Alton Memorial Hospital
One Memorial Drive, Alton, IL 62002 · Acute care hospital · Emergency room
These are Alton Memorial Hospital's own posted figures from its standard-charges file dated December 15, 2025. 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 | $4,111.80 | $6,853.00 | $827.36 – $6,853.00 |
| Emergency room visit, level 1 (minor) CPT 99281 | $568.80 | $948.00 | $84.46 – $1,898.00 |
| Emergency room visit, level 2 CPT 99282 | $1,009.80 | $1,683.00 | $175.49 – $1,898.00 |
| Emergency room visit, level 3 (moderate) CPT 99283 | $1,604.40 | $2,674.00 | $273.42 – $2,674.00 |
| Emergency room visit, level 4 CPT 99284 | $2,259.00 | $3,765.00 | $469.04 – $3,275.55 |
| Emergency room visit, level 5 (most severe) CPT 99285 | $3,330.60 | $5,551.00 | $596.49 – $5,551.00 |
| Simple wound repair (stitches), 2.5 cm or less CPT 12001 | $3,764.13 | $6,273.55 | $215.00 – $8,198.00 |
Imaging
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| 3D screening mammogram (tomosynthesis), add-on CPT 77063 | $30.00 | $50.00 | $11.00 – $210.00 |
| Abdominal X-ray, 1 view CPT 74018 | $159.00 | $265.00 | $39.90 – $449.00 |
| Ankle X-ray, 3 or more views CPT 73610 | $166.20 | $277.00 | $53.00 – $562.89 |
| Bone density scan (DEXA), hips and spine CPT 77080 | $229.20 | $382.00 | $51.13 – $535.05 |
| Breast ultrasound, one breast, complete CPT 76641 | $908.40 | $1,514.00 | $126.43 – $2,098.44 |
| Breast ultrasound, one breast, limited CPT 76642 | $876.00 | $1,460.00 | $98.57 – $1,560.78 |
| Chest X-ray, 1 view CPT 71045 | $261.00 | $435.00 | $30.49 – $449.00 |
| Chest X-ray, 2 views CPT 71046 | $274.20 | $457.00 | $43.02 – $479.37 |
| CT angiogram of the chest (checks for lung clots) CPT 71275 | $1,071.00 | $1,785.00 | $175.68 – $2,136.72 |
| CT angiogram of the head CPT 70496 | $1,341.00 | $2,235.00 | $175.68 – $2,235.00 |
| CT scan of the abdomen and pelvis, with contrast CPT 74177 | $2,839.20 | $4,732.00 | $349.44 – $4,732.00 |
| CT scan of the abdomen and pelvis, without and with contrast CPT 74178 | $2,981.40 | $4,969.00 | $349.44 – $5,265.24 |
| CT scan of the abdomen and pelvis, without contrast CPT 74176 | $1,744.20 | $2,907.00 | $225.02 – $2,907.00 |
| CT scan of the abdomen, without contrast CPT 74150 | $811.80 | $1,353.00 | $104.71 – $1,725.00 |
| CT scan of the chest, with contrast CPT 71260 | $925.80 | $1,543.00 | $175.68 – $1,844.40 |
| CT scan of the chest, without contrast CPT 71250 | $708.60 | $1,181.00 | $104.71 – $1,725.00 |
| CT scan of the head, without contrast CPT 70450 | $859.80 | $1,433.00 | $104.71 – $1,725.00 |
| CT scan of the neck (cervical spine), without contrast CPT 72125 | $907.20 | $1,512.00 | $104.71 – $1,725.00 |
| CT scan of the pelvis, with contrast CPT 72193 | $924.00 | $1,540.00 | $175.68 – $1,944.45 |
| CT scan of the sinuses or face, without contrast CPT 70486 | $792.60 | $1,321.00 | $104.71 – $1,725.00 |
| Diagnostic mammogram, both breasts CPT 77066 | $292.80 | $488.00 | $102.44 – $578.55 |
| Diagnostic mammogram, one breast CPT 77065 | $198.00 | $330.00 | $79.65 – $368.90 |
| Foot X-ray, 3 or more views CPT 73630 | $172.80 | $288.00 | $48.21 – $517.65 |
| Hand X-ray, 3 or more views CPT 73130 | $177.60 | $296.00 | $52.37 – $492.42 |
| Knee X-ray, 3 views CPT 73562 | $184.20 | $307.00 | $59.25 – $580.29 |
| Leg or arm vein ultrasound, both sides CPT 93970 | $1,361.40 | $2,269.00 | $238.99 – $2,839.68 |
| Leg or arm vein ultrasound, one side CPT 93971 | $1,020.60 | $1,701.00 | $104.71 – $1,701.00 |
| Lower back X-ray, 2 or 3 views CPT 72100 | $184.80 | $308.00 | $54.24 – $585.51 |
| MRI of the abdomen, without and with contrast CPT 74183 | $1,960.80 | $3,268.00 | $349.44 – $4,044.63 |
| MRI of the brain, without and with contrast CPT 70553 | $2,020.20 | $3,367.00 | $349.44 – $4,092.48 |
| MRI of the brain, without contrast CPT 70551 | $1,381.80 | $2,303.00 | $238.99 – $2,303.00 |
| MRI of the knee or other leg joint, without contrast CPT 73721 | $1,434.00 | $2,390.00 | $267.88 – $2,742.24 |
| MRI of the lower back (lumbar spine), without contrast CPT 72148 | $1,422.60 | $2,371.00 | $238.99 – $3,826.26 |
| MRI of the mid back (thoracic spine), without contrast CPT 72146 | $1,152.60 | $1,921.00 | $238.99 – $2,250.00 |
| MRI of the neck (cervical spine), without contrast CPT 72141 | $1,380.60 | $2,301.00 | $238.99 – $3,696.63 |
| MRI of the pelvis, without and with contrast CPT 72197 | $1,928.40 | $3,214.00 | $349.44 – $3,214.00 |
| MRI of the shoulder or other arm joint, without contrast CPT 73221 | $1,266.00 | $2,110.00 | $267.88 – $3,593.97 |
| Neck X-ray, 2 or 3 views CPT 72040 | $236.40 | $394.00 | $53.63 – $342.78 |
| Pelvic ultrasound, complete (not pregnancy) CPT 76856 | $614.40 | $1,024.00 | $112.03 – $117.63 |
| Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805 | $633.60 | $1,056.00 | $104.71 – $1,305.87 |
| Pregnancy ultrasound, under 14 weeks, single baby CPT 76801 | $474.00 | $790.00 | $104.71 – $1,019.64 |
| Screening mammogram, both breasts CPT 77067 | $209.40 | $349.00 | $84.26 – $397.59 |
| Shoulder X-ray, 2 or more views CPT 73030 | $199.20 | $332.00 | $47.38 – $539.40 |
| Transvaginal pregnancy ultrasound CPT 76817 | $296.40 | $494.00 | $104.71 – $918.72 |
| Transvaginal ultrasound CPT 76830 | $384.60 | $641.00 | $104.71 – $1,008.33 |
| Ultrasound of the abdomen, complete CPT 76700 | $573.00 | $955.00 | $104.71 – $1,479.00 |
| Ultrasound of the neck or thyroid CPT 76536 | $411.00 | $685.00 | $104.71 – $1,063.14 |
| Wrist X-ray, 3 or more views CPT 73110 | $171.00 | $285.00 | $60.49 – $473.28 |
| X-ray of the lower back, 4 or more views CPT 72110 | $316.20 | $527.00 | $72.35 – $801.27 |
Lab tests
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 | $156.60 | $261.00 | $8.46 – $261.00 |
| Blood culture CPT 87040 | $193.80 | $323.00 | $10.32 – $323.00 |
| Blood draw (venipuncture) CPT 36415 | $14.40 | $24.00 | $4.23 – $34.80 |
| BNP test (heart failure) CPT 83880 | $116.40 | $194.00 | $32.34 – $194.00 |
| C-reactive protein (CRP) test CPT 86140 | $28.20 | $47.00 | $5.18 – $113.97 |
| Chlamydia test (DNA/NAAT) CPT 87491 | $74.40 | $124.00 | $31.00 – $236.64 |
| Complete blood count (CBC) with differential CPT 85025 | $92.40 | $154.00 | $7.77 – $154.00 |
| Complete blood count (CBC), automated CPT 85027 | $60.00 | $100.00 | $6.47 – $126.15 |
| Comprehensive metabolic panel (blood test) CPT 80053 | $215.40 | $359.00 | $10.56 – $359.00 |
| COVID-19 PCR test CPT 87635 | $77.40 | $129.00 | $28.38 – $129.00 |
| D-dimer test (blood clots) CPT 85379 | $66.60 | $111.00 | $10.18 – $185.31 |
| Drug screen, instrument chemistry CPT 80307 | $118.20 | $197.00 | $45.32 – $197.00 |
| Ferritin (iron stores) test CPT 82728 | $58.20 | $97.00 | $13.63 – $201.84 |
| Free T4 (thyroid) test CPT 84439 | $44.40 | $74.00 | $9.02 – $193.14 |
| General health panel (blood tests) CPT 80050 | $277.80 | $463.00 | $27.49 – $463.00 |
| Glucose (blood sugar) test CPT 82947 | $33.60 | $56.00 | $3.93 – $101.79 |
| Gonorrhea test (DNA/NAAT) CPT 87591 | $74.40 | $124.00 | $31.00 – $187.05 |
| Hemoglobin A1c test CPT 83036 | $33.60 | $56.00 | $9.71 – $133.11 |
| Hepatitis C antibody test CPT 86803 | $60.60 | $101.00 | $14.27 – $101.00 |
| HIV-1/HIV-2 antigen and antibody test CPT 87389 | $60.00 | $100.00 | $24.08 – $100.00 |
| Iron test CPT 83540 | $24.60 | $41.00 | $6.47 – $113.97 |
| Kidney function panel CPT 80069 | $187.80 | $313.00 | $8.68 – $313.00 |
| Lipase test (pancreas) CPT 83690 | $75.00 | $125.00 | $6.89 – $173.13 |
| Lipid panel, cholesterol and triglycerides CPT 80061 | $57.00 | $95.00 | $13.39 – $181.83 |
| Liver function panel CPT 80076 | $52.80 | $88.00 | $8.17 – $242.73 |
| Magnesium test CPT 83735 | $93.60 | $156.00 | $6.70 – $156.00 |
| Obstetric blood test panel CPT 80055 | $202.20 | $337.00 | $47.81 – $341.04 |
| Partial thromboplastin time (PTT), clotting test CPT 85730 | $79.20 | $132.00 | $6.01 – $132.00 |
| Pregnancy blood test (hCG), quantitative CPT 84702 | $113.40 | $189.00 | $15.05 – $199.23 |
| Prothrombin time (PT/INR), clotting test CPT 85610 | $17.40 | $29.00 | $4.29 – $33.06 |
| PSA (prostate specific antigen), free CPT 84154 | $58.80 | $98.00 | $18.39 – $168.78 |
| PSA (prostate specific antigen), total CPT 84153 | $76.80 | $128.00 | $18.39 – $201.84 |
| Rapid strep test CPT 87880 | $30.60 | $51.00 | $9.24 – $51.00 |
| Sed rate (ESR) test CPT 85652 | $12.60 | $21.00 | $2.70 – $64.38 |
| TB skin test CPT 86580 | $24.00 | $40.00 | $10.00 – $34.80 |
| Thyroid stimulating hormone (TSH) CPT 84443 | $66.00 | $110.00 | $16.80 – $212.28 |
| Tissue exam by a pathologist (biopsy specimen) CPT 88305 | $186.60 | $311.00 | $42.60 – $582.90 |
| Troponin test (heart damage) CPT 84484 | $85.80 | $143.00 | $12.47 – $143.00 |
| Urinalysis, automated, with microscope CPT 81001 | $25.20 | $42.00 | $3.17 – $46.11 |
| Urinalysis, automated, without microscope CPT 81003 | $15.60 | $26.00 | $2.25 – $34.80 |
| Urinalysis, manual, with microscope CPT 81000 | $24.60 | $41.00 | $4.82 – $35.67 |
| Urinalysis, manual, without microscope CPT 81002 | $24.60 | $41.00 | $3.48 – $41.00 |
| Urine culture, colony count CPT 87086 | $32.40 | $54.00 | $8.07 – $162.69 |
| Urine pregnancy test CPT 81025 | $75.60 | $126.00 | $8.61 – $126.00 |
| Vitamin B12 test CPT 82607 | $64.20 | $107.00 | $15.08 – $182.70 |
| Vitamin D test CPT 82306 | $115.20 | $192.00 | $29.60 – $294.06 |
Heart
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Carotid artery ultrasound, both sides CPT 93880 | $2,481.00 | $4,135.00 | $238.99 – $4,135.00 |
| ECG tracing only (no interpretation) CPT 93005 | $318.00 | $530.00 | $59.09 – $530.00 |
| Echocardiogram (heart ultrasound), complete with Doppler CPT 93306 | $5,346.00 | $8,910.00 | $547.30 – $8,910.00 |
| Left heart catheterization CPT 93452 | $26,263.68 | $43,772.80 | $3,247.17 – $43,772.80 |
| Left heart catheterization with coronary angiogram CPT 93458 | $32,964.33 | $54,940.55 | $3,564.51 – $47,798.28 |
| Nuclear stress test (heart perfusion imaging) CPT 78452 | $2,061.00 | $3,435.00 | $696.75 – $6,872.13 |
Surgery
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Breast biopsy with ultrasound guidance CPT 19083 | $10,486.96 | $17,478.26 | $503.00 – $17,478.26 |
| Carpal tunnel release CPT 64721 | $23,926.69 | $39,877.81 | $3,310.00 – $40,629.83 |
| Colonoscopy with biopsy CPT 45380 | $8,049.53 | $13,415.88 | $1,282.34 – $11,671.82 |
| Colonoscopy with polyp removal (snare) CPT 45385 | $5,965.63 | $9,942.71 | $1,198.57 – $9,329.48 |
| Colonoscopy, diagnostic CPT 45378 | $5,760.14 | $9,600.23 | $931.46 – $8,352.20 |
| Colposcopy with biopsy CPT 57454 | $1,664.40 | $2,774.00 | $305.22 – $9,632.98 |
| Cystoscopy (bladder scope) CPT 52000 | $28,582.28 | $47,637.13 | $739.70 – $112,585.19 |
| Flexible sigmoidoscopy, diagnostic CPT 45330 | $5,466.98 | $9,111.63 | $931.46 – $9,824.79 |
| Hysteroscopy with biopsy or polyp removal CPT 58558 | $35,989.81 | $59,983.02 | $4,316.00 – $52,185.23 |
| Inguinal (groin) hernia repair, open, age 5 or older CPT 49505 | $12,207.67 | $20,346.11 | $3,911.00 – $20,346.11 |
| Lower colon endoscopy with ultrasound CPT 45391 | $4,686.36 | $7,810.60 | $1,198.57 – $6,795.22 |
| Nasal endoscopy, diagnostic CPT 31231 | $8,968.95 | $14,948.25 | $199.93 – $16,959.55 |
| Prostate biopsy CPT 55700 | $16,246.39 | $27,077.32 | $359.02 – $23,557.27 |
| Upper endoscopy (EGD) with biopsy CPT 43239 | $5,692.60 | $9,487.66 | $1,039.03 – $12,175.71 |
| Upper endoscopy (EGD), diagnostic CPT 43235 | $4,318.16 | $7,196.93 | $908.45 – $6,261.33 |
Pregnancy and birth
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Fetal non-stress test CPT 59025 | $1,041.00 | $1,735.00 | $198.66 – $1,509.45 |
| IUD insertion CPT 58300 | $8,915.91 | $14,859.85 | $216.78 – $16,689.25 |
Hospital stays
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Alcohol or drug use disorder, without rehab, without major complications MS-DRG 897 | $10,019.13 | $16,698.55 | $1,011.00 – $24,467.10 |
| C-section, without complications MS-DRG 788 | $9,111.78 | $15,186.30 | $6,872.52 – $27,033.75 |
| Chest pain MS-DRG 313 | $17,176.44 | $28,627.40 | $1,011.00 – $29,934.15 |
| COPD flare-up, with major complications MS-DRG 190 | $22,980.06 | $38,300.10 | $1,011.00 – $35,000.23 |
| COPD flare-up, without complications MS-DRG 192 | $9,003.39 | $15,005.65 | $1,011.00 – $26,848.75 |
| Fainting (syncope) MS-DRG 312 | $19,722.63 | $32,871.05 | $1,011.00 – $34,363.55 |
| Gastrointestinal bleeding, with complications MS-DRG 378 | $22,107.18 | $36,845.30 | $1,011.00 – $36,845.30 |
| Heart failure, with major complications MS-DRG 291 | $25,346.31 | $42,243.85 | $1,011.00 – $40,278.75 |
| Heart failure, without complications MS-DRG 293 | $17,573.49 | $29,289.15 | $1,011.00 – $39,918.85 |
| Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216 | $256,485.35 | $427,475.59 | $14,969.00 – $427,475.59 |
| Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 | $37,980.44 | $63,300.74 | $10,468.75 – $55,747.70 |
| Irregular heartbeat, without complications MS-DRG 310 | $15,758.43 | $26,264.05 | $1,011.00 – $31,003.00 |
| Kidney failure, with complications MS-DRG 683 | $17,932.63 | $29,887.71 | $1,011.00 – $29,105.00 |
| Kidney or urinary tract infection, without major complications MS-DRG 690 | $15,975.84 | $26,626.40 | $1,011.00 – $24,087.30 |
| Neck (cervical) spinal fusion, without complications MS-DRG 473 | $59,629.35 | $99,382.25 | $10,503.84 – $99,998.00 |
| Normal newborn care MS-DRG 795 | $3,866.51 | $6,444.19 | $653.00 – $6,337.65 |
| Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641 | $17,056.74 | $28,427.90 | $1,011.00 – $28,427.90 |
| Pneumonia, with complications MS-DRG 194 | $17,594.19 | $29,323.65 | $1,011.00 – $26,038.15 |
| Pneumonia, with major complications MS-DRG 193 | $24,572.40 | $40,954.00 | $1,011.00 – $36,045.75 |
| Pneumonia, without complications MS-DRG 195 | $13,774.89 | $22,958.15 | $1,011.00 – $22,075.20 |
| Psychoses (inpatient psychiatric stay) MS-DRG 885 | $16,861.86 | $28,103.10 | $660.00 – $31,105.60 |
| Sepsis, with major complications MS-DRG 871 | $30,634.59 | $51,057.65 | $1,011.00 – $56,648.22 |
| Sepsis, without major complications MS-DRG 872 | $19,877.58 | $33,129.30 | $1,011.00 – $34,275.35 |
| Skin infection (cellulitis), without major complications MS-DRG 603 | $16,193.43 | $26,989.05 | $1,011.00 – $23,480.47 |
| Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392 | $16,222.53 | $27,037.55 | $1,011.00 – $24,573.30 |
| Stroke, with complications or clot-busting drug MS-DRG 65 | $27,095.40 | $45,159.00 | $250.00 – $43,995.73 |
| Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743 | $31,492.38 | $52,487.30 | $8,893.12 – $45,663.95 |
| Vaginal delivery, without complications MS-DRG 807 | $7,246.95 | $12,078.25 | $4,701.52 – $10,508.08 |
| Weight loss surgery, without complications MS-DRG 621 | $22,254.36 | $37,090.60 | $12,057.04 – $47,487.12 |
Pain and spine
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Large joint injection or drainage (knee, shoulder, hip) CPT 20610 | $11,106.49 | $18,510.81 | $4,627.70 – $18,510.81 |
| Lower back nerve root injection with imaging guidance CPT 64483 | $9,538.27 | $15,897.11 | $885.90 – $15,897.11 |
| Lower back spinal injection (epidural), with imaging guidance CPT 62323 | $28,093.73 | $46,822.88 | $3,756.00 – $40,735.91 |
| Lower back spinal injection (epidural), without imaging CPT 62322 | $4,360.84 | $7,268.07 | $885.90 – $8,198.00 |
Eye
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 | $3,821.52 | $6,369.20 | $469.73 – $6,771.00 |
Sleep
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Home sleep apnea test CPT 95806 | $870.00 | $1,450.00 | $216.27 – $3,034.00 |
| Sleep study with CPAP titration CPT 95811 | $5,163.00 | $8,605.00 | $860.13 – $8,605.00 |
| Sleep study, overnight in a sleep lab CPT 95810 | $4,633.20 | $7,722.00 | $860.13 – $7,722.00 |
Lungs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Spirometry (breathing test) CPT 94010 | $331.20 | $552.00 | $126.94 – $552.00 |
Therapy
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Manual therapy, 15 minutes CPT 97140 | $81.00 | $135.00 | $26.36 – $332.00 |
| Physical therapy evaluation, low complexity CPT 97161 | $141.60 | $236.00 | $56.32 – $332.00 |
| Physical therapy evaluation, moderate complexity CPT 97162 | $162.60 | $271.00 | $66.66 – $332.00 |
| Physical therapy, therapeutic exercise, 15 minutes CPT 97110 | $90.60 | $151.00 | $27.90 – $332.00 |
| Therapeutic activities, 15 minutes CPT 97530 | $112.20 | $187.00 | $33.22 – $332.00 |
Mental health
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Group psychotherapy CPT 90853 | $316.80 | $528.00 | $237.60 – $528.00 |
| Psychiatric diagnostic evaluation CPT 90791 | $259.20 | $432.00 | $190.00 – $432.00 |
| Psychotherapy, 30 minutes CPT 90832 | $185.40 | $309.00 | $139.05 – $309.00 |
| Psychotherapy, 45 minutes CPT 90834 | $226.20 | $377.00 | $169.65 – $377.00 |
| Psychotherapy, 60 minutes CPT 90837 | $250.80 | $418.00 | $188.10 – $418.00 |
Infusions and injections
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Injection under the skin or into a muscle CPT 96372 | $110.40 | $184.00 | $70.84 – $618.00 |
| IV hydration, each additional hour CPT 96361 | $103.20 | $172.00 | $46.90 – $369.00 |
| IV hydration, first hour CPT 96360 | $475.20 | $792.00 | $166.54 – $792.00 |
| IV push injection of a drug, first CPT 96374 | $242.40 | $404.00 | $103.00 – $626.40 |
| IV push injection, each additional drug CPT 96375 | $218.40 | $364.00 | $46.90 – $618.00 |
Drugs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696 | $30.18 | $50.30 | $6.04 – $111.32 |
| Dexamethasone injection, per 1 mg HCPCS J1100 | $4.77 | $7.95 | $3.60 – $6.92 |
| Fentanyl injection, per 0.1 mg HCPCS J3010 | $79.80 | $133.00 | $15.94 – $414.95 |
| Ketorolac (Toradol) injection, per 15 mg HCPCS J1885 | $3.87 | $6.45 | ? – $5.61 |
| Midazolam (Versed) injection, per 1 mg HCPCS J2250 | $32.67 | $54.45 | $7.62 – $55.24 |
| Morphine injection, up to 10 mg HCPCS J2270 | $4.92 | $8.20 | $1.10 – $37.43 |
| Ondansetron (Zofran) injection, per 1 mg HCPCS J2405 | $10.77 | $17.95 | $1.35 – $62.80 |
| Propofol injection, per 10 mg HCPCS J2704 | $28.98 | $48.30 | ? – $42.02 |
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.