Ascension Seton Smithville

1201 Hill Rd, Smithville, TX 78957 · Critical access hospital · Emergency room

These are Ascension Seton Smithville'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; 131 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	$2,895.84	$8,044.00	$224.41 – $8,044.00
Emergency room visit, level 1 (minor) CPT 99281	$282.33	$784.25	$11.12 – $784.25
Emergency room visit, level 2 CPT 99282	$548.37	$1,523.25	$11.12 – $1,523.25
Emergency room visit, level 3 (moderate) CPT 99283	$731.43	$2,031.75	$11.12 – $2,031.75
Emergency room visit, level 4 CPT 99284	$1,170.00	$3,250.00	$200.00 – $3,250.00
Emergency room visit, level 5 (most severe) CPT 99285	$2,007.00	$5,575.00	$200.00 – $5,575.00
Simple wound repair (stitches), 2.5 cm or less CPT 12001	not posted		$336.98 – $336.98

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	$61.38	$170.50	$25.23 – $155.79
Abdominal X-ray, 1 view CPT 74018	$343.17	$953.25	$18.65 – $428.96
Ankle X-ray, 3 or more views CPT 73610	$371.61	$1,032.25	$23.43 – $464.51
Bone density scan (DEXA), hips and spine CPT 77080	$300.60	$835.00	$32.98 – $375.75
Breast ultrasound, one breast, complete CPT 76641	$157.05	$436.25	$72.72 – $411.33
Breast ultrasound, one breast, limited CPT 76642	$265.68	$738.00	$55.44 – $530.46
Chest X-ray, 1 view CPT 71045	$162.45	$451.25	$13.14 – $323.23
Chest X-ray, 2 views CPT 71046	$919.26	$2,553.50	$20.12 – $1,149.08
CT angiogram of the chest (checks for lung clots) CPT 71275	$1,250.37	$3,473.25	$180.34 – $2,549.16
CT angiogram of the head CPT 70496	$1,284.57	$3,568.25	$180.34 – $2,663.55
CT scan of the abdomen and pelvis, with contrast CPT 74177	$3,447.00	$9,575.00	$228.53 – $4,308.75
CT scan of the abdomen and pelvis, without and with contrast CPT 74178	$3,543.57	$9,843.25	$252.74 – $4,429.46
CT scan of the abdomen and pelvis, without contrast CPT 74176	$2,440.26	$6,778.50	$117.52 – $3,050.32
CT scan of the abdomen, without contrast CPT 74150	$1,203.12	$3,342.00	$93.26 – $1,503.90
CT scan of the chest, with contrast CPT 71260	$2,120.67	$5,890.75	$139.21 – $2,650.84
CT scan of the chest, without contrast CPT 71250	$505.17	$1,403.25	$106.88 – $1,345.00
CT scan of the head, without contrast CPT 70450	$1,347.21	$3,742.25	$75.99 – $1,684.01
CT scan of the neck (cervical spine), without contrast CPT 72125	$1,637.64	$4,549.00	$106.88 – $2,047.05
CT scan of the pelvis, with contrast CPT 72193	$1,358.64	$3,774.00	$173.75 – $1,701.09
CT scan of the sinuses or face, without contrast CPT 70486	$712.71	$1,979.75	$99.87 – $1,345.00
Diagnostic mammogram, both breasts CPT 77066	$189.45	$526.25	$120.37 – $487.50
Diagnostic mammogram, one breast CPT 77065	$146.88	$408.00	$94.06 – $380.94
Foot X-ray, 3 or more views CPT 73630	$136.98	$380.50	$21.59 – $323.23
Hand X-ray, 3 or more views CPT 73130	$368.91	$1,024.75	$23.79 – $461.14
Knee X-ray, 3 views CPT 73562	$392.85	$1,091.25	$27.10 – $491.06
Leg or arm vein ultrasound, both sides CPT 93970	$1,038.60	$2,885.00	$148.38 – $1,673.30
Leg or arm vein ultrasound, one side CPT 93971	$577.71	$1,604.75	$96.28 – $930.75
Lower back X-ray, 2 or 3 views CPT 72100	$346.68	$963.00	$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	$2,505.51	$6,959.75	$329.50 – $4,621.65
MRI of the brain, without and with contrast CPT 70553	$2,241.45	$6,226.25	$274.01 – $3,084.62
MRI of the brain, without contrast CPT 70551	$1,358.46	$3,773.50	$162.73 – $1,969.00
MRI of the knee or other leg joint, without contrast CPT 73721	$1,205.64	$3,349.00	$175.86 – $1,975.92
MRI of the lower back (lumbar spine), without contrast CPT 72148	$1,242.99	$3,452.75	$156.11 – $1,969.00
MRI of the mid back (thoracic spine), without contrast CPT 72146	$1,271.34	$3,531.50	$156.48 – $1,969.00
MRI of the neck (cervical spine), without contrast CPT 72141	$1,871.10	$5,197.50	$156.11 – $2,338.88
MRI of the pelvis, without and with contrast CPT 72197	$1,899.36	$5,276.00	$328.40 – $4,613.24
MRI of the shoulder or other arm joint, without contrast CPT 73221	$1,103.76	$3,066.00	$175.86 – $1,971.71
Neck X-ray, 2 or 3 views CPT 72040	$181.80	$505.00	$22.69 – $323.23
Pelvic ultrasound, complete (not pregnancy) CPT 76856	$256.95	$713.75	$79.30 – $594.65
Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805	$571.23	$1,586.75	$91.54 – $896.31
Pregnancy ultrasound, under 14 weeks, single baby CPT 76801	$336.69	$935.25	$73.52 – $716.67
Screening mammogram, both breasts CPT 77067	$243.90	$677.50	$44.79 – $615.93
Shoulder X-ray, 2 or more views CPT 73030	$143.55	$398.75	$20.48 – $323.23
Transvaginal pregnancy ultrasound CPT 76817	$256.95	$713.75	$62.02 – $587.61
Transvaginal ultrasound CPT 76830	$265.68	$738.00	$88.30 – $706.39
Ultrasound of the abdomen, complete CPT 76700	$415.71	$1,154.75	$85.91 – $927.63
Ultrasound of the neck or thyroid CPT 76536	$417.06	$1,158.50	$92.52 – $866.34
Wrist X-ray, 3 or more views CPT 73110	$392.85	$1,091.25	$27.10 – $491.06
X-ray of the lower back, 4 or more views CPT 72110	$281.52	$782.00	$34.08 – $453.92

Lab tests

Service	Cash price	Gross charge	Insurer rates (min – max)
Basic metabolic panel (blood test) CPT 80048	$237.51	$659.75	$7.04 – $296.89
Blood culture CPT 87040	$183.78	$510.50	$7.37 – $229.72
Blood draw (venipuncture) CPT 36415	$25.29	$70.25	$3.00 – $6.28
BNP test (heart failure) CPT 83880	$239.94	$666.50	$10.85 – $299.93
C-reactive protein (CRP) test CPT 86140	$65.07	$180.75	$4.35 – $81.34
Chlamydia test (DNA/NAAT) CPT 87491	$127.53	$354.25	$16.84 – $260.89
Complete blood count (CBC) with differential CPT 85025	$85.95	$238.75	$1.99 – $107.44
Complete blood count (CBC), automated CPT 85027	$80.64	$224.00	$1.99 – $100.80
Comprehensive metabolic panel (blood test) CPT 80053	$95.13	$264.25	$8.87 – $118.91
COVID-19 PCR test CPT 87635	$40.68	$113.00	$45.20 – $97.49
D-dimer test (blood clots) CPT 85379	$91.62	$254.50	$8.55 – $114.53
Drug screen, instrument chemistry CPT 80307	$451.62	$1,254.50	$32.98 – $564.52
Ferritin (iron stores) test CPT 82728	$118.89	$330.25	$11.45 – $148.61
Free T4 (thyroid) test CPT 84439	$100.62	$279.50	$5.77 – $125.78
General health panel (blood tests) CPT 80050	not posted		$53.28 – $166.36
Glucose (blood sugar) test CPT 82947	$36.54	$101.50	$3.30 – $45.67
Gonorrhea test (DNA/NAAT) CPT 87591	$76.86	$213.50	$16.84 – $191.24
Hemoglobin A1c test CPT 83036	$78.03	$216.75	$8.16 – $97.54
Hepatitis C antibody test CPT 86803	$64.44	$179.00	$10.82 – $106.11
HIV-1/HIV-2 antigen and antibody test CPT 87389	$112.23	$311.75	$8.68 – $179.09
Iron test CPT 83540	$54.99	$152.75	$5.43 – $68.74
Kidney function panel CPT 80069	$236.97	$658.25	$7.29 – $296.21
Lipase test (pancreas) CPT 83690	$66.42	$184.50	$5.79 – $83.03
Lipid panel, cholesterol and triglycerides CPT 80061	$155.97	$433.25	$11.25 – $194.96
Liver function panel CPT 80076	$163.35	$453.75	$6.86 – $204.19
Magnesium test CPT 83735	$120.15	$333.75	$5.63 – $150.19
Obstetric blood test panel CPT 80055	not posted		$83.67 – $83.67
Partial thromboplastin time (PTT), clotting test CPT 85730	$81.81	$227.25	$5.05 – $102.26
Pregnancy blood test (hCG), quantitative CPT 84702	$162.99	$452.75	$9.57 – $203.74
Prothrombin time (PT/INR), clotting test CPT 85610	$70.92	$197.00	$3.60 – $88.65
PSA (prostate specific antigen), free CPT 84154	$221.58	$615.50	$15.45 – $276.98
PSA (prostate specific antigen), total CPT 84153	$89.37	$248.25	$15.45 – $136.74
Rapid strep test CPT 87880	$84.51	$234.75	$12.84 – $105.64
Sed rate (ESR) test CPT 85652	$101.25	$281.25	$2.27 – $126.56
TB skin test CPT 86580	$11.88	$33.00	$8.06 – $18.10
Thyroid stimulating hormone (TSH) CPT 84443	$126.27	$350.75	$7.58 – $157.84
Tissue exam by a pathologist (biopsy specimen) CPT 88305	$219.96	$611.00	$30.78 – $233.00
Troponin test (heart damage) CPT 84484	$74.25	$206.25	$10.47 – $92.81
Urinalysis, automated, with microscope CPT 81001	$90.27	$250.75	$2.66 – $112.84
Urinalysis, automated, without microscope CPT 81003	$50.49	$140.25	$1.89 – $63.11
Urinalysis, manual, with microscope CPT 81000	not posted		$7.03 – $7.03
Urinalysis, manual, without microscope CPT 81002	$21.60	$60.00	$2.92 – $27.00
Urine culture, colony count CPT 87086	$53.28	$148.00	$6.78 – $66.60
Urine pregnancy test CPT 81025	$50.49	$140.25	$7.23 – $63.11
Vitamin B12 test CPT 82607	$112.59	$312.75	$12.67 – $140.74
Vitamin D test CPT 82306	$270.90	$752.50	$24.86 – $338.63

Heart

Service	Cash price	Gross charge	Insurer rates (min – max)
Carotid artery ultrasound, both sides CPT 93880	$1,067.40	$2,965.00	$120.83 – $1,719.70
ECG tracing only (no interpretation) CPT 93005	$154.35	$428.75	$8.06 – $248.68
Echocardiogram (heart ultrasound), complete with Doppler CPT 93306	$2,389.50	$6,637.50	$141.68 – $3,849.75
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	$3,701.79	$10,282.75	$610.21 – $9,289.00
Left heart catheterization with coronary angiogram CPT 93458	$4,307.04	$11,964.00	$739.86 – $11,096.00
Nuclear stress test (heart perfusion imaging) CPT 78452	$1,798.38	$4,995.50	$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	$1,546.19 – $1,546.19
Colposcopy with biopsy CPT 57454	not posted	$515.88 – $515.88
Cystoscopy (bladder scope) CPT 52000	not posted	$1,131.99 – $1,131.99
Ear tubes, under general anesthesia CPT 69436	not posted	$155.52 – $1,578.73
Flexible sigmoidoscopy, diagnostic CPT 45330	not posted	$1,546.19 – $1,546.19
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	$329.25 – $329.25
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	$1,590.03 – $1,590.03
Upper endoscopy (EGD), diagnostic CPT 43235	not posted	$1,590.03 – $1,590.03
Vasectomy CPT 55250	not posted	$228.02 – $2,072.71

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		$969.15 – $2,825.11
Fetal non-stress test CPT 59025	$200.43	$556.75	$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	$478.71	$1,329.75	$20.55 – $412.22
Lower back nerve root injection with imaging guidance CPT 64483	not posted		$1,509.87 – $1,509.87
Lower back spinal injection (epidural), with imaging guidance CPT 62323	$1,245.06	$3,458.50	$99.21 – $1,072.13
Lower back spinal injection (epidural), without imaging CPT 62322	not posted		$1,509.87 – $1,509.87

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	$218.56 – $218.56
Laser treatment of clouding after cataract surgery (YAG) CPT 66821	not posted	$930.39 – $930.39

Eye and ear

Service	Cash price	Gross charge	Insurer rates (min – max)
Hearing test, comprehensive CPT 92557	$154.35	$428.75	$32.63 – $236.58

Sleep

Service	Cash price	Gross charge	Insurer rates (min – max)
Home sleep apnea test CPT 95806	$311.13	$864.25	$113.11 – $509.91
Sleep study with CPAP titration CPT 95811	$2,579.31	$7,164.75	$551.82 – $4,227.20
Sleep study, overnight in a sleep lab CPT 95810	$1,528.29	$4,245.25	$524.25 – $2,504.70

Lungs

Service	Cash price	Gross charge	Insurer rates (min – max)
Spirometry (breathing test) CPT 94010	$356.04	$989.00	$28.58 – $574.15

Therapy

Service	Cash price	Gross charge	Insurer rates (min – max)
Manual therapy, 15 minutes CPT 97140	$71.82	$199.50	$27.61 – $134.43
Physical therapy evaluation, low complexity CPT 97161	$103.05	$286.25	$83.55 – $180.42
Physical therapy evaluation, moderate complexity CPT 97162	$120.24	$334.00	$83.55 – $324.34
Physical therapy, therapeutic exercise, 15 minutes CPT 97110	$63.27	$175.75	$30.31 – $144.05
Therapeutic activities, 15 minutes CPT 97530	$76.23	$211.75	$35.49 – $180.18

Mental health

Service	Cash price	Gross charge	Insurer rates (min – max)
Family psychotherapy, with the patient, 50 minutes CPT 90847	not posted		$272.49 – $272.49
Family psychotherapy, without the patient, 50 minutes CPT 90846	not posted		$272.49 – $272.49
Group psychotherapy CPT 90853	$126.27	$350.75	$24.88 – $67.29
Psychiatric diagnostic evaluation CPT 90791	not posted		$272.49 – $272.49
Psychotherapy, 30 minutes CPT 90832	not posted		$272.49 – $272.49
Psychotherapy, 45 minutes CPT 90834	not posted		$272.49 – $272.49
Psychotherapy, 60 minutes CPT 90837	not posted		$272.49 – $272.49

Infusions and injections

Service	Cash price	Gross charge	Insurer rates (min – max)
Injection under the skin or into a muscle CPT 96372	$166.05	$461.25	$16.22 – $250.95
IV hydration, each additional hour CPT 96361	$109.08	$303.00	$12.99 – $56.81
IV hydration, first hour CPT 96360	$144.00	$400.00	$36.45 – $160.02
IV push injection of a drug, first CPT 96374	$309.60	$860.00	$37.48 – $164.51
IV push injection, each additional drug CPT 96375	$180.00	$500.00	$16.06 – $70.30

Drugs

Service	Cash price	Gross charge	Insurer rates (min – max)
Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696	$95.94	$266.50
Dexamethasone injection, per 1 mg HCPCS J1100	$4.23	$11.75
Fentanyl injection, per 0.1 mg HCPCS J3010	$102.69	$285.25
Ketorolac (Toradol) injection, per 15 mg HCPCS J1885	$12.15	$33.75	? – $1.25
Midazolam (Versed) injection, per 1 mg HCPCS J2250	$42.30	$117.50
Morphine injection, up to 10 mg HCPCS J2270	$221.22	$614.50	$2.57 – $2.57
Ondansetron (Zofran) injection, per 1 mg HCPCS J2405	$6.12	$17.00
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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