Ascension Seton Edgar B Davis

130 Hays Street, Luling, TX 78648 · Critical access hospital · Emergency room

These are Ascension Seton Edgar B Davis's own posted figures from its standard-charges file dated January 1, 2026. They are not a quote. Source: the hospital's file · its price transparency page.

230 of the services we track have a posted price here; 126 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	$1,715.13	$4,764.25	$224.41 – $4,764.25
Emergency room visit, level 1 (minor) CPT 99281	$164.70	$457.50	$14.47 – $457.50
Emergency room visit, level 2 CPT 99282	$307.44	$854.00	$14.47 – $854.00
Emergency room visit, level 3 (moderate) CPT 99283	$500.49	$1,390.25	$14.47 – $1,390.25
Emergency room visit, level 4 CPT 99284	$1,120.23	$3,111.75	$200.00 – $3,111.75
Emergency room visit, level 5 (most severe) CPT 99285	$1,379.88	$3,833.00	$200.00 – $3,833.00
Simple wound repair (stitches), 2.5 cm or less CPT 12001	not posted		$44.25 – $1,000.00

Office visits

Service	Cash price	Insurer rates (min – max)
New patient office visit, about 15 to 29 minutes CPT 99202	not posted	$50.01 – $213.89
New patient office visit, about 30 minutes CPT 99203	not posted	$75.13 – $321.54
New patient office visit, about 45 minutes CPT 99204	not posted	$127.40 – $544.40
New patient office visit, about 60 minutes CPT 99205	not posted	$166.28 – $710.44
Office consultation, about 40 minutes CPT 99243	not posted	$94.91 – $403.84
Office consultation, about 60 minutes CPT 99244	not posted	$152.54 – $649.10
Office visit, established patient, about 10 to 19 minutes CPT 99212	not posted	$25.21 – $107.69
Office visit, established patient, about 20 to 29 minutes CPT 99213	not posted	$50.49 – $215.39
Office visit, established patient, about 30 to 39 minutes CPT 99214	not posted	$77.89 – $332.04
Office visit, established patient, about 40 to 54 minutes CPT 99215	not posted	$109.75 – $468.12
Office visit, established patient, brief (often a nurse) CPT 99211	not posted	$9.14 – $38.89
Preventive checkup, new patient, age 18 to 39 CPT 99385	not posted	$97.03 – $412.80
Preventive checkup, new patient, age 40 to 64 CPT 99386	not posted	$118.07 – $502.52

Imaging

Service	Cash price	Gross charge	Insurer rates (min – max)
3D screening mammogram (tomosynthesis), add-on CPT 77063	$56.88	$158.00	$25.23 – $155.79
Abdominal X-ray, 1 view CPT 74018	$159.48	$443.00	$18.65 – $323.23
Ankle X-ray, 3 or more views CPT 73610	$167.31	$464.75	$23.43 – $323.23
Bone density scan (DEXA), hips and spine CPT 77080	$308.43	$856.75	$32.98 – $385.54
Breast ultrasound, one breast, complete CPT 76641	$160.74	$446.50	$59.11 – $438.37
Breast ultrasound, one breast, limited CPT 76642	$163.35	$453.75	$55.44 – $424.37
Chest X-ray, 1 view CPT 71045	$129.69	$360.25	$13.14 – $323.23
Chest X-ray, 2 views CPT 71046	$214.29	$595.25	$20.12 – $323.23
CT angiogram of the chest (checks for lung clots) CPT 71275	$692.64	$1,924.00	$152.06 – $1,699.47
CT angiogram of the head CPT 70496	$1,822.95	$5,063.75	$152.06 – $2,663.55
CT scan of the abdomen and pelvis, with contrast CPT 74177	$4,300.92	$11,947.00	$223.24 – $5,376.15
CT scan of the abdomen and pelvis, without and with contrast CPT 74178	$4,545.54	$12,626.50	$223.24 – $5,681.93
CT scan of the abdomen and pelvis, without contrast CPT 74176	$3,631.68	$10,088.00	$117.52 – $4,539.60
CT scan of the abdomen, without contrast CPT 74150	$1,804.41	$5,012.25	$72.22 – $2,255.51
CT scan of the chest, with contrast CPT 71260	$1,765.35	$4,903.75	$139.21 – $2,206.69
CT scan of the chest, without contrast CPT 71250	$994.32	$2,762.00	$72.22 – $1,345.00
CT scan of the head, without contrast CPT 70450	$1,365.30	$3,792.50	$72.22 – $1,706.63
CT scan of the neck (cervical spine), without contrast CPT 72125	$1,821.42	$5,059.50	$72.22 – $2,276.78
CT scan of the pelvis, with contrast CPT 72193	$2,049.03	$5,691.75	$152.06 – $2,561.29
CT scan of the sinuses or face, without contrast CPT 70486	$1,072.35	$2,978.75	$72.22 – $1,345.00
Diagnostic mammogram, both breasts CPT 77066	$264.51	$734.75	$113.26 – $487.50
Diagnostic mammogram, one breast CPT 77065	$167.22	$464.50	$88.90 – $380.94
Foot X-ray, 3 or more views CPT 73630	$158.85	$441.25	$21.59 – $323.23
Hand X-ray, 3 or more views CPT 73130	$514.98	$1,430.50	$23.79 – $643.73
Knee X-ray, 3 views CPT 73562	$168.48	$468.00	$27.10 – $323.23
Leg or arm vein ultrasound, both sides CPT 93970	$610.74	$1,696.50	$145.03 – $983.97
Leg or arm vein ultrasound, one side CPT 93971	$649.62	$1,804.50	$72.37 – $1,046.61
Lower back X-ray, 2 or 3 views CPT 72100	$261.45	$726.25	$24.52 – $453.92
MRI of both breasts, without and with contrast CPT 77049	not posted		$274.73 – $2,690.55
MRI of the abdomen, without and with contrast CPT 74183	$1,357.02	$3,769.50	$291.67 – $3,742.38
MRI of the brain, without and with contrast CPT 70553	$1,579.32	$4,387.00	$274.01 – $3,084.62
MRI of the brain, without contrast CPT 70551	$1,094.22	$3,039.50	$162.73 – $1,969.00
MRI of the knee or other leg joint, without contrast CPT 73721	$776.52	$2,157.00	$175.61 – $1,975.92
MRI of the lower back (lumbar spine), without contrast CPT 72148	$784.44	$2,179.00	$156.11 – $1,969.00
MRI of the mid back (thoracic spine), without contrast CPT 72146	$902.88	$2,508.00	$156.48 – $1,969.00
MRI of the neck (cervical spine), without contrast CPT 72141	$1,175.13	$3,264.25	$156.11 – $1,969.00
MRI of the pelvis, without and with contrast CPT 72197	$1,212.93	$3,369.25	$291.67 – $2,677.23
MRI of the shoulder or other arm joint, without contrast CPT 73221	$708.03	$1,966.75	$175.61 – $1,750.00
Neck X-ray, 2 or 3 views CPT 72040	$202.50	$562.50	$22.69 – $323.23
Pelvic ultrasound, complete (not pregnancy) CPT 76856	$295.02	$819.50	$79.30 – $743.31
Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805	$1,037.79	$2,882.75	$91.54 – $1,297.24
Pregnancy ultrasound, under 14 weeks, single baby CPT 76801	$272.52	$757.00	$73.52 – $716.67
Screening mammogram, both breasts CPT 77067	$223.56	$621.00	$44.79 – $615.93
Shoulder X-ray, 2 or more views CPT 73030	$169.56	$471.00	$20.48 – $323.23
Transvaginal pregnancy ultrasound CPT 76817	$321.57	$893.25	$62.02 – $587.61
Transvaginal ultrasound CPT 76830	$288.45	$801.25	$88.30 – $706.39
Ultrasound of the abdomen, complete CPT 76700	$309.60	$860.00	$85.91 – $806.49
Ultrasound of the neck or thyroid CPT 76536	$277.83	$771.75	$92.52 – $693.07
Wrist X-ray, 3 or more views CPT 73110	$176.94	$491.50	$27.10 – $323.23
X-ray of the lower back, 4 or more views CPT 72110	$248.22	$689.50	$34.08 – $453.92

Lab tests

Service	Cash price	Gross charge	Insurer rates (min – max)
Basic metabolic panel (blood test) CPT 80048	$284.13	$789.25	$7.04 – $355.16
Blood culture CPT 87040	$238.14	$661.50	$7.37 – $297.68
Blood draw (venipuncture) CPT 36415	$18.09	$50.25	$3.00 – $6.28
BNP test (heart failure) CPT 83880	$205.83	$571.75	$10.85 – $257.29
C-reactive protein (CRP) test CPT 86140	$21.96	$61.00	$4.35 – $38.48
Chlamydia test (DNA/NAAT) CPT 87491	$72.54	$201.50	$16.84 – $191.24
Complete blood count (CBC) with differential CPT 85025	$39.96	$111.00	$1.99 – $57.82
Complete blood count (CBC), automated CPT 85027	$94.05	$261.25	$1.99 – $117.56
Comprehensive metabolic panel (blood test) CPT 80053	$91.62	$254.50	$8.87 – $114.53
COVID-19 PCR test CPT 87635	$37.71	$104.75	$41.90 – $97.49
D-dimer test (blood clots) CPT 85379	$90.00	$250.00	$8.55 – $112.50
Drug screen, instrument chemistry CPT 80307	$536.13	$1,489.25	$32.98 – $670.16
Ferritin (iron stores) test CPT 82728	$42.84	$119.00	$11.45 – $101.32
Free T4 (thyroid) test CPT 84439	$94.05	$261.25	$5.77 – $117.56
General health panel (blood tests) CPT 80050	not posted		$53.28 – $166.36
Glucose (blood sugar) test CPT 82947	$44.10	$122.50	$3.30 – $55.13
Gonorrhea test (DNA/NAAT) CPT 87591	$68.04	$189.00	$16.84 – $165.27
Hemoglobin A1c test CPT 83036	$108.63	$301.75	$8.16 – $135.79
Hepatitis C antibody test CPT 86803	$54.45	$151.25	$10.82 – $106.11
HIV-1/HIV-2 antigen and antibody test CPT 87389	$214.29	$595.25	$8.68 – $267.86
Iron test CPT 83540	$33.12	$92.00	$5.43 – $48.12
Kidney function panel CPT 80069	$309.69	$860.25	$7.29 – $387.11
Lipase test (pancreas) CPT 83690	$67.68	$188.00	$5.79 – $84.60
Lipid panel, cholesterol and triglycerides CPT 80061	$144.72	$402.00	$11.25 – $180.90
Liver function panel CPT 80076	$196.29	$545.25	$6.86 – $245.36
Magnesium test CPT 83735	$134.01	$372.25	$5.63 – $167.51
Obstetric blood test panel CPT 80055	not posted		$78.89 – $405.84
Partial thromboplastin time (PTT), clotting test CPT 85730	$115.65	$321.25	$5.05 – $144.56
Pregnancy blood test (hCG), quantitative CPT 84702	$90.36	$251.00	$9.57 – $112.95
Prothrombin time (PT/INR), clotting test CPT 85610	$105.21	$292.25	$3.60 – $131.51
PSA (prostate specific antigen), free CPT 84154	$205.83	$571.75	$15.45 – $257.29
PSA (prostate specific antigen), total CPT 84153	$52.47	$145.75	$15.45 – $136.74
Rapid strep test CPT 87880	$105.66	$293.50	$12.84 – $132.07
Sed rate (ESR) test CPT 85652	$28.44	$79.00	$2.27 – $35.55
TB skin test CPT 86580	$8.73	$24.25	$8.06 – $18.10
Thyroid stimulating hormone (TSH) CPT 84443	$62.10	$172.50	$7.58 – $124.97
Tissue exam by a pathologist (biopsy specimen) CPT 88305	$298.44	$829.00	$30.78 – $233.00
Troponin test (heart damage) CPT 84484	$102.78	$285.50	$10.47 – $128.47
Urinalysis, automated, with microscope CPT 81001	$134.01	$372.25	$2.66 – $167.51
Urinalysis, automated, without microscope CPT 81003	$76.14	$211.50	$1.89 – $95.17
Urinalysis, manual, with microscope CPT 81000	not posted		$3.38 – $23.54
Urinalysis, manual, without microscope CPT 81002	$23.04	$64.00	$2.92 – $28.80
Urine culture, colony count CPT 87086	$64.53	$179.25	$6.78 – $80.66
Urine pregnancy test CPT 81025	$56.16	$156.00	$7.23 – $70.20
Vitamin B12 test CPT 82607	$47.61	$132.25	$12.67 – $112.05
Vitamin D test CPT 82306	$282.42	$784.50	$24.86 – $353.02

Heart

Service	Cash price	Gross charge	Insurer rates (min – max)
Carotid artery ultrasound, both sides CPT 93880	$488.97	$1,358.25	$120.83 – $787.78
ECG tracing only (no interpretation) CPT 93005	$242.91	$674.75	$8.06 – $391.36
Echocardiogram (heart ultrasound), complete with Doppler CPT 93306	$1,413.27	$3,925.75	$141.68 – $2,276.93
Electrocardiogram (ECG/EKG) with interpretation CPT 93000	not posted		$16.50 – $81.48
Holter monitor, up to 48 hours CPT 93224	not posted		$85.81 – $375.41
Left heart catheterization CPT 93452	not posted		$610.21 – $14,841.00
Left heart catheterization with coronary angiogram CPT 93458	not posted		$739.86 – $14,841.00
Nuclear stress test (heart perfusion imaging) CPT 78452	not posted		$409.40 – $3,884.58
Treadmill stress test, complete CPT 93015	not posted		$69.42 – $300.63

Surgery

Service	Cash price	Insurer rates (min – max)
ACL reconstruction, arthroscopic CPT 29888	not posted	$969.15 – $6,998.88
Appendix removal, laparoscopic CPT 44970	not posted	$598.63 – $5,655.44
Breast biopsy with ultrasound guidance CPT 19083	not posted	$159.68 – $1,605.94
Carpal tunnel release CPT 64721	not posted	$422.46 – $2,011.64
Colonoscopy with biopsy CPT 45380	not posted	$203.98 – $1,174.94
Colonoscopy with polyp removal (snare) CPT 45385	not posted	$258.93 – $1,174.94
Colonoscopy, diagnostic CPT 45378	not posted	$187.81 – $1,000.00
Colposcopy with biopsy CPT 57454	not posted	$52.23 – $1,000.00
Cystoscopy (bladder scope) CPT 52000	not posted	$81.65 – $11,121.00
Ear tubes, under general anesthesia CPT 69436	not posted	$155.52 – $1,578.73
Flexible sigmoidoscopy, diagnostic CPT 45330	not posted	$56.36 – $1,000.00
Gallbladder removal, laparoscopic CPT 47562	not posted	$655.46 – $19,004.00
Gastric bypass (weight loss surgery), laparoscopic CPT 43644	not posted	$969.15 – $2,118.40
Hysterectomy, laparoscopic, with tubes and/or ovaries CPT 58571	not posted	$893.54 – $9,843.34
Hysteroscopy with biopsy or polyp removal CPT 58558	not posted	$230.83 – $2,922.78
Inguinal (groin) hernia repair, laparoscopic CPT 49650	not posted	$426.11 – $5,655.44
Inguinal (groin) hernia repair, open, age 5 or older CPT 49505	not posted	$517.65 – $3,637.93
Kidney stone shock-wave lithotripsy CPT 50590	not posted	$572.39 – $14,620.00
Knee arthroscopy, meniscus trim (meniscectomy) CPT 29881	not posted	$535.09 – $3,202.82
Lower colon endoscopy with ultrasound CPT 45391	not posted	$262.58 – $1,174.94
Nasal endoscopy, diagnostic CPT 31231	not posted	$56.95 – $1,000.00
Prostate biopsy CPT 55700	not posted	$131.65 – $2,072.71
Prostate removal, laparoscopic or robotic CPT 55866	not posted	$969.15 – $9,843.34
Removal of a breast lump, open surgery CPT 19120	not posted	$409.12 – $3,544.57
Rotator cuff repair, arthroscopic CPT 29827	not posted	$969.15 – $6,998.88
Septoplasty (nasal septum repair) CPT 30520	not posted	$620.34 – $3,064.57
Shoulder arthroscopy, bone shaving (decompression) CPT 29826	not posted	$175.13 – $1,549.00
Sleeve gastrectomy (weight loss surgery), laparoscopic CPT 43775	not posted	$839.69 – $10,225.00
Tonsil and adenoid removal, under age 12 CPT 42820	not posted	$286.93 – $5,675.12
Total hip replacement CPT 27130	not posted	$969.15 – $14,153.00
Total knee replacement CPT 27447	not posted	$969.15 – $14,153.00
Upper endoscopy (EGD) with biopsy CPT 43239	not posted	$140.61 – $1,000.00
Upper endoscopy (EGD), diagnostic CPT 43235	not posted	$124.26 – $1,000.00
Vasectomy CPT 55250	not posted	$228.02 – $2,072.71

Pregnancy and birth

Service	Cash price	Insurer rates (min – max)
C-section delivery, routine care including prenatal and postpartum CPT 59510	not posted	$969.15 – $2,825.11
Fetal non-stress test CPT 59025	not posted	$11.19 – $135.83
IUD insertion CPT 58300	not posted	$39.96 – $1,000.00
Vaginal birth after a prior C-section (VBAC), routine care CPT 59610	not posted	$969.15 – $2,673.73
Vaginal delivery, routine care including prenatal and postpartum CPT 59400	not posted	$969.15 – $2,548.07

Hospital stays

Service	Cash price	Insurer rates (min – max)
Alcohol or drug use disorder, without rehab, without major complications MS-DRG 897	not posted	$1,042.00 – $9,379.00
C-section, without complications MS-DRG 788	not posted	$2,209.00 – $11,802.00
Chest pain MS-DRG 313	not posted	$4,090.40 – $9,379.00
COPD flare-up, with major complications MS-DRG 190	not posted	$6,150.00 – $9,379.00
COPD flare-up, without complications MS-DRG 192	not posted	$4,069.87 – $9,379.00
Fainting (syncope) MS-DRG 312	not posted	$4,493.64 – $9,379.00
Gastrointestinal bleeding, with complications MS-DRG 378	not posted	$5,251.84 – $9,379.00
Heart failure, with major complications MS-DRG 291	not posted	$3,033.62 – $9,379.00
Heart failure, without complications MS-DRG 293	not posted	$3,772.27 – $9,379.00
Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216	not posted	$4,937.00 – $112,179.00
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470	not posted	$4,701.00 – $13,993.00
Irregular heartbeat, without complications MS-DRG 310	not posted	$2,857.12 – $9,379.00
Kidney failure, with complications MS-DRG 683	not posted	$5,012.79 – $9,379.00
Kidney or urinary tract infection, without major complications MS-DRG 690	not posted	$4,178.53 – $9,379.00
Neck (cervical) spinal fusion, without complications MS-DRG 473	not posted	$4,701.00 – $15,398.85
Normal newborn care MS-DRG 795	not posted	$588.00 – $9,379.00
Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641	not posted	$3,920.77 – $9,379.00
Pneumonia, with complications MS-DRG 194	not posted	$5,089.45 – $9,379.00
Pneumonia, with major complications MS-DRG 193	not posted	$6,150.00 – $9,379.00
Pneumonia, without complications MS-DRG 195	not posted	$3,686.55 – $9,379.00
Psychoses (inpatient psychiatric stay) MS-DRG 885	not posted	$1,017.00 – $9,379.00
Sepsis, with major complications MS-DRG 871	not posted	$6,150.00 – $11,769.49
Sepsis, without major complications MS-DRG 872	not posted	$5,100.92 – $9,379.00
Skin infection (cellulitis), without major complications MS-DRG 603	not posted	$3,714.92 – $9,379.00
Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392	not posted	$4,278.74 – $9,379.00
Stroke, with complications or clot-busting drug MS-DRG 65	not posted	$6,150.00 – $9,379.00
Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743	not posted	$4,937.00 – $9,379.00
Vaginal delivery, without complications MS-DRG 807	not posted	$1,962.00 – $10,594.00
Weight loss surgery, without complications MS-DRG 621	not posted	$6,150.00 – $37,415.00

Pain and spine

Service	Cash price	Gross charge	Insurer rates (min – max)
Large joint injection or drainage (knee, shoulder, hip) CPT 20610	$301.68	$838.00	$22.35 – $259.78
Lower back nerve root injection with imaging guidance CPT 64483	not posted		$111.31 – $1,000.00
Lower back spinal injection (epidural), with imaging guidance CPT 62323	$1,647.00	$4,575.00	$99.21 – $1,418.25
Lower back spinal injection (epidural), without imaging CPT 62322	not posted		$85.91 – $1,000.00

Eye

Service	Cash price	Insurer rates (min – max)
Cataract removal with lens implant CPT 66984	not posted	$629.86 – $2,365.58
Eye exam, new patient, comprehensive CPT 92004	not posted	$98.67 – $481.11
Laser treatment of clouding after cataract surgery (YAG) CPT 66821	not posted	$208.33 – $1,000.00

Eye and ear

Service	Cash price	Gross charge	Insurer rates (min – max)
Hearing test, comprehensive CPT 92557	not posted		$32.63 – $574.15

Sleep

Service	Cash price	Insurer rates (min – max)
Home sleep apnea test CPT 95806	not posted	$113.11 – $1,589.00
Sleep study with CPAP titration CPT 95811	not posted	$551.82 – $2,185.10
Sleep study, overnight in a sleep lab CPT 95810	not posted	$524.25 – $2,078.90

Lungs

Service	Cash price	Gross charge	Insurer rates (min – max)
Spirometry (breathing test) CPT 94010	$145.44	$404.00	$28.58 – $236.58

Therapy

Service	Cash price	Gross charge	Insurer rates (min – max)
Manual therapy, 15 minutes CPT 97140	$137.52	$382.00	$27.61 – $134.43
Physical therapy evaluation, low complexity CPT 97161	$143.01	$397.25	$83.55 – $370.64
Physical therapy evaluation, moderate complexity CPT 97162	$155.88	$433.00	$83.55 – $370.64
Physical therapy, therapeutic exercise, 15 minutes CPT 97110	$63.45	$176.25	$30.31 – $144.05
Therapeutic activities, 15 minutes CPT 97530	$84.06	$233.50	$35.49 – $180.18

Mental health

Service	Cash price	Gross charge	Insurer rates (min – max)
Family psychotherapy, with the patient, 50 minutes CPT 90847	$155.97	$433.25	$105.19 – $120.81
Family psychotherapy, without the patient, 50 minutes CPT 90846	not posted		$101.24 – $120.81
Group psychotherapy CPT 90853	$159.93	$444.25	$24.88 – $67.29
Psychiatric diagnostic evaluation CPT 90791	$159.93	$444.25	$120.81 – $127.50
Psychotherapy, 30 minutes CPT 90832	not posted		$62.59 – $67.29
Psychotherapy, 45 minutes CPT 90834	not posted		$83.55 – $120.81
Psychotherapy, 60 minutes CPT 90837	$159.93	$444.25	$120.81 – $127.13

Infusions and injections

Service	Cash price	Gross charge	Insurer rates (min – max)
Injection under the skin or into a muscle CPT 96372	$221.22	$614.50	$16.22 – $250.95
IV hydration, each additional hour CPT 96361	$63.00	$175.00	$12.99 – $56.81
IV hydration, first hour CPT 96360	$108.00	$300.00	$36.45 – $160.02
IV push injection of a drug, first CPT 96374	$135.00	$375.00	$37.48 – $164.51
IV push injection, each additional drug CPT 96375	$108.00	$300.00	$16.06 – $70.30

Drugs

Service	Cash price	Gross charge	Insurer rates (min – max)
Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696	$3.61	$10.03
Dexamethasone injection, per 1 mg HCPCS J1100	$4.95	$13.75
Fentanyl injection, per 0.1 mg HCPCS J3010	$112.95	$313.75
Ketorolac (Toradol) injection, per 15 mg HCPCS J1885	$14.57	$40.48	? – $1.25
Midazolam (Versed) injection, per 1 mg HCPCS J2250	$46.62	$129.50
Morphine injection, up to 10 mg HCPCS J2270	$27.45	$76.25	$2.57 – $2.57
Ondansetron (Zofran) injection, per 1 mg HCPCS J2405	$3.15	$8.75
Saline IV solution, 1000 ml HCPCS J7030	$31.05	$86.25	$2.50 – $2.50

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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