Portsmouth Regional Hospital

333 Borthwick Ave, Portsmouth, NH 03801 · Acute care hospital · Emergency room

These are Portsmouth Regional 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; 139 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	$9,833.00	$9,833.00	$405.12 – $9,341.35
Emergency room visit, level 1 (minor) CPT 99281	$1,338.00	$1,338.00	$55.13 – $1,271.10
Emergency room visit, level 2 CPT 99282	$2,135.00	$2,135.00	$87.96 – $2,028.25
Emergency room visit, level 3 (moderate) CPT 99283	$3,374.00	$3,374.00	$139.01 – $3,205.30
Emergency room visit, level 4 CPT 99284	$5,539.00	$5,539.00	$228.21 – $5,262.05
Emergency room visit, level 5 (most severe) CPT 99285	$10,174.00	$10,174.00	$419.17 – $9,665.30
Simple wound repair (stitches), 2.5 cm or less CPT 12001	not posted		$1,282.50 – $3,460.00

Office visits

Service	Cash price	Gross charge	Insurer rates (min – max)
New patient office visit, about 15 to 29 minutes CPT 99202	$1,332.00	$1,332.00	$54.88 – $1,332.00
New patient office visit, about 30 minutes CPT 99203	$1,374.00	$1,374.00	$56.61 – $1,374.00
New patient office visit, about 45 minutes CPT 99204	$1,584.00	$1,584.00	$65.26 – $1,584.00
New patient office visit, about 60 minutes CPT 99205	$1,591.00	$1,591.00	$65.55 – $1,591.00
Office visit, established patient, about 10 to 19 minutes CPT 99212	$1,227.00	$1,227.00	$50.55 – $1,227.00
Office visit, established patient, about 20 to 29 minutes CPT 99213	$1,367.00	$1,367.00	$56.32 – $1,367.00
Office visit, established patient, about 30 to 39 minutes CPT 99214	$1,578.00	$1,578.00	$65.01 – $1,578.00
Office visit, established patient, about 40 to 54 minutes CPT 99215	$1,584.00	$1,584.00	$65.26 – $1,584.00
Office visit, established patient, brief (often a nurse) CPT 99211	$806.00	$806.00	$33.21 – $806.00
Preventive checkup, new patient, age 18 to 39 CPT 99385	not posted		$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	$52.00	$52.00	$23.61 – $43.39
Abdominal X-ray, 1 view CPT 74018	$335.00	$335.00	$214.39 – $268.00
Ankle X-ray, 3 or more views CPT 73610	$1,041.00	$1,041.00	$42.89 – $988.95
Bone density scan (DEXA), hips and spine CPT 77080	$1,414.00	$1,414.00	$387.18 – $483.98
Breast ultrasound, one breast, complete CPT 76641	$1,887.00	$1,887.00	$77.74 – $1,792.65
Breast ultrasound, one breast, limited CPT 76642	$1,887.00	$1,887.00	$77.74 – $1,792.65
Chest X-ray, 1 view CPT 71045	$335.00	$335.00	$113.54 – $726.73
Chest X-ray, 2 views CPT 71046	$335.00	$335.00	$104.64 – $116.26
CT angiogram of the chest (checks for lung clots) CPT 71275	$11,214.00	$11,214.00	$694.25 – $867.82
CT angiogram of the head CPT 70496	$11,214.00	$11,214.00	$462.02 – $10,653.30
CT scan of the abdomen and pelvis, with contrast CPT 74177	$13,697.00	$13,697.00	$1,327.93 – $1,659.94
CT scan of the abdomen and pelvis, without and with contrast CPT 74178	$14,436.00	$14,436.00	$1,327.93 – $1,659.94
CT scan of the abdomen and pelvis, without contrast CPT 74176	$8,838.00	$8,838.00	$793.43 – $991.80
CT scan of the abdomen, without contrast CPT 74150	$6,395.00	$6,395.00	$263.47 – $6,075.25
CT scan of the chest, with contrast CPT 71260	$9,328.00	$9,328.00	$694.25 – $867.82
CT scan of the chest, without contrast CPT 71250	$6,690.00	$6,690.00	$387.18 – $483.98
CT scan of the head, without contrast CPT 70450	$5,864.00	$5,864.00	$387.18 – $483.98
CT scan of the neck (cervical spine), without contrast CPT 72125	$8,182.00	$8,182.00	$387.18 – $483.98
CT scan of the pelvis, with contrast CPT 72193	$9,726.00	$9,726.00	$694.25 – $867.82
CT scan of the sinuses or face, without contrast CPT 70486	$7,415.00	$7,415.00	$387.18 – $483.98
Diagnostic mammogram, both breasts CPT 77066	$1,153.00	$1,153.00	$47.50 – $1,095.35
Diagnostic mammogram, one breast CPT 77065	$975.00	$975.00	$40.17 – $926.25
Foot X-ray, 3 or more views CPT 73630	$1,104.00	$1,104.00	$45.48 – $1,048.80
Hand X-ray, 3 or more views CPT 73130	$1,085.00	$1,085.00	$44.70 – $1,030.75
Knee X-ray, 3 views CPT 73562	$500.00	$500.00	$20.60 – $475.00
Leg or arm vein ultrasound, both sides CPT 93970	$4,282.00	$4,282.00	$176.42 – $4,067.90
Leg or arm vein ultrasound, one side CPT 93971	$2,543.00	$2,543.00	$104.77 – $2,415.85
Lower back X-ray, 2 or 3 views CPT 72100	$1,209.00	$1,209.00	$387.18 – $483.98
MRI of both breasts, without and with contrast CPT 77049	not posted		$460.60 – $511.78
MRI of the abdomen, without and with contrast CPT 74183	$9,630.00	$9,630.00	$2,754.00 – $3,591.00
MRI of the brain, without and with contrast CPT 70553	$9,146.00	$9,146.00	$1,327.93 – $1,659.94
MRI of the brain, without contrast CPT 70551	$6,891.00	$6,891.00	$2,754.00 – $3,591.00
MRI of the knee or other leg joint, without contrast CPT 73721	$10,333.00	$10,333.00	$425.72 – $9,816.35
MRI of the lower back (lumbar spine), without contrast CPT 72148	$7,613.00	$7,613.00	$2,754.00 – $3,591.00
MRI of the mid back (thoracic spine), without contrast CPT 72146	$7,613.00	$7,613.00	$313.66 – $7,232.35
MRI of the neck (cervical spine), without contrast CPT 72141	$7,613.00	$7,613.00	$793.43 – $991.80
MRI of the pelvis, without and with contrast CPT 72197	$9,630.00	$9,630.00	$1,327.93 – $1,659.94
MRI of the shoulder or other arm joint, without contrast CPT 73221	$10,332.00	$10,332.00	$425.68 – $9,815.40
Neck X-ray, 2 or 3 views CPT 72040	$1,177.00	$1,177.00	$178.78 – $726.73
Pelvic ultrasound, complete (not pregnancy) CPT 76856	$1,974.00	$1,974.00	$387.18 – $483.98
Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805	$1,679.00	$1,679.00	$205.37 – $228.19
Pregnancy ultrasound, under 14 weeks, single baby CPT 76801	$686.00	$686.00	$202.33 – $224.82
Screening mammogram, both breasts CPT 77067	$950.00	$950.00	$39.14 – $902.50
Shoulder X-ray, 2 or more views CPT 73030	$948.00	$948.00	$39.06 – $900.60
Transvaginal pregnancy ultrasound CPT 76817	$1,338.00	$1,338.00	$415.72 – $894.01
Transvaginal ultrasound CPT 76830	$1,983.00	$1,983.00	$387.18 – $483.98
Ultrasound of the abdomen, complete CPT 76700	$2,445.00	$2,445.00	$162.97 – $181.08
Ultrasound of the neck or thyroid CPT 76536	$1,887.00	$1,887.00	$374.04 – $415.60
Wrist X-ray, 3 or more views CPT 73110	$1,083.00	$1,083.00	$44.62 – $1,028.85
X-ray of the lower back, 4 or more views CPT 72110	$595.00	$595.00	$55.17 – $61.30

Lab tests

Service	Cash price	Gross charge	Insurer rates (min – max)
Basic metabolic panel (blood test) CPT 80048	$615.00	$615.00	$158.06 – $584.25
Blood culture CPT 87040	$499.00	$499.00	$9.20 – $54.36
Blood draw (venipuncture) CPT 36415	$63.00	$63.00	$2.60 – $59.85
BNP test (heart failure) CPT 83880	$456.00	$456.00	$117.19 – $433.20
C-reactive protein (CRP) test CPT 86140	$373.00	$373.00	$95.86 – $354.35
Chlamydia test (DNA/NAAT) CPT 87491	$373.00	$373.00	$95.86 – $354.35
Complete blood count (CBC) with differential CPT 85025	not posted		$13.40 – $31.31
Complete blood count (CBC), automated CPT 85027	$221.00	$221.00	$56.80 – $209.95
Comprehensive metabolic panel (blood test) CPT 80053	$818.00	$818.00	$210.23 – $777.10
COVID-19 PCR test CPT 87635	$86.00	$86.00	$22.10 – $81.70
D-dimer test (blood clots) CPT 85379	$303.00	$303.00	$17.55 – $41.03
Drug screen, instrument chemistry CPT 80307	$280.00	$280.00	$107.15 – $250.42
Ferritin (iron stores) test CPT 82728	$350.00	$350.00	$89.95 – $332.50
Free T4 (thyroid) test CPT 84439	$440.00	$440.00	$113.08 – $418.00
General health panel (blood tests) CPT 80050	not posted		$78.22 – $182.80
Glucose (blood sugar) test CPT 82947	$40.00	$40.00	$10.28 – $38.00
Gonorrhea test (DNA/NAAT) CPT 87591	$373.00	$373.00	$95.86 – $354.35
Hemoglobin A1c test CPT 83036	$402.00	$402.00	$103.31 – $381.90
Hepatitis C antibody test CPT 86803	$311.00	$311.00	$12.71 – $75.75
HIV-1/HIV-2 antigen and antibody test CPT 87389	not posted		$41.52 – $97.04
Iron test CPT 83540	$981.00	$981.00	$252.12 – $931.95
Kidney function panel CPT 80069	$681.00	$681.00	$175.02 – $646.95
Lipase test (pancreas) CPT 83690	$134.00	$134.00	$6.14 – $36.29
Lipid panel, cholesterol and triglycerides CPT 80061	$549.00	$549.00	$141.09 – $521.55
Liver function panel CPT 80076	$883.00	$883.00	$226.93 – $838.85
Magnesium test CPT 83735	$411.00	$411.00	$105.63 – $390.45
Obstetric blood test panel CPT 80055	not posted		$82.44 – $192.67
Partial thromboplastin time (PTT), clotting test CPT 85730	$268.00	$268.00	$68.88 – $254.60
Pregnancy blood test (hCG), quantitative CPT 84702	$1,295.00	$1,295.00	$332.81 – $1,230.25
Prothrombin time (PT/INR), clotting test CPT 85610	$175.00	$175.00	$44.98 – $166.25
PSA (prostate specific antigen), free CPT 84154	$287.00	$287.00	$16.39 – $96.79
PSA (prostate specific antigen), total CPT 84153	$659.00	$659.00	$169.36 – $626.05
Rapid strep test CPT 87880	$108.00	$108.00	$28.50 – $66.62
Sed rate (ESR) test CPT 85652	$268.00	$268.00	$68.88 – $254.60
TB skin test CPT 86580	not posted		$42.54 – $99.42
Thyroid stimulating hormone (TSH) CPT 84443	$791.00	$791.00	$203.29 – $751.45
Tissue exam by a pathologist (biopsy specimen) CPT 88305	$1,266.00	$1,266.00	$325.36 – $1,202.70
Troponin test (heart damage) CPT 84484	$272.00	$272.00	$69.90 – $258.40
Urinalysis, automated, with microscope CPT 81001	$234.00	$234.00	$2.82 – $16.68
Urinalysis, automated, without microscope CPT 81003	$187.00	$187.00	$48.06 – $177.65
Urinalysis, manual, with microscope CPT 81000	not posted		$6.93 – $16.20
Urinalysis, manual, without microscope CPT 81002	$52.00	$52.00	$3.10 – $18.30
Urine culture, colony count CPT 87086	$287.00	$287.00	$73.76 – $272.65
Urine pregnancy test CPT 81025	$234.00	$234.00	$60.14 – $222.30
Vitamin B12 test CPT 82607	$497.00	$497.00	$127.73 – $472.15
Vitamin D test CPT 82306	$661.00	$661.00	$169.88 – $627.95

Heart

Service	Cash price	Gross charge	Insurer rates (min – max)
Carotid artery ultrasound, both sides CPT 93880	$3,743.00	$3,743.00	$154.21 – $3,555.85
ECG tracing only (no interpretation) CPT 93005	$715.00	$715.00	$29.46 – $679.25
Echocardiogram (heart ultrasound), complete with Doppler CPT 93306	$5,124.00	$5,124.00	$211.11 – $4,867.80
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		$9,744.30 – $14,408.00
Left heart catheterization with coronary angiogram CPT 93458	not posted		$9,744.30 – $14,408.00
Nuclear stress test (heart perfusion imaging) CPT 78452	$5,642.00	$5,642.00	$1,607.62 – $1,786.24

Surgery

Service	Cash price	Insurer rates (min – max)
ACL reconstruction, arthroscopic CPT 29888	not posted	$10,005.30 – $18,241.00
Appendix removal, laparoscopic CPT 44970	not posted	$10,005.30 – $18,241.00
Breast biopsy with ultrasound guidance CPT 19083	not posted	$1,569.60 – $3,879.00
Carpal tunnel release CPT 64721	not posted	$1,569.60 – $3,879.00
Colonoscopy with biopsy CPT 45380	not posted	$1,569.60 – $7,204.00
Colonoscopy with polyp removal (snare) CPT 45385	not posted	$1,569.60 – $7,204.00
Colonoscopy, diagnostic CPT 45378	not posted	$2,000.00 – $2,000.00
Colposcopy with biopsy CPT 57454	not posted	$1,282.50 – $6,178.00
Cystoscopy (bladder scope) CPT 52000	not posted	$1,282.50 – $3,460.00
Ear tubes, under general anesthesia CPT 69436	not posted	$1,569.60 – $16,924.00
Flexible sigmoidoscopy, diagnostic CPT 45330	not posted	$1,282.50 – $6,178.00
Gallbladder removal, laparoscopic CPT 47562	not posted	$10,005.30 – $18,241.00
Gastric bypass (weight loss surgery), laparoscopic CPT 43644	not posted	$10,005.30 – $28,045.00
Hysterectomy, laparoscopic, with tubes and/or ovaries CPT 58571	not posted	$10,568.70 – $19,971.00
Hysteroscopy with biopsy or polyp removal CPT 58558	not posted	$1,569.60 – $16,924.00
Inguinal (groin) hernia repair, laparoscopic CPT 49650	not posted	$10,005.30 – $30,146.00
Inguinal (groin) hernia repair, open, age 5 or older CPT 49505	not posted	$4,686.30 – $30,146.00
Kidney stone shock-wave lithotripsy CPT 50590	not posted	$34,557.00 – $39,740.00
Knee arthroscopy, meniscus trim (meniscectomy) CPT 29881	not posted	$4,686.30 – $6,290.00
Lower colon endoscopy with ultrasound CPT 45391	not posted	$1,569.60 – $7,204.00
Nasal endoscopy, diagnostic CPT 31231	not posted	$1,282.50 – $3,460.00
Prostate biopsy CPT 55700	not posted	$1,569.60 – $3,879.00
Prostate removal, laparoscopic or robotic CPT 55866	not posted	$10,568.70 – $19,971.00
Removal of a breast lump, open surgery CPT 19120	not posted	$4,686.30 – $16,924.00
Rotator cuff repair, arthroscopic CPT 29827	not posted	$17,235.00 – $20,209.00
Screening colonoscopy, average risk HCPCS G0121	not posted	$1,282.50 – $7,204.00
Screening colonoscopy, high risk HCPCS G0105	not posted	$1,282.50 – $7,204.00
Septoplasty (nasal septum repair) CPT 30520	not posted	$25,711.00 – $30,146.00
Shoulder arthroscopy, bone shaving (decompression) CPT 29826	not posted	$14,433.00 – $16,924.00
Sleeve gastrectomy (weight loss surgery), laparoscopic CPT 43775	not posted	$10,005.30 – $28,045.00
Tonsil and adenoid removal, under age 12 CPT 42820	not posted	$5,604.30 – $16,924.00
Total hip replacement CPT 27130	not posted	$33,630.30 – $49,730.00
Total knee replacement CPT 27447	not posted	$33,630.30 – $49,730.00
Upper endoscopy (EGD) with biopsy CPT 43239	not posted	$1,282.50 – $7,204.00
Upper endoscopy (EGD), diagnostic CPT 43235	not posted	$1,282.50 – $6,178.00
Vasectomy CPT 55250	not posted	$1,569.60 – $7,204.00

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		$4,686.30 – $6,290.00
Fetal non-stress test CPT 59025	$5,210.00	$5,210.00	$214.65 – $4,949.50
IUD insertion CPT 58300	not posted		$1,282.50 – $3,460.00
Vaginal birth after a prior C-section (VBAC), routine care CPT 59610	not posted		$4,686.30 – $6,290.00
Vaginal delivery, routine care including prenatal and postpartum CPT 59400	not posted		$4,686.30 – $6,290.00

Hospital stays

Service	Cash price	Insurer rates (min – max)
Alcohol or drug use disorder, without rehab, without major complications MS-DRG 897	not posted	$1,116.04 – $1,227.65
C-section, without complications MS-DRG 788	not posted	$3,724.00 – $23,361.00
Chest pain MS-DRG 313	not posted	$4,602.00 – $5,752.00
COPD flare-up, with major complications MS-DRG 190	not posted	$4,602.00 – $5,752.00
COPD flare-up, without complications MS-DRG 192	not posted	$4,602.00 – $5,752.00
Fainting (syncope) MS-DRG 312	not posted	$4,602.00 – $5,752.00
Gastrointestinal bleeding, with complications MS-DRG 378	not posted	$4,602.00 – $5,752.00
Heart failure, with major complications MS-DRG 291	not posted	$4,602.00 – $5,752.00
Heart failure, without complications MS-DRG 293	not posted	$4,602.00 – $5,752.00
Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216	not posted	$7,757.00 – $199,969.00
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470	not posted	$7,757.00 – $70,848.00
Irregular heartbeat, without complications MS-DRG 310	not posted	$4,602.00 – $5,752.00
Kidney failure, with complications MS-DRG 683	not posted	$4,602.00 – $5,752.00
Kidney or urinary tract infection, without major complications MS-DRG 690	not posted	$4,602.00 – $5,752.00
Neck (cervical) spinal fusion, without complications MS-DRG 473	not posted	$4,602.00 – $5,752.00
Normal newborn care MS-DRG 795	not posted	$859.50 – $6,332.00
Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641	not posted	$4,602.00 – $5,752.00
Pneumonia, with complications MS-DRG 194	not posted	$4,602.00 – $5,752.00
Pneumonia, with major complications MS-DRG 193	not posted	$4,602.00 – $5,752.00
Pneumonia, without complications MS-DRG 195	not posted	$4,602.00 – $5,752.00
Psychoses (inpatient psychiatric stay) MS-DRG 885	not posted	$1,151.97 – $1,267.17
Sepsis, with major complications MS-DRG 871	not posted	$4,602.00 – $5,752.00
Sepsis, without major complications MS-DRG 872	not posted	$4,602.00 – $5,752.00
Skin infection (cellulitis), without major complications MS-DRG 603	not posted	$4,602.00 – $5,752.00
Spinal fusion except neck, without major complications MS-DRG 460	not posted	$73,279.00 – $73,279.00
Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392	not posted	$4,602.00 – $5,752.00
Stroke, with complications or clot-busting drug MS-DRG 65	not posted	$4,602.00 – $5,752.00
Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743	not posted	$4,602.00 – $5,752.00
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 – $55,741.41

Pain and spine

Service	Cash price	Insurer rates (min – max)
Large joint injection or drainage (knee, shoulder, hip) CPT 20610	not posted	$1,282.50 – $6,178.00
Lower back nerve root injection with imaging guidance CPT 64483	not posted	$1,282.50 – $3,460.00
Lower back spinal injection (epidural), with imaging guidance CPT 62323	not posted	$1,282.50 – $6,178.00
Lower back spinal injection (epidural), without imaging CPT 62322	not posted	$1,282.50 – $6,178.00

Eye

Service	Cash price	Gross charge	Insurer rates (min – max)
Cataract removal with lens implant CPT 66984	not posted		$1,569.60 – $27,423.00
Laser treatment of clouding after cataract surgery (YAG) CPT 66821	not posted		$1,282.50 – $7,204.00

Sleep

Service	Cash price	Gross charge	Insurer rates (min – max)
Home sleep apnea test CPT 95806	$1,256.00	$1,256.00	$1,657.80 – $2,943.00
Sleep study with CPAP titration CPT 95811	$10,760.00	$10,760.00	$443.31 – $10,222.00
Sleep study, overnight in a sleep lab CPT 95810	$9,886.00	$9,886.00	$407.30 – $9,391.70

Lungs

Service	Cash price	Gross charge	Insurer rates (min – max)
Spirometry (breathing test) CPT 94010	$1,066.00	$1,066.00	$43.92 – $1,012.70

Therapy

Service	Cash price	Gross charge	Insurer rates (min – max)
Manual therapy, 15 minutes CPT 97140	$245.00	$245.00	$10.09 – $232.75
Physical therapy evaluation, low complexity CPT 97161	$730.00	$730.00	$30.08 – $693.50
Physical therapy evaluation, moderate complexity CPT 97162	$730.00	$730.00	$30.08 – $693.50
Physical therapy, therapeutic exercise, 15 minutes CPT 97110	$245.00	$245.00	$10.09 – $232.75
Therapeutic activities, 15 minutes CPT 97530	$245.00	$245.00	$10.09 – $232.75

Mental health

Service	Cash price	Gross charge	Insurer rates (min – max)
Family psychotherapy, with the patient, 50 minutes CPT 90847	$1,073.00	$1,073.00	$44.21 – $1,019.35
Family psychotherapy, without the patient, 50 minutes CPT 90846	$1,073.00	$1,073.00	$44.21 – $1,019.35
Group psychotherapy CPT 90853	$496.00	$496.00	$20.44 – $471.20
Psychiatric diagnostic evaluation CPT 90791	$755.00	$755.00	$31.11 – $717.25
Psychotherapy, 30 minutes CPT 90832	$671.00	$671.00	$27.65 – $637.45
Psychotherapy, 45 minutes CPT 90834	$1,007.00	$1,007.00	$41.49 – $956.65
Psychotherapy, 60 minutes CPT 90837	$1,302.00	$1,302.00	$53.64 – $1,236.90

Infusions and injections

Service	Cash price	Gross charge	Insurer rates (min – max)
Injection under the skin or into a muscle CPT 96372	$343.00	$343.00	$14.13 – $325.85
IV hydration, each additional hour CPT 96361	$510.00	$510.00	$21.01 – $484.50
IV hydration, first hour CPT 96360	$808.00	$808.00	$33.29 – $767.60
IV push injection of a drug, first CPT 96374	$739.00	$739.00	$30.45 – $702.05
IV push injection, each additional drug CPT 96375	$508.00	$508.00	$20.93 – $482.60

Drugs

Service	Cash price	Gross charge	Insurer rates (min – max)
Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696	$124.00	$124.00	$5.11 – $124.00
Dexamethasone injection, per 1 mg HCPCS J1100	$32.00	$32.00	$1.32 – $32.00
Fentanyl injection, per 0.1 mg HCPCS J3010	$378.00	$378.00	$15.57 – $378.00
Ketorolac (Toradol) injection, per 15 mg HCPCS J1885	$102.00	$102.00	$4.20 – $96.90
Midazolam (Versed) injection, per 1 mg HCPCS J2250	$92.00	$92.00	$3.79 – $92.00
Morphine injection, up to 10 mg HCPCS J2270	$79.20	$79.20	$3.26 – $79.20
Ondansetron (Zofran) injection, per 1 mg HCPCS J2405	$41.00	$41.00	$1.69 – $41.00
Propofol injection, per 10 mg HCPCS J2704	$168.00	$168.00	$6.92 – $168.00
Saline IV solution, 1000 ml HCPCS J7030	$19.00	$19.00	$4.11 – $9.41

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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