-01
5091 OTHER Level 1 Breast/Lymphatic Surgery And Related Procedures 4 4 — — $1,206.46 $9,683.80 $2,506.25 2025-08-01
5101 OTHER Level 1 Strapping And Cast Application 7 7 — — $162.96 $407.41 $283.80 2025-08-01
5111 OTHER Level 1 Musculoskeletal Procedures 2 2 — — $694.72 $3,442.78 $2,068.75 2025-08-01
5112 OTHER Level 2 Musculoskeletal Procedures 9 9 — — $707.30 $5,399.99 $1,452.47 2025-08-01
5113 OTHER Level 3 Musculoskeletal Procedures 11 11 — — $853.60 $8,739.67 $2,800.12 2025-08-01
5114 OTHER Level 4 Musculoskeletal Procedures 11 11 — — $853.60 $12,014.57 $4,625.12 2025-08-01
5115 OTHER Level 5 Musculoskeletal Procedures 9 9 — — $2,805.73 $39,095.28 $12,418.49 2025-08-01
5164 OTHER Level 4 ENT Procedures 1 1 — — $3,861.32 $3,861.32 $3,861.32 2025-08-01
5182 OTHER Level 2 Vascular Procedures 3 3 — — $840.10 $2,559.86 $1,221.00 2025-08-01
5183 OTHER Level 3 Vascular Procedures 13 13 — — $582.43 $41,637.12 $3,259.04 2025-08-01
5184 OTHER Level 4 Vascular Procedures 7 7 — — $1,524.29 $6,900.40 $1,900.74 2025-08-01
5241 OTHER Level 1 Blood Product Exchange And Related Services 12 12 — — $174.99 $3,234.28 $817.59 2025-08-01
5301 OTHER Level 1 Upper Gi Procedures 16 16 — — $114.18 $5,803.14 $1,369.61 2025-08-01
5302 OTHER Level 2 Upper Gi Procedures 7 7 — — $853.60 $8,890.29 $2,221.31 2025-08-01
5311 OTHER Level 1 Lower Gi Procedures 14 14 — — $198.55 $4,952.81 $1,769.19 2025-08-01
5312 OTHER Level 2 Lower Gi Procedures 22 22 — — $271.42 $2,934.55 $1,387.51 2025-08-01
5313 OTHER Level 3 Lower Gi Procedures 12 12 — — $853.60 $5,211.91 $2,588.22 2025-08-01
5341 OTHER Level 1 Abdominal/Peritoneal/Biliary And Related Procedures 10 10 — — $886.60 $7,855.43 $3,876.25 2025-08-01
5342 OTHER Level 2 Abdominal/Peritoneal/Biliary And Related Procedures 6 6 — — $1,846.50 $8,659.39 $4,441.09 2025-08-01
536 MS_DRG Fractures Of Hip And Pelvis Without Mcc 1 1 — — $2,448.07 $2,448.07 $2,448.07 2025-08-01
5361 OTHER Level 1 Laparoscopy And Related Services 16 16 — — $771.94 $8,633.37 $2,931.83 2025-08-01
5362 OTHER Level 2 Laparoscopy And Related Services 9 9 — — $853.60 $7,281.40 $5,030.00 2025-08-01
5373 OTHER Level 3 Urology And Related Services 1 1 — — $1,009.13 $1,009.13 $1,009.13 2025-08-01
5374 OTHER Level 4 Urology And Related Services 3 3 — — $866.90 $9,679.77 $3,297.68 2025-08-01
5375 OTHER Level 5 Urology And Related Services 2 2 — — $835.70 $2,009.98 $1,422.84 2025-08-01
5411 OTHER Level 1 Gynecologic Procedures 1 1 — — $266.49 $266.49 $266.49 2025-08-01
5414 OTHER Level 4 Gynecologic Procedures 12 12 — — $481.80 $4,012.27 $1,692.55 2025-08-01
5415 OTHER Level 5 Gynecologic Procedures 7 7 — — $853.60 $15,718.59 $2,830.98 2025-08-01
5431 OTHER Level 1 Nerve Procedures 13 13 — — $216.50 $4,194.35 $1,587.54 2025-08-01
5441 OTHER Level 1 Nerve Injections 10 10 — — $104.11 $654.41 $257.25 2025-08-01
5442 OTHER Level 2 Nerve Injections 17 17 — — $110.00 $1,604.72 $639.88 2025-08-01
5443 OTHER Level 3 Nerve Injections 15 15 — — $4.07 $2,265.24 $1,027.54 2025-08-01
5462 OTHER Level 2 Neurostimulator And Related Procedures 8 8 — — $305.86 $13,561.98 $3,357.18 2025-08-01
5463 OTHER Level 3 Neurostimulator And Related Procedures 1 1 — — $11,104.60 $11,104.60 $11,104.60 2025-08-01
5464 OTHER Level 4 Neurostimulator And Related Procedures 1 1 — — $14,509.26 $14,509.26 $14,509.26 2025-08-01
5481 OTHER Laser Eye Procedures 2 2 — — $198.55 $198.55 $198.55 2025-08-01
5491 OTHER Level 1 Intraocular Procedures 17 17 — — $1,156.62 $4,587.47 $1,819.40 2025-08-01
5503 OTHER Level 3 Extraocular, Repair, And Plastic Eye Procedures 1 1 — — $1,129.49 $1,129.49 $1,129.49 2025-08-01
552 MS_DRG Medical Back Problems Without Mcc 3 3 — — $1,632.00 $4,769.94 $3,448.00 2025-08-01
5521 OTHER Level 1 Imaging Without Contrast 31 31 — — $16.34 $2,083.10 $128.61 2025-08-01
5522 OTHER Level 2 Imaging Without Contrast 32 32 — — $1.00 $663.58 $233.72 2025-08-01
5523 OTHER Level 3 Imaging Without Contrast 26 26 — — $131.27 $1,023.00 $510.97 2025-08-01
5524 OTHER Level 4 Imaging Without Contrast 22 22 — — $107.95 $2,363.52 $728.89 2025-08-01
553 MS_DRG Bone Diseases And Arthropathies With Mcc 1 1 — — $10,005.10 $10,005.10 $10,005.10 2025-08-01
556 MS_DRG Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc 1 1 — — $8,008.51 $8,008.51 $8,008.51 2025-08-01
5571 OTHER Level 1 Imaging With Contrast 24 24 — — $24.75 $1,193.89 $489.12 2025-08-01
5572 OTHER Level 2 Imaging With Contrast 25 25 — — $295.90 $2,000.35 $825.30 2025-08-01
5573 OTHER Level 3 Imaging With Contrast 16 16 — — $228.33 $3,677.59 $1,013.10 2025-08-01
558 MS_DRG Tendonitis, Myositis And Bursitis Without Mcc 1 1 — — $6,867.84 $6,867.84 $6,867.84 2025-08-01
559 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Mcc 1 1 — — $5,923.59 $5,923.59 $5,923.59 2025-08-01
5591 OTHER Level 1 Nuclear Medicine And Related Services 18 18 — — $108.90 $1,318.98 $538.95 2025-08-01
5592 OTHER Level 2 Nuclear Medicine And Related Services 17 17 — — $327.60 $2,773.84 $1,001.55 2025-08-01
5593 OTHER Level 3 Nuclear Medicine And Related Services 19 19 — — $357.32 $2,989.16 $1,589.27 2025-08-01
5594 OTHER Level 4 Nuclear Medicine And Related Services 14 14 — — $1,327.98 $6,856.63 $2,263.35 2025-08-01
56 MS_DRG Degenerative Nervous System Disorders With Mcc 1 1 — — $9,845.49 $9,845.49 $9,845.49 2025-08-01
560 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue With Cc 2 2 — — $3,899.60 $22,852.66 $13,376.13 2025-08-01
561 MS_DRG Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc 2 2 — — $5,909.57 $7,712.35 $6,810.96 2025-08-01
562 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 1 1 — — $10,104.00 $10,104.00 $10,104.00 2025-08-01
563 MS_DRG Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Wit… 2 2 — — $3,261.00 $7,726.01 $5,493.51 2025-08-01
566 MS_DRG Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc 1 1 — — $7,255.10 $7,255.10 $7,255.10 2025-08-01
5671 OTHER Level 1 Pathology 17 17 — — $9.90 $772.34 $70.82 2025-08-01
5672 OTHER Level 2 Pathology 6 6 — — $84.18 $1,600.63 $277.84 2025-08-01
5673 OTHER Level 3 Pathology 11 11 — — $60.94 $3,996.80 $1,520.92 2025-08-01
5691 OTHER Level 1 Drug Administration 17 17 — — $144.60 $6,405.52 $2,278.18 2025-08-01
5692 OTHER Level 2 Drug Administration 7 7 — — $6.24 $130.28 $47.52 2025-08-01
5693 OTHER Level 3 Drug Administration 15 15 — — $43.23 $1,616.10 $426.94 2025-08-01
5694 OTHER Level 4 Drug Administration 4 4 — — $680.94 $2,313.85 $810.39 2025-08-01
57 MS_DRG Degenerative Nervous System Disorders Without Mcc 1 1 — — $12,840.09 $12,840.09 $12,840.09 2025-08-01
571 MS_DRG Skin Debridement With Cc 2 2 — — $10,588.62 $15,156.00 $12,872.31 2025-08-01
5721 OTHER Level 1 Diagnostic Tests And Related Services 19 19 — — $58.82 $485.94 $222.70 2025-08-01
5722 OTHER Level 2 Diagnostic Tests And Related Services 24 24 — — $51.15 $1,146.87 $313.63 2025-08-01
5724 OTHER Level 4 Diagnostic Tests And Related Services 15 15 — — $432.90 $2,310.56 $633.12 2025-08-01
5731 OTHER Level 1 Minor Procedures 1 1 — — $6.05 $6.05 $6.05 2025-08-01
5732 OTHER Level 2 Minor Procedures 10 10 — — $23.86 $587.31 $110.88 2025-08-01
5733 OTHER Level 3 Minor Procedures 24 24 — — $11.51 $358.60 $91.83 2025-08-01
5734 OTHER Level 4 Minor Procedures 22 22 — — $63.82 $513.94 $210.42 2025-08-01
5771 OTHER Cardiac Rehabilitation 8 8 — — $284.76 $2,007.54 $892.70 2025-08-01
5781 OTHER Resuscitation And Cardioversion 3 3 — — $1,229.37 $6,272.50 $2,506.13 2025-08-01
579 MS_DRG Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc 1 1 — — $6,159.81 $6,159.81 $6,159.81 2025-08-01
5823 OTHER Level 3 Health And Behavior Services 6 6 — — $84.88 $200.00 $94.50 2025-08-01
59 MS_DRG Multiple Sclerosis And Cerebellar Ataxia With Cc 1 1 — — $9,583.90 $9,583.90 $9,583.90 2025-08-01
594 MS_DRG Skin Ulcers Without Cc/Mcc 1 1 — — $5,540.04 $5,540.04 $5,540.04 2025-08-01
602 MS_DRG Cellulitis With Mcc 1 1 — — $4,721.88 $4,721.88 $4,721.88 2025-08-01
603 MS_DRG Cellulitis Without Mcc 3 3 — — $4,734.02 $12,021.22 $5,160.31 2025-08-01
616 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 2 2 — — $4,904.45 $11,844.33 $8,374.39 2025-08-01
617 MS_DRG Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With… 4 4 — — $10,307.76 $13,392.96 $10,950.52 2025-08-01
623 MS_DRG Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disor… 1 1 — — $14,984.06 $14,984.06 $14,984.06 2025-08-01
629 MS_DRG Other Endocrine, Nutritional And Metabolic O.r. Procedures With Cc 1 1 — — $14,656.93 $14,656.93 $14,656.93 2025-08-01
637 MS_DRG Diabetes With Mcc 2 2 — — $1,573.15 $11,385.43 $6,479.29 2025-08-01
638 MS_DRG Diabetes With Cc 6 6 — — $1,632.00 $12,462.71 $6,026.15 2025-08-01
639 MS_DRG Diabetes Without Cc/Mcc 1 1 — — $3,457.46 $3,457.46 $3,457.46 2025-08-01
64 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Mcc 4 4 — — $1,601.90 $17,175.50 $9,534.62 2025-08-01
640 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With M… 1 1 — — $3,467.44 $3,467.44 $3,467.44 2025-08-01
641 MS_DRG Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Withou… 7 7 — — $1,684.00 $22,160.16 $5,942.00 2025-08-01
643 MS_DRG Endocrine Disorders With Mcc 1 1 — — $8,732.76 $8,732.76 $8,732.76 2025-08-01
644 MS_DRG Endocrine Disorders With Cc 1 1 — — $14,379.72 $14,379.72 $14,379.72 2025-08-01
65 MS_DRG Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours 2 2 — — $4,731.00 $6,207.36 $5,469.18 2025-08-01
673 MS_DRG Other Kidney And Urinary Tract Procedures With Mcc 1 1 — — $14,794.71 $14,794.71 $14,794.71 2025-08-01
674 MS_DRG Other Kidney And Urinary Tract Procedures With Cc 1 1 — — $12,051.36 $12,051.36 $12,051.36 2025-08-01
68 MS_DRG Precerebral Occlusion Without Infarction Without Mcc 1 1 — — $5,775.43 $5,775.43 $5,775.43 2025-08-01
682 MS_DRG Renal Failure With Mcc 4 4 — — $6,874.79 $8,167.64 $7,771.94 2025-08-01
683 MS_DRG Renal Failure With Cc 5 5 — — $1,460.48 $10,917.98 $3,368.00 2025-08-01
689 MS_DRG Kidney And Urinary Tract Infections With Mcc 3 3 — — $1,716.96 $5,816.85 $1,780.00 2025-08-01
690 MS_DRG Kidney And Urinary Tract Infections Without Mcc 6 6 — — $1,936.50 $6,943.30 $5,536.76 2025-08-01
694 MS_DRG Urinary Stones Without Mcc 1 1 — — $11,000.00 $11,000.00 $11,000.00 2025-08-01
70 MS_DRG Other Cerebrovascular Disorders With Mcc 1 1 — — $1,858.47 $1,858.47 $1,858.47 2025-08-01
7043 OTHER Infliximab Not Biosimil 10mg 3 3 — — $2,569.66 $5,890.68 $2,954.48 2025-08-01
728 MS_DRG Inflammation Of The Male Reproductive System Without Mcc 1 1 — — $10,104.00 $10,104.00 $10,104.00 2025-08-01
74 MS_DRG Cranial And Peripheral Nerve Disorders Without Mcc 1 1 — — $7,054.34 $7,054.34 $7,054.34 2025-08-01
742 MS_DRG Uterine And Adnexa Procedures For Non-malignancy With Cc/Mcc 1 1 — — $9,549.29 $9,549.29 $9,549.29 2025-08-01
755 MS_DRG Malignancy, Female Reproductive System With Cc 1 1 — — $1,722.96 $1,722.96 $1,722.96 2025-08-01
788 MS_DRG Cesarean Section Without Sterilization Without Cc/Mcc 1 1 — — $1,068.50 $1,068.50 $1,068.50 2025-08-01
809 MS_DRG Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Co… 1 1 — — $10,886.23 $10,886.23 $10,886.23 2025-08-01
811 MS_DRG Red Blood Cell Disorders With Mcc 2 2 — — $3,186.30 $6,867.84 $5,027.07 2025-08-01
853 MS_DRG Infectious And Parasitic Diseases With O.r. Procedures With Mcc 1 1 — — $6,874.84 $6,874.84 $6,874.84 2025-08-01
864 MS_DRG Fever And Inflammatory Conditions 1 1 — — $3,154.00 $3,154.00 $3,154.00 2025-08-01
865 MS_DRG Viral Illness With Mcc 1 1 — — $6,308.00 $6,308.00 $6,308.00 2025-08-01
867 MS_DRG Other Infectious And Parasitic Diseases Diagnoses With Mcc 1 1 — — $9,101.50 $9,101.50 $9,101.50 2025-08-01
868 MS_DRG Other Infectious And Parasitic Diseases Diagnoses With Cc 1 1 — — $7,167.36 $7,167.36 $7,167.36 2025-08-01
871 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc 8 8 — — $3,039.93 $16,936.00 $6,054.91 2025-08-01
872 MS_DRG Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc 6 6 — — $4,171.98 $7,330.27 $5,900.23 2025-08-01
884 MS_DRG Organic Disturbances And Intellectual Disability 1 1 — — $3,050.67 $3,050.67 $3,050.67 2025-08-01
9002 OTHER Tenecteplase Injection 2 2 — — $8,833.11 $18,069.32 $13,451.22 2025-08-01
9008 OTHER Inj Tezepelumab-ekko, 1mg 4 4 — — $2,663.28 $10,899.00 $4,869.09 2025-08-01
9013 OTHER Inj Risankizumab-rzaa?1 Mg 3 3 — — $8,994.00 $19,671.95 $11,466.94 2025-08-01
9126 OTHER Natalizumab Injection 3 3 — — $7,221.00 $13,250.23 $11,108.51 2025-08-01
9132 OTHER Prothrombin Complex Kcentra 5 5 — — $6,175.13 $10,277.89 $7,242.10 2025-08-01
9133 OTHER Rabies Ig, Im/sc 5 5 — — $133.87 $13,113.90 $2,111.45 2025-08-01
9139 OTHER Rabies Vaccine, IM 7 7 — — $11.00 $8,934.76 $563.77 2025-08-01
917 MS_DRG Poisoning And Toxic Effects Of Drugs With Mcc 1 1 — — $11,765.25 $11,765.25 $11,765.25 2025-08-01
9186 OTHER Inj., Rituximab, 10 Mg 5 5 — — $7,123.28 $14,200.21 $8,273.96 2025-08-01
92 MS_DRG Other Disorders Of Nervous System With Cc 1 1 — — $8,420.00 $8,420.00 $8,420.00 2025-08-01
920 MS_DRG Complications Of Treatment With Cc 1 1 — — $10,058.90 $10,058.90 $10,058.90 2025-08-01
9200 OTHER Inj, Remdesivir, 1 Mg 2 2 — — $3,118.65 $3,237.44 $3,178.05 2025-08-01
9274 OTHER Crotalidae Poly Immune Fab 2 2 — — $17,186.90 $26,910.42 $22,048.66 2025-08-01
9291 OTHER Inj, Clindamycin Phosp 300mg 1 1 — — $50.35 $50.35 $50.35 2025-08-01
9300 OTHER Omalizumab Injection 7 7 — — $926.75 $2,549.20 $1,703.04 2025-08-01
9327 OTHER Inj. Romosozumab-aqqg 1 Mg 6 6 — — $13.97 $3,824.09 $1,628.65 2025-08-01
9357 OTHER Inj. Eptinezumab-jjmr 1 Mg 4 4 — — $1,153.26 $1,456.92 $1,263.35 2025-08-01
9367 OTHER Inj Ruxience, 10 Mg 1 1 — — $6,070.38 $6,070.38 $6,070.38 2025-08-01
9369 OTHER Inj, Metronidazole, 10 Mg 1 1 — — $546.16 $546.16 $546.16 2025-08-01
9381 OTHER Inj. Avsola, 10 Mg 1 1 — — $4,136.55 $4,136.55 $4,136.55 2025-08-01
9434 OTHER Inj Anifrolumab-fnia 1mg 1 1 — — $4,170.08 $4,170.08 $4,170.08 2025-08-01
9441 OTHER Inj Ferric Carboxymaltos 1mg 10 10 — — $43.23 $2,963.70 $1,153.40 2025-08-01
9466 OTHER Inj., Benralizumab, 1 Mg 1 1 — — $50.45 $50.45 $50.45 2025-08-01
947 MS_DRG Signs And Symptoms With Mcc 5 5 — — $4,398.00 $14,170.00 $9,695.07 2025-08-01
9473 OTHER Injection, Mepolizumab, 1mg 4 4 — — $2,056.09 $6,094.16 $2,369.41 2025-08-01
948 MS_DRG Signs And Symptoms Without Mcc 5 5 — — $5,484.88 $12,465.09 $8,336.96 2025-08-01
9494 OTHER Injection, Ocrelizumab 4 4 — — $213.81 $25,275.72 $1,870.08 2025-08-01
95 MS_DRG Bacterial And Tuberculous Infections Of Nervous System With Cc 1 1 — — $11,635.00 $11,635.00 $11,635.00 2025-08-01
950 MS_DRG Aftercare Without Cc/Mcc 2 2 — — $8,310.06 $15,281.26 $11,795.66 2025-08-01
951 MS_DRG Other Factors Influencing Health Status 5 5 — — $1,334.77 $3,659.27 $2,333.00 2025-08-01
9512 OTHER Rbc Leukocytes Reduced 2 2 — — $477.49 $7,177.32 $3,827.40 2025-08-01
9517 OTHER Red Blood Cells Unit 1 1 — — $51.42 $51.42 $51.42 2025-08-01
9536 OTHER Platelets Pheresis Path Redu 1 1 — — $3,847.59 $3,847.59 $3,847.59 2025-08-01
987 MS_DRG Non-extensive O.r. Procedures Unrelated To Principal Diagnosis With Mcc 1 1 — — $6,834.56 $6,834.56 $6,834.56 2025-08-01
N800 OTHER Clinical Diagnostic Lab Services 43 43 — — $5.72 $344.81 $81.41 2025-08-01
N801 OTHER Therapy Services 29 29 — — $91.97 $1,172.62 $287.40 2025-08-01
N804 OTHER Mammography Services 26 26 — — $104.58 $524.07 $134.27 2025-08-01
N809 OTHER Other Medicine 9 9 — — $86.32 $1,521.00 $217.20 2025-08-01
N811 OTHER Observation, Other 1 1 — — $1,319.50 $1,319.50 $1,319.50 2025-08-01
N900 OTHER Non-covered Services 24 24 — — $70.81 $1,428.34 $241.43 2025-08-01
N902 OTHER Packaged Services 3 3 — — $15.00 $66.00 $66.00 2025-08-01
N905 OTHER Not Recognized By Opps 3 3 — — $86.31 $288.48 $191.31 2025-08-01
N907 OTHER Not Billable To Fi 5 5 — — $27.52 $400.32 $200.72 2025-08-01
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