Other senior care options in Pennsylvania:

Best Nursing Homes in Pennsylvania

Why trust this guide? Our editorial team analyzed 177 nursing homes in Pennsylvania using Centers for Medicare & Medicaid Services (CMS) data, inspection records, complaints, amenities, and facility-level details. How we rank nursing homes in PA
Reviewed by
Last updated
Jun 2026
We analyzed
177 homes
Other senior care options in Pennsylvania:
Avg Overall CMS Rating: 3.0/ 5The average Overall CMS Rating for all CMS-certified nursing homes in Pennsylvania. Ratings combine health inspections, staffing, and quality measures, with inspections weighted most. Individual facilities can vary widely from this average.
National Average: 3.2/ 5
Avg Staffing Rating: 3.4/ 5The average Staffing Rating across all CMS-certified nursing homes in Pennsylvania. Reflects nursing staff hours per resident per day (including RNs), adjusted for residents' care needs. Individual facilities can vary widely from this average.
National Average: 3.4/ 5
Avg Health Insp. Rating: 2.8/ 5The average Health Inspection Rating across all CMS-certified nursing homes in Pennsylvania. Based on each facility's recent inspections and complaint investigations, weighing the number, scope, and severity of deficiencies. Individual facilities can vary widely from this average.
National Average: 3.0/ 5

Compare Nursing Homes around Pennsylvania

The information below is reported by the Pennsylvania Department of Human Services and Department of Health.

149 facilities compared · CMS & PA Dept. of Health data

Dock Woods
NH
AL
IL
MC
RC
Lansdale
80
Facility 80
PA AVG 94
Rank #293 / 555
85.0%
Facility 85.0%
PA AVG 78.7%
Rank #95 / 518
+8%
4.69
Facility 4.69
PA AVG 4.15
Rank #62 / 207
-6% +13%
$0
Facility $0
PA AVG $61.2k
Rank #1 / 210
86
Facility 86
PA AVG 83
Rank #193 / 460
- - - 70 -
21
Facility 21
PA AVG 46
Rank #524 / 668
Living Branches
$26.4M
Facility $26.4M
PA AVG $32.8M
Rank #45 / 209
$11.5M
Facility $11.5M
PA AVG $6.7M
Rank #84 / 209
43.8%
Facility 43.8%
PA AVG 40%
Rank #188 / 209
395557
Riverton Enhanced Senior Living
NH
AL
IL
MC
RC
Allentown (Rittersville)
90
Facility 90
PA AVG 94
Rank #251 / 555
76.7%
Facility 76.7%
PA AVG 78.7%
Rank #194 / 518
-3%
3.51
Facility 3.51
PA AVG 4.15
Rank #174 / 207
+19% -15%
$0
Facility $0
PA AVG $61.2k
Rank #1 / 210
91
Facility 91
PA AVG 83
Rank #112 / 460
7
Facility 7
PA AVG 31.3
Rank #46 / 207
1.4
Facility 1.4
PA AVG 4.4
Rank #19 / 207
- 69 -
56
Facility 56
PA AVG 46
Rank #237 / 668
Lee-Anne Liberatore
$16.0M
Facility $16.0M
PA AVG $32.8M
Rank #140 / 209
$7.2M
Facility $7.2M
PA AVG $6.7M
Rank #127 / 209
45.1%
Facility 45.1%
PA AVG 40%
Rank #76 / 209
395171
Homestead Village
NH
AL
IL
MC
Lancaster (Rohrerstown)
100
Facility 100
PA AVG 94
Rank #203 / 555
57.0%
Facility 57.0%
PA AVG 78.7%
Rank #392 / 518
-28%
5.33
Facility 5.33
PA AVG 4.15
Rank #26 / 207
-23% +29%
$0
Facility $0
PA AVG $61.2k
Rank #1 / 210
91
Facility 91
PA AVG 83
Rank #112 / 460
7
Facility 7
PA AVG 31.3
Rank #46 / 207
3.5
Facility 3.5
PA AVG 4.4
Rank #97 / 207
- 51 -
16
Facility 16
PA AVG 46
Rank #559 / 668
Douglas Motter
$21.4M
Facility $21.4M
PA AVG $32.8M
Rank #57 / 209
$12.2M
Facility $12.2M
PA AVG $6.7M
Rank #68 / 209
57%
Facility 57%
PA AVG 40%
Rank #162 / 209
395720
Dunwoody Village
NH
MC
NC
RC
Newtown Square
81
Facility 81
PA AVG 94
Rank #289 / 555
92.6%
Facility 92.6%
PA AVG 78.7%
Rank #37 / 518
+18%
5.96
Facility 5.96
PA AVG 4.15
Rank #13 / 207
+13% +44%
$0
Facility $0
PA AVG $61.2k
Rank #1 / 210
86
Facility 86
PA AVG 83
Rank #193 / 460
5
Facility 5
PA AVG 31.3
Rank #31 / 207
2.5
Facility 2.5
PA AVG 4.4
Rank #53 / 207
- 66 -
64
Facility 64
PA AVG 46
Rank #184 / 668
Maureen Casey
$40.1M
Facility $40.1M
PA AVG $32.8M
Rank #30 / 209
$21.7M
Facility $21.7M
PA AVG $6.7M
Rank #17 / 209
54%
Facility 54%
PA AVG 40%
Rank #80 / 209
395329
Friendship Village of South Hills
NH
AL
IL
MC
Upper St Clair (Boyce)
102
Facility 102
PA AVG 94
Rank #199 / 555
78.4%
Facility 78.4%
PA AVG 78.7%
Rank #172 / 518
0%
3.93
Facility 3.93
PA AVG 4.15
Rank #141 / 207
+3% -5%
$0
Facility $0
PA AVG $61.2k
Rank #1 / 210
81
Facility 81
PA AVG 83
Rank #274 / 460
15
Facility 15
PA AVG 31.3
Rank #92 / 207
5.0
Facility 5.0
PA AVG 4.4
Rank #141 / 207
- 78 -
8
Facility 8
PA AVG 46
Rank #611 / 668
Dina Stover
$30.2M
Facility $30.2M
PA AVG $32.8M
Rank #61 / 209
$14.6M
Facility $14.6M
PA AVG $6.7M
Rank #39 / 209
48.3%
Facility 48.3%
PA AVG 40%
Rank #86 / 209
395688
Barclay Friends
NH
AL
MC
RC
West Chester (North Franklin Street)
103
Facility 103
PA AVG 94
Rank #196 / 555
49.5%
Facility 49.5%
PA AVG 78.7%
Rank #438 / 518
-37%
4.70
Facility 4.70
PA AVG 4.15
Rank #62 / 207
+12% +13%
$9.4k
Facility $9.4k
PA AVG $61.2k
Rank #154 / 210
74
Facility 74
PA AVG 83
Rank #348 / 460
1
Facility 1
PA AVG 31.3
Rank #1 / 207
1.0
Facility 1.0
PA AVG 4.4
Rank #1 / 207
- 61 A+
35
Facility 35
PA AVG 46
Rank #421 / 668
Barclay Friends
$19.0M
Facility $19.0M
PA AVG $32.8M
Rank #98 / 209
$11.7M
Facility $11.7M
PA AVG $6.7M
Rank #70 / 209
61.7%
Facility 61.7%
PA AVG 40%
Rank #56 / 209
395848
The Hill at Whitemarsh
NH
AL
MC
RC
Lafayette Hill
52
Facility 52
PA AVG 94
Rank #431 / 555
48.1%
Facility 48.1%
PA AVG 78.7%
Rank #447 / 518
-39%
5.46
Facility 5.46
PA AVG 4.15
Rank #22 / 207
+46% +32%
$0
Facility $0
PA AVG $61.2k
Rank #1 / 210
91
Facility 91
PA AVG 83
Rank #112 / 460
6
Facility 6
PA AVG 31.3
Rank #38 / 207
2.0
Facility 2.0
PA AVG 4.4
Rank #31 / 207
- 25 -
0
Facility 0
PA AVG 46
Rank #664 / 668
Bruce Ficken
$8.2M
Facility $8.2M
PA AVG $32.8M
Rank #17 / 209
$19.4M
Facility $19.4M
PA AVG $6.7M
Rank #21 / 209
237.4%
Facility 237.4%
PA AVG 40%
Rank #172 / 209
396113
Kirkland Village
NH
AL
HC
IL
MC
RC
Bethlehem
64
Facility 64
PA AVG 94
Rank #383 / 555
46.9%
Facility 46.9%
PA AVG 78.7%
Rank #454 / 518
-40%
4.30
Facility 4.30
PA AVG 4.15
Rank #90 / 207
+46% +4%
$21.6k
Facility $21.6k
PA AVG $61.2k
Rank #176 / 210
84
Facility 84
PA AVG 83
Rank #220 / 460
8
Facility 8
PA AVG 31.3
Rank #53 / 207
4.0
Facility 4.0
PA AVG 4.4
Rank #115 / 207
- 30 A+
12
Facility 12
PA AVG 46
Rank #591 / 668
Presbyterian Homes, Inc.
$26.2M
Facility $26.2M
PA AVG $32.8M
Rank #68 / 209
$8.9M
Facility $8.9M
PA AVG $6.7M
Rank #123 / 209
34.1%
Facility 34.1%
PA AVG 40%
Rank #194 / 209
395916
Kendal-Crosslands Communities
NH
AL
IL
MC
Kennett Square
51
Facility 51
PA AVG 94
Rank #437 / 555
66.7%
Facility 66.7%
PA AVG 78.7%
Rank #299 / 518
-15%
6.47
Facility 6.47
PA AVG 4.15
Rank #6 / 207
+49% +56%
$12.7k
Facility $12.7k
PA AVG $61.2k
Rank #161 / 210
99
Facility 99
PA AVG 83
Rank #17 / 460
4
Facility 4
PA AVG 31.3
Rank #20 / 207
2.0
Facility 2.0
PA AVG 4.4
Rank #31 / 207
1 34 -
9
Facility 9
PA AVG 46
Rank #603 / 668
Catherine Emig
$25.4M
Facility $25.4M
PA AVG $32.8M
Rank #38 / 209
$16.0M
Facility $16.0M
PA AVG $6.7M
Rank #42 / 209
63%
Facility 63%
PA AVG 40%
Rank #154 / 209
395388
Presbyterian Lodge
NH
AL
HC
IL
NC
PC
RC
Erie (Southwest Erie)
51
Facility 51
PA AVG 94
Rank #437 / 555
74.6%
Facility 74.6%
PA AVG 78.7%
Rank #216 / 518
-5%
4.60
Facility 4.60
PA AVG 4.15
Rank #70 / 207
+64% +11%
$0
Facility $0
PA AVG $61.2k
Rank #1 / 210
-
6
Facility 6
PA AVG 31.3
Rank #38 / 207
3.0
Facility 3.0
PA AVG 4.4
Rank #71 / 207
- 48 -
71
Facility 71
PA AVG 46
Rank #135 / 668
Millcreek Manor
$4.6M
Facility $4.6M
PA AVG $32.8M
Rank #196 / 209
$3.0M
Facility $3.0M
PA AVG $6.7M
Rank #199 / 209
65.7%
Facility 65.7%
PA AVG 40%
Rank #101 / 209
395474
Garden Spot Village
NH
ADC
AL
IL
MC
New Holland
110
Facility 110
PA AVG 94
Rank #166 / 555
56.4%
Facility 56.4%
PA AVG 78.7%
Rank #397 / 518
-28%
5.15
Facility 5.15
PA AVG 4.15
Rank #32 / 207
+15% +24%
$8.0k
Facility $8.0k
PA AVG $61.2k
Rank #142 / 210
92
Facility 92
PA AVG 83
Rank #98 / 460
4
Facility 4
PA AVG 31.3
Rank #20 / 207
1.3
Facility 1.3
PA AVG 4.4
Rank #12 / 207
2 66 -
32
Facility 32
PA AVG 46
Rank #445 / 668
Donald Aldrich
$10.1M
Facility $10.1M
PA AVG $32.8M
Rank #14 / 209
$19.0M
Facility $19.0M
PA AVG $6.7M
Rank #24 / 209
188%
Facility 188%
PA AVG 40%
Rank #187 / 209
396079
Gwynedd Healthcare & Rehabilitation Center
NH
HC
MC
RC
Lansdale (Sumneytown Pike)
181
Facility 181
PA AVG 94
Rank #26 / 555
92.7%
Facility 92.7%
PA AVG 78.7%
Rank #36 / 518
+18%
4.09
Facility 4.09
PA AVG 4.15
Rank #111 / 207
-41% -1%
$24.1k
Facility $24.1k
PA AVG $61.2k
Rank #179 / 210
-
17
Facility 17
PA AVG 31.3
Rank #103 / 207
3.4
Facility 3.4
PA AVG 4.4
Rank #95 / 207
1 172 -
8
Facility 8
PA AVG 46
Rank #611 / 668
Michelle Taylor
$22.6M
Facility $22.6M
PA AVG $32.8M
Rank #94 / 209
$10.1M
Facility $10.1M
PA AVG $6.7M
Rank #77 / 209
44.5%
Facility 44.5%
PA AVG 40%
Rank #84 / 209
395479
Fountain View at Logan Square
NH
IL
MC
RC
Philadelphia (Center City)
101
Facility 101
PA AVG 94
Rank #201 / 555
63.4%
Facility 63.4%
PA AVG 78.7%
Rank #327 / 518
-19%
3.14
Facility 3.14
PA AVG 4.15
Rank #204 / 207
+20% -24%
$43.2k
Facility $43.2k
PA AVG $61.2k
Rank #190 / 210
77
Facility 77
PA AVG 83
Rank #315 / 460
50
Facility 50
PA AVG 31.3
Rank #181 / 207
3.6
Facility 3.6
PA AVG 4.4
Rank #103 / 207
1 64 -
95
Facility 95
PA AVG 46
Rank #6 / 668
Steven Stefanelli
$17.4M
Facility $17.4M
PA AVG $32.8M
Rank #53 / 209
$6.4M
Facility $6.4M
PA AVG $6.7M
Rank #67 / 209
36.6%
Facility 36.6%
PA AVG 40%
Rank #167 / 209
395662
Freedom Village at Brandywine
NH
AL
IL
MC
RC
Coatesville
60
Facility 60
PA AVG 94
Rank #399 / 555
90.9%
Facility 90.9%
PA AVG 78.7%
Rank #48 / 518
+15%
4.23
Facility 4.23
PA AVG 4.15
Rank #99 / 207
+31% +2%
$0
Facility $0
PA AVG $61.2k
Rank #1 / 210
-
5
Facility 5
PA AVG 31.3
Rank #31 / 207
1.7
Facility 1.7
PA AVG 4.4
Rank #27 / 207
- 46 A+
9
Facility 9
PA AVG 46
Rank #603 / 668
Danielle Geyer
$12.5M
Facility $12.5M
PA AVG $32.8M
Rank #42 / 209
$14.5M
Facility $14.5M
PA AVG $6.7M
Rank #55 / 209
116%
Facility 116%
PA AVG 40%
Rank #170 / 209
396062
Lima Estates
NH
AL
IL
MC
Media
60
Facility 60
PA AVG 94
Rank #399 / 555
62.3%
Facility 62.3%
PA AVG 78.7%
Rank #336 / 518
-21%
4.54
Facility 4.54
PA AVG 4.15
Rank #78 / 207
+122% +10%
$0
Facility $0
PA AVG $61.2k
Rank #1 / 210
- - - - 5 A+
24
Facility 24
PA AVG 46
Rank #511 / 668
-
$16.5M
Facility $16.5M
PA AVG $32.8M
Rank #113 / 209
$8.3M
Facility $8.3M
PA AVG $6.7M
Rank #134 / 209
50.7%
Facility 50.7%
PA AVG 40%
Rank #165 / 209
395492
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Nursing Home Explorer
Overview of Naamans Creek Country Manor

Naamans Creek Country Manor is a non-profit nursing home in Garnet Valley, PA, offering long-term care, skilled nursing, and rehabilitation. The community ensures older adults are comfortable and safe with a compassionate and home-like environment. With 24-hour care, therapies, and a wide range of specialized care, residents receive the utmost attention and care for their unique needs and preferences. Focusing on residents’ recovery, personalized care plans are also provided based on their unique needs and habits.

Social gatherings and various games promote social interactions and encourage residents to live actively. Well-lit common areas and a top-notch rehabilitation gym are also available for residents’ wellness and leisure. Nestled in the tree-lined neighborhood of Garnet Valley, the community guarantees a stress-free retirement. This nursing home has excellent services and thoughtfully curated amenities dedicated to older adults’ well-being, making it a good option for senior living in Pennsylvania.

Contact Naamans Creek Country Manor

Overview of Meadowview Rehabilitation and Nursing Center

Meadowview Rehabilitation and Nursing Center is a top-rated nursing home in Philadelphia, PA, offering memory care, skilled nursing, rehabilitation, and hospice. Dedicated to older adults’ comfort and healing, the community continuously promotes a compassionate and welcoming environment. Chef-prepared meals, 24-hour care, and recreational opportunities are also offered to enrich residents’ living experiences. Through personalized care plans, residents receive exceptional care dedicated to their recovery and well-being.

Educational programs, social gatherings, and fitness activities foster social engagement and encourage residents to continue learning. Lively common areas and accessible living spaces are also available, so residents can rest and move around comfortably. Residents also experience a stress-free retirement, as it is beautifully located in the tree-lined neighborhood of Philadelphia. As one of the trusted options for senior living in Pennsylvania, this nursing home strives to help older adults thrive in retirement.

Contact Meadowview Rehabilitation And Nursing Center

Overview of Wyndmoor Hills Rehabilitation and Nursing Center

Wyndmoor Hills Rehabilitation & Nursing is a nursing home in Wyndmoor, PA, focusing on subacute rehabilitation, skilled nursing, and a wide range of specialized care. Promoting a nurturing and home-like environment, the community ensures older adults are well-cared for during their stay. With 24-hour care, gourmet home-style meals, and concierge services, residents also experience a worry-free retirement. Through an innovative approach to care, the community provides therapies daily to ensure quick recovery and help residents live to their potential.

Fun gatherings and a variety of recreational activities foster engagement and encourage residents to live actively. Spacious, private rooms, a cozy outdoor patio, and landscaped gardens also ensure residents can rest and move around comfortably. A stress-free retirement is also guaranteed, as it is surrounded by trees in the peaceful neighborhood of Wyndmoor. As one of the trusted options for senior living in Pennsylvania, this nursing home ensures high standards of care for older adults’ welfare.

Contact Wyndmoor Hills Rehabilitation and Nursing Center

Overview of Hickory House Nursing Home

Hickory House Nursing Home is a compassionate nursing home in Honey Brook, PA, offering rehabilitation and skilled nursing. With its home-like setting, the community ensures older adults can keep their peace of mind. Residents are also guaranteed the utmost comfort and safety, with housekeeping, laundry, a fine dining program, and transportation services. Following a holistic approach to care, the community strives to help residents recover and live comfortably in retirement.

Pet visits, recreational programs, and light exercise help prevent loneliness and encourage residents to stay active. A beauty and barber shop, a library, and beautiful courtyards are also available for residents’ relaxation and wellness. Nestled in the serene residential area of Honey Brook, the community guarantees a stress-free lifestyle. As one of the trusted options for senior living in Pennsylvania, this nursing home ensures older adults can thrive in retirement.

Contact Hickory House Nursing Home

Overview of Exton Post Acute

Exton Post Acute is a nursing home in Exton, PA, offering rehabilitation and skilled nursing. Featuring spacious, private rooms in a clean setting, the community ensures older adults are comfortable and safe. Excellent services, including housekeeping, laundry, gourmet dining, and 24/7 care, are also offered to enrich residents’ living experiences. Prioritizing residents’ recovery, individualized care plans are provided based on their needs and preferences.

Light exercises, social events, and a variety of recreational activities provide residents with more opportunities to try out new hobbies and have fun. Well-lit lounges and spacious grounds also ensure residents can rest and move around comfortably. Set along Lincoln Highway, near bus stops, schools, and healthcare providers, the community ensures accessibility and convenience. This nursing home has exceptional services and top-notch amenities, making it a great choice for senior living in Pennsylvania.

Contact Exton Post Acute

Overview of Complete Care at Harston Hall

Surrounded by convenient local amenities in Flourtown, PA, Complete Care at Harston Hall is a distinct community that offers short-term rehabilitation and long-term care. Residents here receive top-notch care and support for their special needs with the community’s comprehensive care options, which include memory care, hospice care, wound care, cardiac care, and other specialized care. With beautifully furnished accommodations in a nurturing environment, residents will surely feel at ease.

Fun activities and engaging programs are also conducted to keep residents socially engaged and active. Mealtimes are also something to look forward to, with delicious and healthy restaurant-style dining that aims to satisfy residents’ dietary needs and preferences. The community is good for those seeking care to jump back into their lives and live their golden years with a little less worry.

Contact Complete Care at Harston Hall

Overview of Penn State Rehabilitation Hospital

Nestled in the neighborhood of Hummelstown, PA, Penn State Rehabilitation Hospital is a dedicated senior living community, offering an array of excellent rehabilitative services and outpatient programs designed to help seniors get back to their routines after hospitalization. Residents here are offered access to physical, speech, and occupational therapy services, as well as an array of specialized services, such as ReVital cancer rehabilitation, stroke rehabilitation, and more.

The team collaborates closely with every resident to curate a personalized therapy plan that aligns with their needs and recovery goals. The community utilizes leading technology in helping residents regain their strengths or maintain their mobility, ensuring they are able to continue their lifestyle and avoid going back to the hospital. Here, residents can enjoy their peace of mind knowing that their healing journey is guided by a capable team of professionals.

Contact Penn State Rehabilitation Hospital

Ranking Methodology

How we rank these nursing homes

Every nursing home above is evaluated across five weighted categories using CMS data including Care Compare, Payroll-Based Journal, and Medicare Cost Reports.

  • CMS data
  • 5 weighted categories
  • Updated quarterly
Full methodology

Weighting overview

  • 35%
    Care Quality
  • 20%
    Staffing
  • 20%
    Regulatory
  • 20%
    Operational
  • 5%
    Environment
01

Care Quality 35%

The largest single share of every ranking. CMS star ratings and quality measures that reflect actual care delivered to residents.

  • Includes
  • Overall Rating
  • Health Inspection
  • QM Rating
  • Long-Stay QM
  • Short-Stay QM
02

Staffing Adequacy 20%

The strongest predictor of resident outcomes. Volume and stability of nursing care, drawn from CMS Payroll-Based Journal.

  • Includes
  • Nurse Hrs/Res/Day
  • RN vs State
  • Total Nurse Staff Hrs vs State
  • RN Turnover
03

Regulatory & Safety Record 20%

Inspection patterns that star ratings can mask. We weight per-inspection rates more heavily than raw counts.

  • Includes
  • Citations
  • Citations/Inspection
  • Severe Citations
  • Fines
  • Accreditations
04

Operational & Financial Stability 20%

Stable operations and sound finances are leading indicators of consistent care over time.

  • Includes
  • Occupancy vs State
  • Avg Length of Stay
  • Revenue
  • Payroll %
  • Years in Operation
  • Admin Tenure
05

Environment & Accessibility 5%

Context that matters to families but doesn't directly measure clinical care. Weighted lower for nursing homes than for assisted or independent living.

  • Includes
  • Walk Score
  • BBB Rating
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Frequently Asked Questions about Nursing Homes in Pennsylvania

What's the difference between assisted living and a nursing home in Pennsylvania?

Assisted living in Pennsylvania is a residential model focused on housing, hospitality, and help with daily activities. Nursing homes (skilled nursing facilities) provide 24/7 medical care from licensed nurses for residents with significant health needs, and are regulated more strictly under both state and federal CMS rules.

Does Pennsylvania Medicaid cover nursing home care?

Yes — Pennsylvania Medicaid covers nursing home care for residents who meet income, asset, and medical-need eligibility requirements. Most CMS-certified nursing homes accept Medicaid as a primary payer once long-term-care eligibility is established.

What is nursing home care?

Nursing homes (also called skilled nursing facilities) provide 24/7 medical care from licensed nurses, rehabilitation services, and long-term custodial care for residents with significant health or functional needs.

How many nursing homes are listed on this page?

This page features 177 nursing homes in Pennsylvania. Use the filters and comparison tools above to compare ratings, amenities, and pricing.

How do I choose the right nursing home in Pennsylvania?

Start by matching the level of care offered to the resident's current and anticipated needs, then compare licensing status, staff-to-resident ratios, recent inspection results, and pricing. Tour at least two or three communities in Pennsylvania, talk to current residents and families, and confirm what is included in the base rate versus billed as add-on services.

What should I look for when visiting nursing homes in Pennsylvania?

Pay attention to staff interactions with residents, cleanliness and odor, food quality at meal times, the activity calendar, and how questions about pricing and care plans are answered. Ask to see the most recent state inspection report, the move-out / level-of-care-change policy, and a sample monthly bill that lists every fee.