Piedmont Newton Hospital
5126 Hospital Drive NE, Covington, GA 30014 · Acute care hospital · Emergency room
These are Piedmont Newton Hospital's own posted figures from its standard-charges file dated July 1, 2026. They are not a quote. Source: the hospital's file · its price transparency page.
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Emergency room
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Critical care, first 30 to 74 minutes CPT 99291 | $1,827.90 | $6,093.00 | $595.29 – $5,179.05 |
| Emergency room visit, level 1 (minor) CPT 99281 | $299.97 | $999.90 | $55.94 – $999.90 |
| Emergency room visit, level 2 CPT 99282 | $464.97 | $1,549.90 | $151.04 – $1,549.90 |
| Emergency room visit, level 3 (moderate) CPT 99283 | $629.97 | $2,099.90 | $251.73 – $2,099.90 |
| Emergency room visit, level 4 CPT 99284 | $828.63 | $2,762.10 | $352.42 – $2,382.00 |
| Emergency room visit, level 5 (most severe) CPT 99285 | $1,160.61 | $3,868.70 | $447.52 – $3,288.40 |
| Simple wound repair (stitches), 2.5 cm or less CPT 12001 | $287.70 | $959.00 | $98.39 – $959.00 |
Office visits
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| New patient office visit, about 15 to 29 minutes CPT 99202 | $136.50 | $455.00 | ? – $455.00 |
| New patient office visit, about 30 minutes CPT 99203 | $156.90 | $523.00 | ? – $523.00 |
| New patient office visit, about 45 minutes CPT 99204 | $199.50 | $665.00 | ? – $665.00 |
| New patient office visit, about 60 minutes CPT 99205 | $967.50 | $3,225.00 | $330.89 – $330.89 |
| Office visit, established patient, about 10 to 19 minutes CPT 99212 | $125.70 | $419.00 | ? – $419.00 |
| Office visit, established patient, about 20 to 29 minutes CPT 99213 | $150.90 | $503.00 | ? – $503.00 |
| Office visit, established patient, about 30 to 39 minutes CPT 99214 | $172.80 | $576.00 | ? – $576.00 |
| Office visit, established patient, about 40 to 54 minutes CPT 99215 | $941.40 | $3,138.00 | $3.14 – $2,667.30 |
| Office visit, established patient, brief (often a nurse) CPT 99211 | $100.50 | $335.00 | $34.37 – $34.37 |
Imaging
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| 3D screening mammogram (tomosynthesis), add-on CPT 77063 | $37.62 | $125.40 | $12.25 – $125.40 |
| Abdominal X-ray, 1 view CPT 74018 | $215.16 | $717.20 | $34.01 – $609.62 |
| Ankle X-ray, 3 or more views CPT 73610 | $270.90 | $903.00 | $44.44 – $767.55 |
| Bone density scan (DEXA), hips and spine CPT 77080 | $385.44 | $1,284.80 | $46.53 – $1,092.08 |
| Breast ultrasound, one breast, complete CPT 76641 | $464.31 | $1,547.70 | $107.09 – $1,315.55 |
| Breast ultrasound, one breast, limited CPT 76642 | $332.32 | $1,107.75 | $83.07 – $941.59 |
| Chest X-ray, 1 view CPT 71045 | $123.84 | $412.80 | $27.21 – $350.88 |
| Chest X-ray, 2 views CPT 71046 | $154.80 | $516.00 | $36.60 – $438.60 |
| CT angiogram of the chest (checks for lung clots) CPT 71275 | $1,481.70 | $4,939.00 | |
| CT angiogram of the head CPT 70496 | $1,579.05 | $5,263.50 | $405.00 – $4,473.98 |
| CT scan of the abdomen and pelvis, with contrast CPT 74177 | $2,266.42 | $7,554.75 | $405.00 – $6,421.54 |
| CT scan of the abdomen and pelvis, without and with contrast CPT 74178 | $2,594.02 | $8,646.75 | $405.00 – $7,349.74 |
| CT scan of the abdomen and pelvis, without contrast CPT 74176 | $1,840.86 | $6,136.20 | $405.00 – $5,215.77 |
| CT scan of the abdomen, without contrast CPT 74150 | $1,165.50 | $3,885.00 | $261.88 – $3,302.25 |
| CT scan of the chest, with contrast CPT 71260 | $1,278.91 | $4,263.05 | $405.00 – $3,623.59 |
| CT scan of the chest, without contrast CPT 71250 | $1,004.64 | $3,348.80 | $261.88 – $2,846.48 |
| CT scan of the head, without contrast CPT 70450 | $1,082.77 | $3,609.24 | $261.88 – $3,067.85 |
| CT scan of the neck (cervical spine), without contrast CPT 72125 | $1,188.99 | $3,963.30 | $261.88 – $3,368.81 |
| CT scan of the pelvis, with contrast CPT 72193 | $1,331.82 | $4,439.40 | $405.00 – $3,773.49 |
| CT scan of the sinuses or face, without contrast CPT 70486 | $862.62 | $2,875.40 | $261.88 – $2,444.09 |
| Diagnostic mammogram, both breasts CPT 77066 | $318.46 | $1,061.55 | $103.71 – $902.32 |
| Diagnostic mammogram, one breast CPT 77065 | $232.62 | $775.40 | $75.76 – $659.09 |
| Foot X-ray, 3 or more views CPT 73630 | $227.04 | $756.80 | $41.31 – $643.28 |
| Hand X-ray, 3 or more views CPT 73130 | $199.71 | $665.70 | $45.49 – $565.85 |
| Knee X-ray, 3 views CPT 73562 | $235.62 | $785.40 | $50.18 – $667.59 |
| Leg or arm vein ultrasound, both sides CPT 93970 | $690.92 | $2,303.08 | $225.01 – $1,957.62 |
| Leg or arm vein ultrasound, one side CPT 93971 | $553.01 | $1,843.38 | $180.10 – $1,566.87 |
| Lower back X-ray, 2 or 3 views CPT 72100 | $356.07 | $1,186.90 | $46.01 – $1,008.87 |
| MRI of both breasts, without and with contrast CPT 77049 | $2,154.57 | $7,181.90 | $683.00 – $6,104.62 |
| MRI of the abdomen, without and with contrast CPT 74183 | $2,091.21 | $6,970.70 | |
| MRI of the brain, without and with contrast CPT 70553 | $2,202.42 | $7,341.40 | $683.00 – $6,240.19 |
| MRI of the brain, without contrast CPT 70551 | $1,343.10 | $4,477.00 | |
| MRI of the knee or other leg joint, without contrast CPT 73721 | $1,515.69 | $5,052.30 | $493.61 – $4,294.46 |
| MRI of the lower back (lumbar spine), without contrast CPT 72148 | $1,710.72 | $5,702.40 | $557.12 – $4,847.04 |
| MRI of the mid back (thoracic spine), without contrast CPT 72146 | $1,605.78 | $5,352.60 | $522.95 – $4,549.71 |
| MRI of the neck (cervical spine), without contrast CPT 72141 | $1,521.63 | $5,072.10 | $495.54 – $4,311.29 |
| MRI of the pelvis, without and with contrast CPT 72197 | $1,934.46 | $6,448.20 | $629.99 – $5,480.97 |
| MRI of the shoulder or other arm joint, without contrast CPT 73221 | $1,411.41 | $4,704.70 | $459.65 – $3,999.00 |
| Neck X-ray, 2 or 3 views CPT 72040 | $285.78 | $952.60 | $45.49 – $809.71 |
| Pelvic ultrasound, complete (not pregnancy) CPT 76856 | $481.80 | $1,606.00 | $114.92 – $1,365.10 |
| Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805 | $542.52 | $1,808.40 | $139.53 – $1,537.14 |
| Pregnancy ultrasound, under 14 weeks, single baby CPT 76801 | $430.65 | $1,435.50 | $111.26 – $1,220.18 |
| Screening mammogram, both breasts CPT 77067 | $280.98 | $936.60 | $91.51 – $796.11 |
| Shoulder X-ray, 2 or more views CPT 73030 | $217.35 | $724.50 | $40.79 – $615.83 |
| Transvaginal pregnancy ultrasound CPT 76817 | $385.77 | $1,285.90 | $89.87 – $1,093.02 |
| Transvaginal ultrasound CPT 76830 | $487.74 | $1,625.80 | |
| Ultrasound of the abdomen, complete CPT 76700 | $581.13 | $1,937.10 | $123.34 – $1,646.54 |
| Ultrasound of the neck or thyroid CPT 76536 | $614.46 | $2,048.20 | $131.63 – $1,740.97 |
| Wrist X-ray, 3 or more views CPT 73110 | $206.25 | $687.50 | $51.75 – $584.38 |
| X-ray of the lower back, 4 or more views CPT 72110 | $444.51 | $1,481.70 | $62.20 – $1,259.45 |
Lab tests
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 | $131.38 | $437.95 | ? – $372.26 |
| Blood culture CPT 87040 | $150.76 | $502.55 | ? – $427.17 |
| Blood draw (venipuncture) CPT 36415 | $13.39 | $44.65 | ? – $37.95 |
| BNP test (heart failure) CPT 83880 | $121.05 | $403.50 | ? – $342.98 |
| C-reactive protein (CRP) test CPT 86140 | $87.78 | $292.60 | ? – $248.71 |
| Chlamydia test (DNA/NAAT) CPT 87491 | $87.77 | $292.56 | ? – $248.68 |
| Complete blood count (CBC) with differential CPT 85025 | $61.81 | $206.03 | $4.92 – $175.13 |
| Complete blood count (CBC), automated CPT 85027 | $56.43 | $188.10 | $4.10 – $159.89 |
| Comprehensive metabolic panel (blood test) CPT 80053 | $146.77 | $489.25 | ? – $415.86 |
| COVID-19 PCR test CPT 87635 | $75.70 | $252.33 | ? – $214.48 |
| D-dimer test (blood clots) CPT 85379 | $96.61 | $322.05 | ? – $273.74 |
| Drug screen, instrument chemistry CPT 80307 | $142.45 | $474.83 | ? – $403.61 |
| Ferritin (iron stores) test CPT 82728 | $67.35 | $224.50 | ? – $190.83 |
| Free T4 (thyroid) test CPT 84439 | $60.06 | $200.20 | ? – $170.17 |
| General health panel (blood tests) CPT 80050 | $236.83 | $789.45 | ? – $671.03 |
| Glucose (blood sugar) test CPT 82947 | $39.04 | $130.15 | $2.48 – $110.63 |
| Gonorrhea test (DNA/NAAT) CPT 87591 | $82.29 | $274.30 | ? – $233.16 |
| Hemoglobin A1c test CPT 83036 | $53.85 | $179.50 | ? – $152.58 |
| Hepatitis C antibody test CPT 86803 | $120.55 | $401.85 | ? – $341.57 |
| HIV-1/HIV-2 antigen and antibody test CPT 87389 | $118.84 | $396.15 | ? – $336.73 |
| Iron test CPT 83540 | $50.70 | $169.00 | ? – $143.65 |
| Kidney function panel CPT 80069 | $86.92 | $289.75 | ? – $246.29 |
| Lipase test (pancreas) CPT 83690 | $76.83 | $256.11 | ? – $217.69 |
| Lipid panel, cholesterol and triglycerides CPT 80061 | $98.32 | $327.75 | ? – $278.59 |
| Liver function panel CPT 80076 | $106.30 | $354.35 | ? – $301.20 |
| Magnesium test CPT 83735 | $45.00 | $150.00 | ? – $127.50 |
| Obstetric blood test panel CPT 80055 | $124.20 | $414.00 | ? – $351.90 |
| Partial thromboplastin time (PTT), clotting test CPT 85730 | $54.72 | $182.40 | $3.80 – $155.04 |
| Pregnancy blood test (hCG), quantitative CPT 84702 | $106.19 | $353.98 | ? – $300.88 |
| Prothrombin time (PT/INR), clotting test CPT 85610 | $39.06 | $130.20 | $2.49 – $110.67 |
| PSA (prostate specific antigen), free CPT 84154 | $61.56 | $205.20 | ? – $174.42 |
| PSA (prostate specific antigen), total CPT 84153 | $100.89 | $336.30 | ? – $285.86 |
| Rapid strep test CPT 87880 | $72.10 | $240.35 | $7.59 – $204.30 |
| Sed rate (ESR) test CPT 85652 | $33.06 | $110.20 | $1.71 – $93.67 |
| TB skin test CPT 86580 | $49.20 | $164.00 | $4.09 – $139.40 |
| Thyroid stimulating hormone (TSH) CPT 84443 | $73.03 | $243.43 | ? – $206.92 |
| Tissue exam by a pathologist (biopsy specimen) CPT 88305 | $2,436.18 | $8,120.60 | ? – $6,902.51 |
| Troponin test (heart damage) CPT 84484 | $125.67 | $418.89 | ? – $356.06 |
| Urinalysis, automated, with microscope CPT 81001 | $63.27 | $210.90 | $2.01 – $179.27 |
| Urinalysis, automated, without microscope CPT 81003 | $36.19 | $120.65 | ? – $102.55 |
| Urinalysis, manual, with microscope CPT 81000 | $38.70 | $129.00 | $2.01 – $109.65 |
| Urinalysis, manual, without microscope CPT 81002 | $36.76 | $122.55 | ? – $104.17 |
| Urine culture, colony count CPT 87086 | $85.78 | $285.95 | ? – $243.06 |
| Urine pregnancy test CPT 81025 | $115.14 | $383.80 | $4.01 – $326.23 |
| Vitamin B12 test CPT 82607 | $81.12 | $270.40 | ? – $229.84 |
| Vitamin D test CPT 82306 | $78.75 | $262.50 | ? – $223.13 |
Heart
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Carotid artery ultrasound, both sides CPT 93880 | $884.07 | $2,946.90 | $287.91 – $2,504.87 |
| ECG tracing only (no interpretation) CPT 93005 | $190.08 | $633.60 | |
| Echocardiogram (heart ultrasound), complete with Doppler CPT 93306 | $1,552.98 | $5,176.60 | $505.75 – $4,400.11 |
| Left heart catheterization CPT 93452 | $5,253.60 | $17,512.00 | $1,710.92 – $14,885.20 |
| Left heart catheterization with coronary angiogram CPT 93458 | $7,356.03 | $24,520.10 | $2,395.61 – $20,842.09 |
| Nuclear stress test (heart perfusion imaging) CPT 78452 | $2,440.68 | $8,135.60 | $562.27 – $6,915.26 |
Surgery
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Breast biopsy with ultrasound guidance CPT 19083 | $2,189.40 | $7,298.00 | $373.68 – $6,203.30 |
| Colonoscopy with biopsy CPT 45380 | $1,391.58 | $4,638.60 | $475.92 – $4,632.00 |
| Colonoscopy with polyp removal (snare) CPT 45385 | $1,529.20 | $5,097.33 | $522.99 – $4,632.00 |
| Colposcopy with biopsy CPT 57454 | $567.90 | $1,893.00 | $194.22 – $1,893.00 |
| Cystoscopy (bladder scope) CPT 52000 | $1,667.70 | $5,559.00 | $570.35 – $4,725.15 |
| Flexible sigmoidoscopy, diagnostic CPT 45330 | $1,203.93 | $4,013.10 | $411.74 – $3,498.35 |
| Kidney stone shock-wave lithotripsy CPT 50590 | $12,206.97 | $40,689.90 | $708.20 – $34,586.42 |
| Lower colon endoscopy with ultrasound CPT 45391 | $1,270.35 | $4,234.50 | $434.46 – $4,234.50 |
| Screening colonoscopy, average risk HCPCS G0121 | $1,525.29 | $5,084.30 | $521.65 – $4,321.66 |
| Screening colonoscopy, high risk HCPCS G0105 | $1,525.29 | $5,084.30 | $521.65 – $4,321.66 |
| Upper endoscopy (EGD) with biopsy CPT 43239 | $1,389.27 | $4,630.91 | $475.13 – $3,936.27 |
| Upper endoscopy (EGD), diagnostic CPT 43235 | $1,542.28 | $5,140.94 | $527.46 – $4,369.80 |
Pregnancy and birth
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Fetal non-stress test CPT 59025 | $585.00 | $1,950.00 | $1,236.00 – $1,902.00 |
| IUD insertion CPT 58300 | $466.05 | $1,553.50 | $159.39 – $1,553.50 |
Hospital stays
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Alcohol or drug use disorder, without rehab, without major complications MS-DRG 897 | $9,949.70 | $33,165.68 | |
| C-section, without complications MS-DRG 788 | $14,534.87 | $48,449.58 | $1,485.00 – $9,476.34 |
| Chest pain MS-DRG 313 | $9,648.94 | $32,163.13 | $1,250.00 – $7,668.85 |
| COPD flare-up, with major complications MS-DRG 190 | $11,969.06 | $39,896.86 | $1,250.00 – $26,314.52 |
| COPD flare-up, without complications MS-DRG 192 | $8,727.31 | $29,091.05 | $1,250.00 – $15,251.35 |
| Fainting (syncope) MS-DRG 312 | $12,940.64 | $43,135.48 | $1,250.00 – $20,705.73 |
| Gastrointestinal bleeding, with complications MS-DRG 378 | $14,310.22 | $47,700.72 | $1,485.00 – $23,297.51 |
| Heart failure, with major complications MS-DRG 291 | $11,985.16 | $39,950.54 | $1,250.00 – $30,497.95 |
| Heart failure, without complications MS-DRG 293 | $7,747.13 | $25,823.78 | $1,250.00 – $13,517.89 |
| Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216 | $149,162.41 | $497,208.04 | $74,044.12 – $219,066.24 |
| Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 | $45,567.69 | $151,892.31 | |
| Irregular heartbeat, without complications MS-DRG 310 | $9,911.13 | $33,037.10 | $1,250.00 – $13,519.44 |
| Kidney failure, with complications MS-DRG 683 | $10,400.20 | $34,667.32 | $1,250.00 – $20,805.50 |
| Kidney or urinary tract infection, without major complications MS-DRG 690 | $10,600.44 | $35,334.80 | $1,250.00 – $19,230.48 |
| Neck (cervical) spinal fusion, without complications MS-DRG 473 | $42,548.74 | $141,829.15 | $20,094.58 – $57,995.52 |
| Normal newborn care MS-DRG 795 | $1,586.85 | $5,289.51 | |
| Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641 | $11,054.16 | $36,847.20 | |
| Pneumonia, with complications MS-DRG 194 | $10,722.64 | $35,742.13 | $1,250.00 – $19,144.96 |
| Pneumonia, with major complications MS-DRG 193 | $12,260.77 | $40,869.24 | $1,250.00 – $12,167.88 |
| Pneumonia, without complications MS-DRG 195 | $7,315.88 | $24,386.26 | $1,250.00 – $14,930.65 |
| Psychoses (inpatient psychiatric stay) MS-DRG 885 | $9,661.51 | $32,205.02 | $1,958.00 – $32,205.02 |
| Sepsis, with major complications MS-DRG 871 | $20,741.89 | $69,139.64 | |
| Sepsis, without major complications MS-DRG 872 | $13,392.55 | $44,641.83 | $1,250.00 – $24,309.51 |
| Skin infection (cellulitis), without major complications MS-DRG 603 | $8,511.85 | $28,372.85 | $1,250.00 – $20,689.10 |
| Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392 | $11,360.20 | $37,867.35 | $1,485.00 – $18,520.18 |
| Stroke, with complications or clot-busting drug MS-DRG 65 | $14,964.87 | $49,882.89 | $1,250.00 – $24,000.69 |
| Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743 | $22,403.90 | $74,679.68 | $11,271.90 – $29,474.07 |
| Vaginal delivery, without complications MS-DRG 807 | $9,605.68 | $32,018.94 | $1,250.00 – $7,322.20 |
| Weight loss surgery, without complications MS-DRG 621 | $28,819.31 | $96,064.37 |
Pain and spine
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Large joint injection or drainage (knee, shoulder, hip) CPT 20610 | $1,145.70 | $3,819.00 | $373.68 – $3,498.35 |
| Lower back nerve root injection with imaging guidance CPT 64483 | $1,754.40 | $5,848.00 | $571.35 – $4,970.80 |
| Lower back spinal injection (epidural), with imaging guidance CPT 62323 | $1,343.25 | $4,477.50 | $437.45 – $3,805.88 |
| Lower back spinal injection (epidural), without imaging CPT 62322 | $1,660.80 | $5,536.00 | $540.87 – $4,705.60 |
Eye
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Eye exam, new patient, comprehensive CPT 92004 | $268.50 | $895.00 | $87.44 – $895.00 |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 | $424.20 | $1,414.00 | $138.15 – $1,414.00 |
Sleep
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Home sleep apnea test CPT 95806 | $552.75 | $1,842.50 | $180.01 – $1,842.50 |
| Sleep study with CPAP titration CPT 95811 | $2,921.25 | $9,737.50 | $951.35 – $8,276.88 |
| Sleep study, overnight in a sleep lab CPT 95810 | $2,531.08 | $8,436.95 | $824.29 – $7,171.41 |
Lungs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Spirometry (breathing test) CPT 94010 | $245.43 | $818.10 | $79.93 – $695.39 |
Therapy
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Manual therapy, 15 minutes CPT 97140 | $107.70 | $359.00 | $35.07 – $359.00 |
| Physical therapy evaluation, low complexity CPT 97161 | $175.03 | $583.45 | $57.00 – $495.93 |
| Physical therapy evaluation, moderate complexity CPT 97162 | $176.83 | $589.43 | $57.59 – $501.02 |
| Physical therapy, therapeutic exercise, 15 minutes CPT 97110 | $75.81 | $252.70 | $24.69 – $252.70 |
| Therapeutic activities, 15 minutes CPT 97530 | $71.53 | $238.45 | $23.30 – $238.45 |
Infusions and injections
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Injection under the skin or into a muscle CPT 96372 | $129.06 | $430.20 | $42.03 – $430.20 |
| IV hydration, each additional hour CPT 96361 | $114.46 | $381.55 | $37.28 – $381.55 |
| IV hydration, first hour CPT 96360 | $237.90 | $793.00 | $77.48 – $674.05 |
| IV push injection of a drug, first CPT 96374 | $175.95 | $586.50 | $57.30 – $571.00 |
| IV push injection, each additional drug CPT 96375 | $157.22 | $524.06 | $51.20 – $524.06 |
Drugs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696 | $141.57 | $471.91 | $4.01 – $401.12 |
| Dexamethasone injection, per 1 mg HCPCS J1100 | $14.24 | $47.48 | $1.01 – $40.36 |
| Fentanyl injection, per 0.1 mg HCPCS J3010 | $334.85 | $1,116.17 | $32.05 – $948.74 |
| Ketorolac (Toradol) injection, per 15 mg HCPCS J1885 | $15.49 | $51.64 | ? – $43.89 |
| Midazolam (Versed) injection, per 1 mg HCPCS J2250 | $34.04 | $113.47 | $3.29 – $96.45 |
| Morphine injection, up to 10 mg HCPCS J2270 | $45.61 | $152.03 | $7.62 – $129.23 |
| Ondansetron (Zofran) injection, per 1 mg HCPCS J2405 | $5.68 | $18.92 | ? – $16.08 |
| Propofol injection, per 10 mg HCPCS J2704 | $54.32 | $181.08 | $10.49 – $153.92 |
| Saline IV solution, 1000 ml HCPCS J7030 | $30.19 | $100.65 | $1.21 – $85.55 |
Cash price: the hospital's posted discounted price for people paying themselves. Gross charge: its list price before any discount. Insurer rates: the lowest and highest rates it says it negotiated with any insurer. When the file lists a service on several rows, this page shows one (the facility row for the usual setting); the service's own page lists every row.