Frisbie Memorial Hospital

11 Whitehall Road, Rochester, NH 03867 · Acute care hospital · Emergency room

These are Frisbie Memorial Hospital's own posted figures from its standard-charges file dated September 1, 2026. They are not a quote. Source: the hospital's file · its price transparency page.

229 of the services we track have a posted price here; 142 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	$3,818.00	$3,818.00	$11,975.00 – $15,343.00
Emergency room visit, level 1 (minor) CPT 99281	$804.00	$804.00	$66.25 – $643.20
Emergency room visit, level 2 CPT 99282	$1,064.00	$1,064.00	$87.67 – $851.20
Emergency room visit, level 3 (moderate) CPT 99283	$1,533.00	$1,533.00	$126.32 – $1,226.40
Emergency room visit, level 4 CPT 99284	$2,931.00	$2,931.00	$241.51 – $2,344.80
Emergency room visit, level 5 (most severe) CPT 99285	$4,949.00	$4,949.00	$407.80 – $3,959.20
Simple wound repair (stitches), 2.5 cm or less CPT 12001	not posted		$1,332.00 – $2,723.00

Office visits

Service	Cash price	Gross charge	Insurer rates (min – max)
New patient office visit, about 15 to 29 minutes CPT 99202	$211.00	$211.00	$17.39 – $168.80
New patient office visit, about 30 minutes CPT 99203	$416.00	$416.00	$34.28 – $332.80
New patient office visit, about 45 minutes CPT 99204	$598.00	$598.00	$49.28 – $478.40
New patient office visit, about 60 minutes CPT 99205	$674.00	$674.00	$55.54 – $539.20
Office visit, established patient, about 10 to 19 minutes CPT 99212	$502.00	$502.00	$41.36 – $401.60
Office visit, established patient, about 20 to 29 minutes CPT 99213	$388.00	$388.00	$31.97 – $310.40
Office visit, established patient, about 30 to 39 minutes CPT 99214	$521.00	$521.00	$42.93 – $416.80
Office visit, established patient, about 40 to 54 minutes CPT 99215	$647.00	$647.00	$53.31 – $517.60
Office visit, established patient, brief (often a nurse) CPT 99211	$259.00	$259.00	$21.34 – $207.20
Preventive checkup, new patient, age 18 to 39 CPT 99385	$190.00	$190.00	$67.81 – $69.91
Preventive checkup, new patient, age 40 to 64 CPT 99386	not posted		$82.40 – $84.95

Imaging

Service	Cash price	Gross charge	Insurer rates (min – max)
3D screening mammogram (tomosynthesis), add-on CPT 77063	$56.00	$56.00	$23.61 – $43.39
Abdominal X-ray, 1 view CPT 74018	$718.00	$718.00	$160.01 – $3,032.81
Ankle X-ray, 3 or more views CPT 73610	$1,538.00	$1,538.00	$126.73 – $1,230.40
Bone density scan (DEXA), hips and spine CPT 77080	$2,056.00	$2,056.00	$163.91 – $191.12
Breast ultrasound, one breast, complete CPT 76641	$1,139.00	$1,139.00	$93.85 – $911.20
Breast ultrasound, one breast, limited CPT 76642	$2,033.00	$2,033.00	$167.52 – $1,626.40
Chest X-ray, 1 view CPT 71045	$512.00	$512.00	$92.67 – $108.05
Chest X-ray, 2 views CPT 71046	$915.00	$915.00	$52.43 – $61.13
CT angiogram of the chest (checks for lung clots) CPT 71275	$7,607.00	$7,607.00	$626.82 – $6,085.60
CT angiogram of the head CPT 70496	$7,748.00	$7,748.00	$638.44 – $6,198.40
CT scan of the abdomen and pelvis, with contrast CPT 74177	$8,348.00	$8,348.00	$687.88 – $6,678.40
CT scan of the abdomen and pelvis, without and with contrast CPT 74178	$8,745.00	$8,745.00	$720.59 – $6,996.00
CT scan of the abdomen and pelvis, without contrast CPT 74176	$6,662.00	$6,662.00	$548.95 – $5,329.60
CT scan of the abdomen, without contrast CPT 74150	$4,716.00	$4,716.00	$388.60 – $3,772.80
CT scan of the chest, with contrast CPT 71260	$6,047.00	$6,047.00	$498.27 – $4,837.60
CT scan of the chest, without contrast CPT 71250	$4,606.00	$4,606.00	$379.53 – $3,684.80
CT scan of the head, without contrast CPT 70450	$5,413.00	$5,413.00	$446.03 – $4,330.40
CT scan of the neck (cervical spine), without contrast CPT 72125	$6,072.00	$6,072.00	$500.33 – $4,857.60
CT scan of the pelvis, with contrast CPT 72193	$5,465.00	$5,465.00	$450.32 – $4,372.00
CT scan of the sinuses or face, without contrast CPT 70486	$5,059.00	$5,059.00	$416.86 – $4,047.20
Diagnostic mammogram, both breasts CPT 77066	$1,299.00	$1,299.00	$111.52 – $204.99
Diagnostic mammogram, one breast CPT 77065	$1,265.00	$1,265.00	$104.24 – $1,012.00
Foot X-ray, 3 or more views CPT 73630	$1,577.00	$1,577.00	$129.94 – $1,261.60
Hand X-ray, 3 or more views CPT 73130	$1,571.00	$1,571.00	$129.45 – $1,256.80
Knee X-ray, 3 views CPT 73562	$1,493.00	$1,493.00	$123.02 – $1,194.40
Leg or arm vein ultrasound, both sides CPT 93970	$4,547.00	$4,547.00	$374.67 – $3,637.60
Leg or arm vein ultrasound, one side CPT 93971	$3,029.00	$3,029.00	$249.59 – $2,423.20
Lower back X-ray, 2 or 3 views CPT 72100	$959.00	$959.00	$79.02 – $767.20
MRI of both breasts, without and with contrast CPT 77049	not posted		$1,829.94 – $2,133.63
MRI of the abdomen, without and with contrast CPT 74183	$9,603.00	$9,603.00	$2,711.00 – $3,521.00
MRI of the brain, without and with contrast CPT 70553	$9,603.00	$9,603.00	$2,711.00 – $3,521.00
MRI of the brain, without contrast CPT 70551	$6,398.00	$6,398.00	$2,711.00 – $3,521.00
MRI of the knee or other leg joint, without contrast CPT 73721	$10,032.00	$10,032.00	$826.64 – $8,025.60
MRI of the lower back (lumbar spine), without contrast CPT 72148	$5,016.00	$5,016.00	$2,711.00 – $3,521.00
MRI of the mid back (thoracic spine), without contrast CPT 72146	$6,018.00	$6,018.00	$2,711.00 – $3,521.00
MRI of the neck (cervical spine), without contrast CPT 72141	$6,018.00	$6,018.00	$2,711.00 – $3,521.00
MRI of the pelvis, without and with contrast CPT 72197	$9,603.00	$9,603.00	$2,711.00 – $3,521.00
MRI of the shoulder or other arm joint, without contrast CPT 73221	$10,032.00	$10,032.00	$826.64 – $8,025.60
Neck X-ray, 2 or 3 views CPT 72040	$1,301.00	$1,301.00	$107.20 – $1,040.80
Pelvic ultrasound, complete (not pregnancy) CPT 76856	$1,823.00	$1,823.00	$566.99 – $3,730.96
Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805	$1,618.00	$1,618.00	$484.91 – $565.38
Pregnancy ultrasound, under 14 weeks, single baby CPT 76801	$1,722.00	$1,722.00	$242.81 – $283.11
Screening mammogram, both breasts CPT 77067	$1,431.00	$1,431.00	$117.91 – $1,144.80
Shoulder X-ray, 2 or more views CPT 73030	$2,129.00	$2,129.00	$175.43 – $1,703.20
Transvaginal pregnancy ultrasound CPT 76817	$1,009.00	$1,009.00	$498.89 – $3,730.96
Transvaginal ultrasound CPT 76830	$1,849.00	$1,849.00	$169.26 – $197.35
Ultrasound of the abdomen, complete CPT 76700	$2,270.00	$2,270.00	$419.17 – $488.73
Ultrasound of the neck or thyroid CPT 76536	$2,215.00	$2,215.00	$586.83 – $3,730.96
Wrist X-ray, 3 or more views CPT 73110	$706.00	$706.00	$58.17 – $564.80
X-ray of the lower back, 4 or more views CPT 72110	$1,232.00	$1,232.00	$101.52 – $985.60

Lab tests

Service	Cash price	Gross charge	Insurer rates (min – max)
Basic metabolic panel (blood test) CPT 80048	$386.00	$386.00	$7.54 – $185.93
Blood culture CPT 87040	$395.00	$395.00	$9.20 – $226.80
Blood draw (venipuncture) CPT 36415	$71.00	$71.00	$5.85 – $56.80
BNP test (heart failure) CPT 83880	$383.00	$383.00	$101.65 – $306.40
C-reactive protein (CRP) test CPT 86140	$162.00	$162.00	$4.61 – $113.90
Chlamydia test (DNA/NAAT) CPT 87491	$348.00	$348.00	$31.26 – $771.05
Complete blood count (CBC) with differential CPT 85025	not posted		$12.78 – $32.56
Complete blood count (CBC), automated CPT 85027	$219.00	$219.00	$58.12 – $175.20
Comprehensive metabolic panel (blood test) CPT 80053	$504.00	$504.00	$9.40 – $231.86
COVID-19 PCR test CPT 87635	$117.00	$117.00	$31.05 – $93.60
D-dimer test (blood clots) CPT 85379	$399.00	$399.00	$9.07 – $223.78
Drug screen, instrument chemistry CPT 80307	$558.00	$558.00	$148.09 – $446.40
Ferritin (iron stores) test CPT 82728	$387.00	$387.00	$22.42 – $57.12
Free T4 (thyroid) test CPT 84439	$241.00	$241.00	$8.03 – $198.08
General health panel (blood tests) CPT 80050	not posted		$74.62 – $190.10
Glucose (blood sugar) test CPT 82947	$197.00	$197.00	$6.46 – $16.47
Gonorrhea test (DNA/NAAT) CPT 87591	$348.00	$348.00	$57.72 – $147.06
Hemoglobin A1c test CPT 83036	$210.00	$210.00	$55.73 – $168.00
Hepatitis C antibody test CPT 86803	$247.00	$247.00	$23.47 – $59.81
HIV-1/HIV-2 antigen and antibody test CPT 87389	$258.00	$258.00	$68.47 – $206.40
Iron test CPT 83540	$134.00	$134.00	$5.77 – $142.33
Kidney function panel CPT 80069	$227.00	$227.00	$7.74 – $190.64
Lipase test (pancreas) CPT 83690	$187.00	$187.00	$11.33 – $28.88
Lipid panel, cholesterol and triglycerides CPT 80061	$474.00	$474.00	$125.80 – $379.20
Liver function panel CPT 80076	$170.00	$170.00	$13.44 – $34.24
Magnesium test CPT 83735	$174.00	$174.00	$46.18 – $139.20
Obstetric blood test panel CPT 80055	not posted		$78.65 – $200.37
Partial thromboplastin time (PTT), clotting test CPT 85730	$226.00	$226.00	$9.89 – $25.19
Pregnancy blood test (hCG), quantitative CPT 84702	$383.00	$383.00	$24.76 – $63.07
Prothrombin time (PT/INR), clotting test CPT 85610	$105.00	$105.00	$27.87 – $84.00
PSA (prostate specific antigen), free CPT 84154	$245.00	$245.00	$16.39 – $403.96
PSA (prostate specific antigen), total CPT 84153	$300.00	$300.00	$30.25 – $77.07
Rapid strep test CPT 87880	$147.00	$147.00	$39.01 – $117.60
Sed rate (ESR) test CPT 85652	$19.00	$19.00	$2.41 – $59.48
TB skin test CPT 86580	$111.00	$111.00	$29.46 – $88.80
Thyroid stimulating hormone (TSH) CPT 84443	$460.00	$460.00	$14.97 – $369.13
Tissue exam by a pathologist (biopsy specimen) CPT 88305	$3,469.00	$3,469.00	$920.67 – $2,775.20
Troponin test (heart damage) CPT 84484	$405.00	$405.00	$11.11 – $274.13
Urinalysis, automated, with microscope CPT 81001	$189.00	$189.00	$5.21 – $13.29
Urinalysis, automated, without microscope CPT 81003	$88.00	$88.00	$23.36 – $70.40
Urinalysis, manual, with microscope CPT 81000	not posted		$6.61 – $16.85
Urinalysis, manual, without microscope CPT 81002	$63.00	$63.00	$16.72 – $50.40
Urine culture, colony count CPT 87086	$222.00	$222.00	$13.28 – $33.82
Urine pregnancy test CPT 81025	$178.00	$178.00	$47.24 – $142.40
Vitamin B12 test CPT 82607	$268.00	$268.00	$13.43 – $331.28
Vitamin D test CPT 82306	$505.00	$505.00	$134.03 – $404.00

Heart

Service	Cash price	Gross charge	Insurer rates (min – max)
Carotid artery ultrasound, both sides CPT 93880	$3,543.00	$3,543.00	$291.94 – $2,834.40
ECG tracing only (no interpretation) CPT 93005	$392.00	$392.00	$32.30 – $313.60
Echocardiogram (heart ultrasound), complete with Doppler CPT 93306	$4,189.00	$4,189.00	$345.17 – $3,351.20
Electrocardiogram (ECG/EKG) with interpretation CPT 93000	not posted		$12.90 – $13.30
Holter monitor, up to 48 hours CPT 93224	not posted		$59.93 – $61.78
Left heart catheterization CPT 93452	not posted		$8,291.00 – $15,364.00
Left heart catheterization with coronary angiogram CPT 93458	not posted		$8,291.00 – $15,364.00
Nuclear stress test (heart perfusion imaging) CPT 78452	$6,477.00	$6,477.00	$2,319.58 – $2,704.52

Surgery

Service	Cash price	Insurer rates (min – max)
ACL reconstruction, arthroscopic CPT 29888	not posted	$8,512.00 – $18,158.00
Appendix removal, laparoscopic CPT 44970	not posted	$8,512.00 – $18,158.00
Breast biopsy with ultrasound guidance CPT 19083	not posted	$1,450.00 – $16,279.00
Carpal tunnel release CPT 64721	not posted	$1,450.00 – $6,929.00
Colonoscopy with biopsy CPT 45380	not posted	$1,450.00 – $6,929.00
Colonoscopy with polyp removal (snare) CPT 45385	not posted	$1,450.00 – $6,929.00
Colonoscopy, diagnostic CPT 45378	not posted	$1,332.00 – $6,929.00
Colposcopy with biopsy CPT 57454	not posted	$1,332.00 – $5,943.00
Cystoscopy (bladder scope) CPT 52000	not posted	$1,332.00 – $5,943.00
Ear tubes, under general anesthesia CPT 69436	not posted	$1,450.00 – $16,279.00
Flexible sigmoidoscopy, diagnostic CPT 45330	not posted	$1,332.00 – $5,943.00
Gallbladder removal, laparoscopic CPT 47562	not posted	$8,512.00 – $18,158.00
Gastric bypass (weight loss surgery), laparoscopic CPT 43644	not posted	$8,512.00 – $26,976.00
Hysterectomy, laparoscopic, with tubes and/or ovaries CPT 58571	not posted	$8,993.00 – $19,985.00
Hysteroscopy with biopsy or polyp removal CPT 58558	not posted	$13,748.00 – $16,279.00
Inguinal (groin) hernia repair, laparoscopic CPT 49650	not posted	$8,512.00 – $28,998.00
Inguinal (groin) hernia repair, open, age 5 or older CPT 49505	not posted	$3,302.00 – $28,998.00
Kidney stone shock-wave lithotripsy CPT 50590	not posted	$3,302.00 – $6,298.00
Knee arthroscopy, meniscus trim (meniscectomy) CPT 29881	not posted	$44,397.00 – $51,057.00
Lower colon endoscopy with ultrasound CPT 45391	not posted	$1,450.00 – $6,929.00
Nasal endoscopy, diagnostic CPT 31231	not posted	$1,332.00 – $2,723.00
Prostate biopsy CPT 55700	not posted	$1,450.00 – $3,149.00
Prostate removal, laparoscopic or robotic CPT 55866	not posted	$8,993.00 – $19,985.00
Removal of a breast lump, open surgery CPT 19120	not posted	$3,302.00 – $16,279.00
Rotator cuff repair, arthroscopic CPT 29827	not posted	$8,512.00 – $19,440.00
Screening colonoscopy, average risk HCPCS G0121	not posted	$5,851.00 – $6,929.00
Screening colonoscopy, high risk HCPCS G0105	not posted	$1,332.00 – $6,929.00
Septoplasty (nasal septum repair) CPT 30520	not posted	$1,450.00 – $28,998.00
Shoulder arthroscopy, bone shaving (decompression) CPT 29826	not posted	$13,748.00 – $16,279.00
Sleeve gastrectomy (weight loss surgery), laparoscopic CPT 43775	not posted	$8,512.00 – $26,976.00
Tonsil and adenoid removal, under age 12 CPT 42820	not posted	$4,769.00 – $16,279.00
Total hip replacement CPT 27130	not posted	$14,000.00 – $51,057.00
Total knee replacement CPT 27447	not posted	$28,614.00 – $53,020.00
Upper endoscopy (EGD) with biopsy CPT 43239	not posted	$1,332.00 – $2,723.00
Upper endoscopy (EGD), diagnostic CPT 43235	not posted	$5,019.00 – $5,943.00
Vasectomy CPT 55250	not posted	$1,450.00 – $6,929.00

Pregnancy and birth

Service	Cash price	Gross charge	Insurer rates (min – max)
C-section delivery, routine care including prenatal and postpartum CPT 59510	not posted		$3,302.00 – $6,298.00
Fetal non-stress test CPT 59025	$416.00	$416.00	$34.28 – $332.80
IUD insertion CPT 58300	not posted		$1,332.00 – $2,723.00
Vaginal birth after a prior C-section (VBAC), routine care CPT 59610	not posted		$3,302.00 – $6,298.00
Vaginal delivery, routine care including prenatal and postpartum CPT 59400	not posted		$3,302.00 – $6,298.00

Hospital stays

Service	Cash price	Insurer rates (min – max)
Alcohol or drug use disorder, without rehab, without major complications MS-DRG 897	not posted	$1,000.19 – $1,020.19
C-section, without complications MS-DRG 788	not posted	$2,252.94 – $4,278.00
Chest pain MS-DRG 313	not posted	$3,609.00 – $5,552.00
COPD flare-up, with major complications MS-DRG 190	not posted	$3,609.00 – $5,552.00
COPD flare-up, without complications MS-DRG 192	not posted	$3,609.00 – $5,552.00
Fainting (syncope) MS-DRG 312	not posted	$3,609.00 – $5,552.00
Gastrointestinal bleeding, with complications MS-DRG 378	not posted	$3,609.00 – $5,552.00
Heart failure, with major complications MS-DRG 291	not posted	$3,609.00 – $5,552.00
Heart failure, without complications MS-DRG 293	not posted	$3,609.00 – $5,552.00
Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216	not posted	$7,757.00 – $199,950.00
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470	not posted	$7,757.00 – $70,180.00
Irregular heartbeat, without complications MS-DRG 310	not posted	$3,609.00 – $5,552.00
Kidney failure, with complications MS-DRG 683	not posted	$3,609.00 – $5,552.00
Kidney or urinary tract infection, without major complications MS-DRG 690	not posted	$3,609.00 – $5,552.00
Neck (cervical) spinal fusion, without complications MS-DRG 473	not posted	$3,609.00 – $5,552.00
Normal newborn care MS-DRG 795	not posted	$702.52 – $702.52
Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641	not posted	$3,609.00 – $5,552.00
Pneumonia, with complications MS-DRG 194	not posted	$3,609.00 – $5,552.00
Pneumonia, with major complications MS-DRG 193	not posted	$3,609.00 – $5,552.00
Pneumonia, without complications MS-DRG 195	not posted	$3,609.00 – $5,552.00
Psychoses (inpatient psychiatric stay) MS-DRG 885	not posted	$974.84 – $994.34
Sepsis, with major complications MS-DRG 871	not posted	$3,609.00 – $5,552.00
Sepsis, without major complications MS-DRG 872	not posted	$3,609.00 – $5,552.00
Skin infection (cellulitis), without major complications MS-DRG 603	not posted	$3,609.00 – $5,552.00
Spinal fusion except neck, without major complications MS-DRG 460	not posted	$73,272.00 – $73,272.00
Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392	not posted	$3,609.00 – $5,552.00
Stroke, with complications or clot-busting drug MS-DRG 65	not posted	$3,609.00 – $5,552.00
Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743	not posted	$3,609.00 – $5,552.00
Vaginal delivery, without complications MS-DRG 807	not posted	$2,252.94 – $2,252.94
Weight loss surgery, without complications MS-DRG 621	not posted	$7,757.00 – $44,567.19

Pain and spine

Service	Cash price	Insurer rates (min – max)
Large joint injection or drainage (knee, shoulder, hip) CPT 20610	not posted	$1,332.00 – $5,943.00
Lower back nerve root injection with imaging guidance CPT 64483	not posted	$1,332.00 – $5,943.00
Lower back spinal injection (epidural), with imaging guidance CPT 62323	not posted	$1,332.00 – $5,943.00
Lower back spinal injection (epidural), without imaging CPT 62322	not posted	$1,332.00 – $5,943.00

Eye

Service	Cash price	Gross charge	Insurer rates (min – max)
Cataract removal with lens implant CPT 66984	not posted		$1,450.00 – $26,378.00
Laser treatment of clouding after cataract surgery (YAG) CPT 66821	not posted		$1,332.00 – $6,929.00

Sleep

Service	Cash price	Gross charge	Insurer rates (min – max)
Home sleep apnea test CPT 95806	$805.00	$805.00	$1,651.00 – $3,671.00
Sleep study with CPAP titration CPT 95811	$8,377.00	$8,377.00	$488.00 – $1,083.00
Sleep study, overnight in a sleep lab CPT 95810	$6,381.00	$6,381.00	$488.00 – $1,083.00

Lungs

Service	Cash price	Gross charge	Insurer rates (min – max)
Spirometry (breathing test) CPT 94010	$488.00	$488.00	$40.21 – $390.40

Therapy

Service	Cash price	Gross charge	Insurer rates (min – max)
Manual therapy, 15 minutes CPT 97140	$224.00	$224.00	$18.46 – $179.20
Physical therapy evaluation, low complexity CPT 97161	$387.00	$387.00	$31.89 – $309.60
Physical therapy evaluation, moderate complexity CPT 97162	$600.00	$600.00	$49.44 – $480.00
Physical therapy, therapeutic exercise, 15 minutes CPT 97110	$224.00	$224.00	$18.46 – $179.20
Therapeutic activities, 15 minutes CPT 97530	$224.00	$224.00	$18.46 – $179.20

Mental health

Service	Cash price	Gross charge	Insurer rates (min – max)
Family psychotherapy, with the patient, 50 minutes CPT 90847	$806.00	$806.00	$66.41 – $486.02
Family psychotherapy, without the patient, 50 minutes CPT 90846	$806.00	$806.00	$66.41 – $486.02
Group psychotherapy CPT 90853	$496.00	$496.00	$40.87 – $396.80
Psychiatric diagnostic evaluation CPT 90791	$887.00	$887.00	$73.09 – $534.86
Psychotherapy, 30 minutes CPT 90832	$887.00	$887.00	$73.09 – $709.60
Psychotherapy, 45 minutes CPT 90834	$806.00	$806.00	$66.41 – $486.02
Psychotherapy, 60 minutes CPT 90837	$887.00	$887.00	$73.09 – $709.60

Infusions and injections

Service	Cash price	Gross charge	Insurer rates (min – max)
Injection under the skin or into a muscle CPT 96372	$703.00	$703.00	$57.93 – $562.40
IV hydration, each additional hour CPT 96361	$503.00	$503.00	$41.45 – $402.40
IV hydration, first hour CPT 96360	$1,208.00	$1,208.00	$99.54 – $966.40
IV push injection of a drug, first CPT 96374	$1,151.00	$1,151.00	$94.84 – $920.80
IV push injection, each additional drug CPT 96375	$268.00	$268.00	$22.08 – $214.40

Drugs

Service	Cash price	Gross charge	Insurer rates (min – max)
Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696	$160.00	$160.00	$13.18 – $128.00
Dexamethasone injection, per 1 mg HCPCS J1100	$83.00	$83.00	$6.84 – $66.40
Fentanyl injection, per 0.1 mg HCPCS J3010	$291.00	$291.00	$23.98 – $232.80
Ketorolac (Toradol) injection, per 15 mg HCPCS J1885	$83.00	$83.00	$6.84 – $66.40
Midazolam (Versed) injection, per 1 mg HCPCS J2250	$172.00	$172.00	$14.17 – $137.60
Morphine injection, up to 10 mg HCPCS J2270	$41.00	$41.00	$3.38 – $32.80
Ondansetron (Zofran) injection, per 1 mg HCPCS J2405	$14.00	$14.00	$1.15 – $11.20
Propofol injection, per 10 mg HCPCS J2704	$282.00	$282.00	$23.24 – $225.60
Saline IV solution, 1000 ml HCPCS J7030	$65.00	$65.00	$2.12 – $5.27

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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