Fairview Lakes Health Services

5200 Fairview Boulevard, Wyoming, MN 55092 · Acute care hospital · Emergency room

These are Fairview Lakes Health Services's own posted figures from its standard-charges file dated February 5, 2026. They are not a quote. Source: the hospital's file · its price transparency page.

234 of the services we track have a posted price here; 180 of them have a discounted cash price. Tap a service to compare it with nearby hospitals. How to read these numbers.

Emergency room

Service	Cash price	Gross charge	Insurer rates (min – max)
Critical care, first 30 to 74 minutes CPT 99291	$1,409.52	$3,515.00	$236.01 – $3,163.50
Emergency room visit, level 1 (minor) CPT 99281	$207.32	$517.00	$52.00 – $1,617.00
Emergency room visit, level 2 CPT 99282	$242.61	$605.00	$84.00 – $1,617.00
Emergency room visit, level 3 (moderate) CPT 99283	$292.13	$728.50	$185.04 – $1,617.00
Emergency room visit, level 4 CPT 99284	$500.85	$1,249.00	$227.90 – $1,617.00
Emergency room visit, level 5 (most severe) CPT 99285	$708.40	$1,766.58	$228.73 – $2,423.00
Simple wound repair (stitches), 2.5 cm or less CPT 12001	$218.55	$545.00	$283.95 – $490.50

Office visits

Service	Cash price	Gross charge	Insurer rates (min – max)
New patient office visit, about 15 to 29 minutes CPT 99202	$186.85	$298.00	$32.29 – $268.20
New patient office visit, about 30 minutes CPT 99203	$285.08	$454.67	$55.97 – $409.20
New patient office visit, about 45 minutes CPT 99204	$423.12	$674.82	$91.85 – $632.16
New patient office visit, about 60 minutes CPT 99205	$558.03	$890.00	$124.62 – $859.94
Office consultation, about 40 minutes CPT 99243	$257.70	$411.00	$60.99 – $415.19
Office consultation, about 60 minutes CPT 99244	$372.44	$594.00	$93.05 – $600.06
Office visit, established patient, about 10 to 19 minutes CPT 99212	$138.75	$346.00	$59.16 – $483.68
Office visit, established patient, about 20 to 29 minutes CPT 99213	$152.77	$380.95	$118.31 – $774.46
Office visit, established patient, about 30 to 39 minutes CPT 99214	$221.00	$551.10	$182.41 – $1,091.15
Office visit, established patient, about 40 to 54 minutes CPT 99215	$295.41	$736.67	$257.17 – $1,534.53
Office visit, established patient, brief (often a nurse) CPT 99211	$42.22	$105.27	$18.36 – $201.54
Preventive checkup, new patient, age 18 to 39 CPT 99385	not posted		$91.06 – $1,105.55
Preventive checkup, new patient, age 40 to 64 CPT 99386	not posted		$104.82 – $1,269.65

Imaging

Service	Cash price	Gross charge	Insurer rates (min – max)
3D screening mammogram (tomosynthesis), add-on CPT 77063	$42.91	$107.00	$36.66 – $449.13
Abdominal X-ray, 1 view CPT 74018	$100.25	$250.00	$47.51 – $263.86
Ankle X-ray, 3 or more views CPT 73610	$218.35	$544.50	$62.29 – $490.05
Bone density scan (DEXA), hips and spine CPT 77080	$158.40	$395.00	$65.24 – $355.50
Breast ultrasound, one breast, complete CPT 76641	$218.35	$544.50	$80.99 – $490.05
Breast ultrasound, one breast, limited CPT 76642	$297.15	$741.00	$67.05 – $666.90
Chest X-ray, 1 view CPT 71045	$129.55	$323.07	$37.91 – $290.76
Chest X-ray, 2 views CPT 71046	$143.16	$357.00	$51.22 – $321.30
CT angiogram of the chest (checks for lung clots) CPT 71275	$642.81	$1,603.00	$167.46 – $1,442.70
CT angiogram of the head CPT 70496	$567.84	$1,416.05	$167.46 – $1,274.44
CT scan of the abdomen and pelvis, with contrast CPT 74177	$734.65	$1,832.02	$202.87 – $1,648.82
CT scan of the abdomen and pelvis, without and with contrast CPT 74178	$817.32	$2,038.20	$202.87 – $1,834.38
CT scan of the abdomen and pelvis, without contrast CPT 74176	$515.78	$1,286.21	$202.87 – $1,359.31
CT scan of the abdomen, without contrast CPT 74150	$470.78	$1,174.00	$80.99 – $1,056.60
CT scan of the chest, with contrast CPT 71260	$579.14	$1,444.22	$167.46 – $1,299.80
CT scan of the chest, without contrast CPT 71250	$470.82	$1,174.10	$80.99 – $1,056.69
CT scan of the head, without contrast CPT 70450	$362.11	$903.00	$80.99 – $841.00
CT scan of the neck (cervical spine), without contrast CPT 72125	$472.38	$1,178.00	$80.99 – $1,060.20
CT scan of the pelvis, with contrast CPT 72193	$650.03	$1,621.00	$167.46 – $1,458.90
CT scan of the sinuses or face, without contrast CPT 70486	$561.40	$1,400.00	$80.99 – $1,260.00
Diagnostic mammogram, both breasts CPT 77066	$231.00	$576.03	$80.31 – $1,381.94
Diagnostic mammogram, one breast CPT 77065	$178.85	$446.00	$88.50 – $1,094.04
Foot X-ray, 3 or more views CPT 73630	$220.83	$550.68	$57.86 – $495.61
Hand X-ray, 3 or more views CPT 73130	$214.74	$535.50	$63.76 – $481.95
Knee X-ray, 3 views CPT 73562	$232.18	$578.99	$67.05 – $521.09
Leg or arm vein ultrasound, both sides CPT 93970	$494.84	$1,234.00	$177.37 – $1,359.31
Leg or arm vein ultrasound, one side CPT 93971	$251.61	$627.44	$80.99 – $800.00
Lower back X-ray, 2 or 3 views CPT 72100	$155.59	$388.00	$64.51 – $349.20
MRI of both breasts, without and with contrast CPT 77049	$1,024.16	$2,554.00	$540.83 – $3,071.93
MRI of the abdomen, without and with contrast CPT 74183	$1,253.53	$3,126.00	$335.92 – $2,813.40
MRI of the brain, without and with contrast CPT 70553	$1,162.21	$2,898.26	$335.92 – $2,608.44
MRI of the brain, without contrast CPT 70551	$643.21	$1,604.01	$227.36 – $1,443.61
MRI of the knee or other leg joint, without contrast CPT 73721	$1,209.02	$3,015.00	$227.36 – $2,713.50
MRI of the lower back (lumbar spine), without contrast CPT 72148	$759.90	$1,895.00	$227.36 – $1,705.50
MRI of the mid back (thoracic spine), without contrast CPT 72146	$722.21	$1,801.00	$227.36 – $1,620.90
MRI of the neck (cervical spine), without contrast CPT 72141	$753.08	$1,878.00	$227.36 – $1,690.20
MRI of the pelvis, without and with contrast CPT 72197	$1,239.90	$3,092.00	$335.92 – $2,782.80
MRI of the shoulder or other arm joint, without contrast CPT 73221	$1,219.55	$3,041.26	$227.36 – $2,737.14
Neck X-ray, 2 or 3 views CPT 72040	$150.78	$376.00	$63.76 – $338.40
Pelvic ultrasound, complete (not pregnancy) CPT 76856	$236.61	$590.05	$80.99 – $531.04
Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805	$273.89	$683.00	$80.99 – $614.70
Pregnancy ultrasound, under 14 weeks, single baby CPT 76801	$266.27	$664.00	$80.99 – $597.60
Screening mammogram, both breasts CPT 77067	$188.07	$469.00	$66.64 – $1,117.06
Shoulder X-ray, 2 or more views CPT 73030	$223.15	$556.47	$57.11 – $500.82
Transvaginal pregnancy ultrasound CPT 76817	$230.98	$576.00	$80.99 – $518.40
Transvaginal ultrasound CPT 76830	$223.38	$557.04	$80.99 – $501.34
Ultrasound of the abdomen, complete CPT 76700	$278.31	$694.04	$80.99 – $624.63
Ultrasound of the neck or thyroid CPT 76536	$259.85	$648.00	$80.99 – $583.20
Wrist X-ray, 3 or more views CPT 73110	$218.71	$545.41	$67.05 – $490.87
X-ray of the lower back, 4 or more views CPT 72110	$205.32	$512.00	$71.62 – $460.80

Lab tests

Service	Cash price	Gross charge	Insurer rates (min – max)
Basic metabolic panel (blood test) CPT 80048	$75.39	$188.00	$8.32 – $169.20
Blood culture CPT 87040	$75.40	$188.03	$10.15 – $169.23
Blood draw (venipuncture) CPT 36415	$18.85	$47.00	$2.84 – $42.30
BNP test (heart failure) CPT 83880	$112.29	$280.01	$38.63 – $345.49
C-reactive protein (CRP) test CPT 86140	$38.82	$96.79	$5.10 – $87.11
Chlamydia test (DNA/NAAT) CPT 87491	$77.40	$193.00	$18.80 – $581.56
Complete blood count (CBC) with differential CPT 85025	$53.74	$134.00	$5.25 – $120.60
Complete blood count (CBC), automated CPT 85027	$87.82	$219.00	$4.80 – $197.10
Comprehensive metabolic panel (blood test) CPT 80053	$88.55	$220.80	$10.39 – $198.72
COVID-19 PCR test CPT 87635	$52.95	$132.03	$48.31 – $357.58
D-dimer test (blood clots) CPT 85379	$40.91	$102.00	$7.57 – $91.80
Drug screen, instrument chemistry CPT 80307	$181.66	$453.00	$236.01 – $407.70
Ferritin (iron stores) test CPT 82728	$49.73	$124.00	$13.41 – $120.93
Free T4 (thyroid) test CPT 84439	$69.38	$173.00	$8.88 – $155.70
General health panel (blood tests) CPT 80050	not posted		$16.61 – $328.21
Glucose (blood sugar) test CPT 82947	$18.29	$45.59	$3.87 – $41.03
Gonorrhea test (DNA/NAAT) CPT 87591	$82.61	$206.00	$21.29 – $308.06
Hemoglobin A1c test CPT 83036	$30.88	$77.00	$9.55 – $86.38
Hepatitis C antibody test CPT 86803	$50.53	$126.00	$14.04 – $126.68
HIV-1/HIV-2 antigen and antibody test CPT 87389	$50.13	$125.00	$18.80 – $213.05
Iron test CPT 83540	$30.48	$76.00	$6.37 – $68.40
Kidney function panel CPT 80069	$78.60	$196.00	$8.54 – $176.40
Lipase test (pancreas) CPT 83690	$28.88	$72.00	$6.78 – $64.80
Lipid panel, cholesterol and triglycerides CPT 80061	$41.01	$102.25	$13.18 – $118.04
Liver function panel CPT 80076	$48.14	$120.03	$8.04 – $108.03
Magnesium test CPT 83735	$26.47	$66.00	$6.59 – $59.40
Obstetric blood test panel CPT 80055	not posted		$16.61 – $420.34
Partial thromboplastin time (PTT), clotting test CPT 85730	$58.98	$147.08	$5.91 – $132.37
Pregnancy blood test (hCG), quantitative CPT 84702	$36.90	$92.00	$14.81 – $132.44
Prothrombin time (PT/INR), clotting test CPT 85610	$31.33	$78.12	$40.70 – $70.30
PSA (prostate specific antigen), free CPT 84154	$22.46	$56.00	$18.10 – $161.23
PSA (prostate specific antigen), total CPT 84153	$58.55	$146.01	$18.10 – $161.23
Rapid strep test CPT 87880	$36.70	$91.50	$13.81 – $143.95
Sed rate (ESR) test CPT 85652	$30.88	$77.00	$2.01 – $69.30
TB skin test CPT 86580	not posted		$9.15 – $56.03
Thyroid stimulating hormone (TSH) CPT 84443	$37.30	$93.00	$16.53 – $146.83
Tissue exam by a pathologist (biopsy specimen) CPT 88305	$127.12	$317.00	$165.16 – $285.30
Troponin test (heart damage) CPT 84484	$44.87	$111.89	$12.27 – $109.40
Urinalysis, automated, with microscope CPT 81001	$33.69	$84.01	$2.35 – $75.61
Urinalysis, automated, without microscope CPT 81003	$28.07	$70.00	$36.47 – $63.00
Urinalysis, manual, with microscope CPT 81000	not posted		$2.69 – $34.55
Urinalysis, manual, without microscope CPT 81002	not posted		$2.33 – $31.68
Urine culture, colony count CPT 87086	$34.09	$85.00	$7.94 – $76.50
Urine pregnancy test CPT 81025	$38.90	$97.01	$5.76 – $87.31
Vitamin B12 test CPT 82607	$46.12	$115.00	$14.84 – $132.44
Vitamin D test CPT 82306	$66.23	$165.14	$29.13 – $259.11

Heart

Service	Cash price	Gross charge	Insurer rates (min – max)
Carotid artery ultrasound, both sides CPT 93880	$382.60	$954.09	$131.68 – $1,359.31
ECG tracing only (no interpretation) CPT 93005	$89.43	$223.00	$116.18 – $200.70
Echocardiogram (heart ultrasound), complete with Doppler CPT 93306	$665.33	$1,659.17	$202.87 – $1,493.25
Electrocardiogram (ECG/EKG) with interpretation CPT 93000	$36.89	$58.82	$9.89 – $70.98
Holter monitor, up to 48 hours CPT 93224	not posted		$154.57 – $627.63
Left heart catheterization CPT 93452	$3,548.05	$8,848.00	$1,580.00 – $7,963.20
Left heart catheterization with coronary angiogram CPT 93458	$3,912.56	$9,757.00	$1,580.00 – $8,781.30
Nuclear stress test (heart perfusion imaging) CPT 78452	$1,477.69	$3,685.00	$791.66 – $3,316.50
Treadmill stress test, complete CPT 93015	not posted		$153.16 – $1,037.76

Surgery

Service	Cash price	Gross charge	Insurer rates (min – max)
ACL reconstruction, arthroscopic CPT 29888	not posted		$2,466.00 – $16,340.69
Appendix removal, laparoscopic CPT 44970	$1,459.03	$2,327.00	$395.45 – $2,756.44
Breast biopsy with ultrasound guidance CPT 19083	$2,602.09	$6,489.00	$375.48 – $5,840.10
Carpal tunnel release CPT 64721	not posted		$1,012.25 – $4,746.00
Colonoscopy with biopsy CPT 45380	$1,435.18	$3,579.00	$829.00 – $3,533.51
Colonoscopy with polyp removal (snare) CPT 45385	$1,473.18	$3,673.75	$811.47 – $3,533.51
Colonoscopy, diagnostic CPT 45378	$1,207.82	$3,012.00	$694.30 – $3,500.00
Colposcopy with biopsy CPT 57454	$778.35	$1,941.00	$231.65 – $1,855.66
Cystoscopy (bladder scope) CPT 52000	$746.67	$1,862.00	$508.30 – $2,872.00
Ear tubes, under general anesthesia CPT 69436	$2,762.69	$6,889.50	$338.87 – $6,200.55
Flexible sigmoidoscopy, diagnostic CPT 45330	$811.86	$2,024.57	$581.85 – $2,872.00
Gallbladder removal, laparoscopic CPT 47562	$1,587.93	$2,532.58	$432.19 – $3,010.63
Gastric bypass (weight loss surgery), laparoscopic CPT 43644	not posted		$2,466.00 – $13,586.15
Hysterectomy, laparoscopic, with tubes and/or ovaries CPT 58571	$2,255.32	$3,597.00	$608.14 – $4,274.95
Hysteroscopy with biopsy or polyp removal CPT 58558	$3,566.08	$5,687.52	$152.38 – $5,118.77
Inguinal (groin) hernia repair, laparoscopic CPT 49650	$1,580.61	$2,520.90	$287.57 – $2,268.81
Inguinal (groin) hernia repair, open, age 5 or older CPT 49505	not posted		$1,383.00 – $8,072.44
Kidney stone shock-wave lithotripsy CPT 50590	not posted		$2,626.52 – $14,121.00
Knee arthroscopy, meniscus trim (meniscectomy) CPT 29881	not posted		$1,383.00 – $7,421.78
Lower colon endoscopy with ultrasound CPT 45391	$1,182.95	$2,950.00	$620.33 – $3,533.51
Nasal endoscopy, diagnostic CPT 31231	$643.61	$1,605.00	$132.27 – $1,611.45
Prostate biopsy CPT 55700	$2,145.76	$5,351.00	$980.00 – $4,815.90
Prostate removal, laparoscopic or robotic CPT 55866	not posted		$2,193.00 – $23,814.79
Removal of a breast lump, open surgery CPT 19120	$1,297.89	$2,070.00	$278.86 – $1,941.06
Rotator cuff repair, arthroscopic CPT 29827	not posted		$2,466.00 – $16,340.69
Screening colonoscopy, average risk HCPCS G0121	$1,032.58	$2,575.00	$653.00 – $2,872.00
Screening colonoscopy, high risk HCPCS G0105	$874.99	$2,182.00	$653.00 – $2,872.00
Septoplasty (nasal septum repair) CPT 30520	$1,756.23	$2,801.00	$465.64 – $3,302.78
Shoulder arthroscopy, bone shaving (decompression) CPT 29826	not posted		$321.00 – $1,831.33
Sleeve gastrectomy (weight loss surgery), laparoscopic CPT 43775	not posted		$2,097.39 – $9,370.00
Tonsil and adenoid removal, under age 12 CPT 42820	$739.09	$1,178.77	$201.14 – $1,406.28
Total hip replacement CPT 27130	$3,156.95	$5,035.00	$858.26 – $5,973.38
Total knee replacement CPT 27447	not posted		$2,193.00 – $29,431.77
Upper endoscopy (EGD) with biopsy CPT 43239	$837.25	$2,087.89	$659.32 – $3,500.00
Upper endoscopy (EGD), diagnostic CPT 43235	$820.53	$2,046.19	$659.32 – $3,500.00
Vasectomy CPT 55250	$854.29	$1,362.50	$159.45 – $1,226.25

Pregnancy and birth

Service	Cash price	Gross charge	Insurer rates (min – max)
C-section delivery, routine care including prenatal and postpartum CPT 59510	$6,310.13	$10,064.00	$1,305.47 – $12,068.90
Fetal non-stress test CPT 59025	$280.50	$699.48	$44.56 – $1,179.00
IUD insertion CPT 58300	$238.20	$594.00	$75.18 – $950.08
Vaginal birth after a prior C-section (VBAC), routine care CPT 59610	$5,968.42	$9,519.00	$1,305.47 – $11,364.10
Vaginal delivery, routine care including prenatal and postpartum CPT 59400	$5,762.76	$9,191.00	$1,305.47 – $10,977.88

Hospital stays

Service	Cash price	Insurer rates (min – max)
Alcohol or drug use disorder, without rehab, without major complications MS-DRG 897	not posted	$3,863.13 – $19,320.96
C-section, without complications MS-DRG 788	not posted	$3,701.93 – $18,794.55
Chest pain MS-DRG 313	not posted	$3,150.72 – $15,757.92
COPD flare-up, with major complications MS-DRG 190	not posted	$4,847.30 – $24,243.12
COPD flare-up, without complications MS-DRG 192	not posted	$2,809.39 – $14,050.81
Fainting (syncope) MS-DRG 312	not posted	$3,814.12 – $19,075.84
Gastrointestinal bleeding, with complications MS-DRG 378	not posted	$4,291.54 – $21,463.60
Heart failure, with major complications MS-DRG 291	not posted	$5,617.91 – $28,097.25
Heart failure, without complications MS-DRG 293	not posted	$2,476.82 – $12,387.48
Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216	not posted	$40,569.27 – $240,373.18
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470	not posted	$7,999.15 – $47,395.00
Irregular heartbeat, without complications MS-DRG 310	not posted	$2,477.25 – $12,389.66
Kidney failure, with complications MS-DRG 683	not posted	$3,832.50 – $19,167.76
Kidney or urinary tract infection, without major complications MS-DRG 690	not posted	$3,542.37 – $17,716.72
Neck (cervical) spinal fusion, without complications MS-DRG 473	not posted	$10,124.07 – $59,985.18
Normal newborn care MS-DRG 795	not posted	$720.00 – $5,705.11
Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641	not posted	$3,405.40 – $17,031.69
Pneumonia, with complications MS-DRG 194	not posted	$3,526.62 – $17,637.93
Pneumonia, with major complications MS-DRG 193	not posted	$5,751.81 – $28,766.96
Pneumonia, without complications MS-DRG 195	not posted	$2,750.32 – $13,755.35
Psychoses (inpatient psychiatric stay) MS-DRG 885	not posted	$6,112.40 – $30,570.36
Sepsis, with major complications MS-DRG 871	not posted	$8,500.38 – $42,513.56
Sepsis, without major complications MS-DRG 872	not posted	$4,477.96 – $22,395.94
Skin infection (cellulitis), without major complications MS-DRG 603	not posted	$3,811.06 – $19,060.52
Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392	not posted	$3,411.53 – $17,062.33
Stroke, with complications or clot-busting drug MS-DRG 65	not posted	$4,421.07 – $22,111.43
Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743	not posted	$5,145.18 – $30,485.24
Vaginal delivery, without complications MS-DRG 807	not posted	$2,603.09 – $13,885.72
Weight loss surgery, without complications MS-DRG 621	not posted	$6,255.33 – $37,062.90

Pain and spine

Service	Cash price	Gross charge	Insurer rates (min – max)
Large joint injection or drainage (knee, shoulder, hip) CPT 20610	$529.93	$1,321.50	$92.27 – $1,189.35
Lower back nerve root injection with imaging guidance CPT 64483	$1,513.38	$3,774.00	$262.09 – $3,396.60
Lower back spinal injection (epidural), with imaging guidance CPT 62323	$1,127.82	$2,812.50	$447.85 – $2,872.00
Lower back spinal injection (epidural), without imaging CPT 62322	$1,164.91	$2,905.00	$677.99 – $2,872.00

Eye

Service	Cash price	Gross charge	Insurer rates (min – max)
Cataract removal with lens implant CPT 66984	not posted		$1,124.00 – $5,216.99
Eye exam, new patient, comprehensive CPT 92004	not posted		$76.96 – $316.13
Laser treatment of clouding after cataract surgery (YAG) CPT 66821	$2,642.44	$6,589.60	$417.79 – $5,930.64

Eye and ear

Service	Cash price	Gross charge	Insurer rates (min – max)
Hearing test, comprehensive CPT 92557	$146.00	$364.09	$34.95 – $357.89

Sleep

Service	Cash price	Insurer rates (min – max)
Home sleep apnea test CPT 95806	not posted	$112.75 – $2,979.10
Sleep study with CPAP titration CPT 95811	not posted	$774.78 – $2,979.10
Sleep study, overnight in a sleep lab CPT 95810	not posted	$774.78 – $2,979.10

Lungs

Service	Cash price	Gross charge	Insurer rates (min – max)
Spirometry (breathing test) CPT 94010	$127.17	$317.12	$42.34 – $357.89

Therapy

Service	Cash price	Gross charge	Insurer rates (min – max)
Manual therapy, 15 minutes CPT 97140	$64.41	$160.60	$20.58 – $222.08
Physical therapy evaluation, low complexity CPT 97161	$137.55	$343.00	$74.25 – $308.70
Physical therapy evaluation, moderate complexity CPT 97162	$136.34	$340.00	$74.25 – $306.00
Physical therapy, therapeutic exercise, 15 minutes CPT 97110	$69.78	$174.00	$21.83 – $222.08
Therapeutic activities, 15 minutes CPT 97530	$70.95	$176.92	$26.25 – $222.08

Mental health

Service	Cash price	Gross charge	Insurer rates (min – max)
Family psychotherapy, with the patient, 50 minutes CPT 90847	$285.92	$713.00	$114.12 – $641.70
Family psychotherapy, without the patient, 50 minutes CPT 90846	$234.99	$586.00	$108.90 – $527.40
Group psychotherapy CPT 90853	$272.28	$679.00	$353.76 – $611.10
Psychiatric diagnostic evaluation CPT 90791	$367.32	$916.00	$122.36 – $824.40
Psychotherapy, 30 minutes CPT 90832	$218.55	$545.00	$283.95 – $490.50
Psychotherapy, 45 minutes CPT 90834	$206.12	$514.00	$104.70 – $462.60
Psychotherapy, 60 minutes CPT 90837	$317.20	$791.00	$412.11 – $711.90

Infusions and injections

Service	Cash price	Gross charge	Insurer rates (min – max)
Injection under the skin or into a muscle CPT 96372	$84.21	$210.00	$38.61 – $1,617.00
IV hydration, each additional hour CPT 96361	$88.71	$221.20	$26.67 – $199.08
IV hydration, first hour CPT 96360	$207.32	$517.00	$70.85 – $481.94
IV push injection of a drug, first CPT 96374	$205.72	$513.00	$79.93 – $481.94
IV push injection, each additional drug CPT 96375	$72.01	$179.57	$93.56 – $161.61

Drugs

Service	Cash price	Gross charge	Insurer rates (min – max)
Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696	$12.03	$30.00	$12.00 – $27.00
Dexamethasone injection, per 1 mg HCPCS J1100	$4.45	$11.09	$5.78 – $9.98
Fentanyl injection, per 0.1 mg HCPCS J3010	$20.05	$50.00	$20.00 – $45.00
Hydromorphone (Dilaudid) injection, up to 4 mg HCPCS J1170	$24.18	$60.27	$31.40 – $54.25
Ketorolac (Toradol) injection, per 15 mg HCPCS J1885	$20.05	$50.00	$20.00 – $45.00
Midazolam (Versed) injection, per 1 mg HCPCS J2250	$20.05	$50.00	$20.00 – $45.00
Morphine injection, up to 10 mg HCPCS J2270	$150.06	$374.20	$149.68 – $336.78
Ondansetron (Zofran) injection, per 1 mg HCPCS J2405	$5.10	$12.69	$5.08 – $11.43
Propofol injection, per 10 mg HCPCS J2704	$1.01	$2.50	$1.30 – $2.25
Saline IV solution, 1000 ml HCPCS J7030	$28.12	$70.11	$36.53 – $63.10

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.

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