Baylor Scott & White Medical Center Grapevine
1650 W College St., Grapevine, TX 76051 · Acute care hospital · Emergency room
These are Baylor Scott & White Medical Center Grapevine's own posted figures from its standard-charges file dated June 29, 2026. They are not a quote. Source: the hospital's file · its price transparency page.
208 of the services we track have a posted price here; 153 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 | $2,540.23 | $4,233.71 | $635.06 – $6,643.00 |
| Emergency room visit, level 1 (minor) CPT 99281 | $286.94 | $478.23 | $71.73 – $859.00 |
| Emergency room visit, level 2 CPT 99282 | $469.39 | $782.31 | $117.35 – $1,718.00 |
| Emergency room visit, level 3 (moderate) CPT 99283 | $770.04 | $1,283.40 | $192.51 – $2,691.00 |
| Emergency room visit, level 4 CPT 99284 | $1,273.68 | $2,122.80 | $318.42 – $3,894.00 |
| Emergency room visit, level 5 (most severe) CPT 99285 | $2,327.80 | $3,879.67 | $569.27 – $6,643.00 |
| Simple wound repair (stitches), 2.5 cm or less CPT 12001 | $483.80 | $806.34 | $120.95 – $604.75 |
Imaging
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| 3D screening mammogram (tomosynthesis), add-on CPT 77063 | $95.23 | $158.71 | $50.46 – $185.00 |
| Abdominal X-ray, 1 view CPT 74018 | $247.64 | $412.73 | $30.40 – $336.80 |
| Ankle X-ray, 3 or more views CPT 73610 | $296.24 | $493.74 | $36.75 – $370.31 |
| Bone density scan (DEXA), hips and spine CPT 77080 | $381.19 | $635.32 | $39.09 – $476.49 |
| Breast ultrasound, one breast, complete CPT 76641 | $442.26 | $737.10 | $99.94 – $552.83 |
| Breast ultrasound, one breast, limited CPT 76642 | $346.19 | $576.99 | $83.19 – $432.74 |
| Chest X-ray, 1 view CPT 71045 | $220.04 | $366.74 | $25.73 – $336.80 |
| Chest X-ray, 2 views CPT 71046 | $393.82 | $656.37 | $33.75 – $492.28 |
| CT angiogram of the chest (checks for lung clots) CPT 71275 | $3,774.58 | $6,290.97 | $167.67 – $4,718.23 |
| CT angiogram of the head CPT 70496 | $3,544.24 | $5,907.07 | $167.67 – $4,430.30 |
| CT scan of the abdomen and pelvis, with contrast CPT 74177 | $3,890.61 | $6,484.35 | $312.08 – $4,863.26 |
| CT scan of the abdomen and pelvis, without and with contrast CPT 74178 | $4,172.12 | $6,953.54 | $333.49 – $5,215.15 |
| CT scan of the abdomen and pelvis, without contrast CPT 74176 | $3,538.08 | $5,896.80 | $188.11 – $4,422.60 |
| CT scan of the abdomen, without contrast CPT 74150 | $2,177.28 | $3,628.80 | $99.94 – $2,721.60 |
| CT scan of the chest, with contrast CPT 71260 | $2,003.90 | $3,339.84 | $167.67 – $2,504.88 |
| CT scan of the chest, without contrast CPT 71250 | $1,680.11 | $2,800.19 | $99.94 – $2,177.00 |
| CT scan of the head, without contrast CPT 70450 | $1,907.15 | $3,178.59 | $99.94 – $2,383.94 |
| CT scan of the neck (cervical spine), without contrast CPT 72125 | $2,042.26 | $3,403.77 | $99.94 – $2,552.83 |
| CT scan of the pelvis, with contrast CPT 72193 | $2,199.47 | $3,665.78 | $167.67 – $2,749.34 |
| CT scan of the sinuses or face, without contrast CPT 70486 | $1,704.54 | $2,840.90 | $99.94 – $2,177.00 |
| Diagnostic mammogram, both breasts CPT 77066 | $340.20 | $567.00 | $85.05 – $507.96 |
| Diagnostic mammogram, one breast CPT 77065 | $272.16 | $453.60 | $68.04 – $396.93 |
| Foot X-ray, 3 or more views CPT 73630 | $365.31 | $608.85 | $34.41 – $456.64 |
| Hand X-ray, 3 or more views CPT 73130 | $317.78 | $529.64 | $37.43 – $397.23 |
| Knee X-ray, 3 views CPT 73562 | $319.24 | $532.06 | $41.10 – $399.05 |
| Leg or arm vein ultrasound, both sides CPT 93970 | $1,200.85 | $2,001.42 | $184.78 – $1,501.07 |
| Leg or arm vein ultrasound, one side CPT 93971 | $803.29 | $1,338.82 | $99.94 – $1,117.00 |
| Lower back X-ray, 2 or 3 views CPT 72100 | $337.54 | $562.56 | $40.10 – $472.98 |
| MRI of both breasts, without and with contrast CPT 77049 | $1,876.12 | $3,126.87 | $469.03 – $2,699.00 |
| MRI of the abdomen, without and with contrast CPT 74183 | $3,810.24 | $6,350.40 | $333.49 – $4,762.80 |
| MRI of the brain, without and with contrast CPT 70553 | $3,149.11 | $5,248.52 | $328.11 – $3,936.39 |
| MRI of the brain, without contrast CPT 70551 | $2,189.86 | $3,649.76 | $202.15 – $2,737.32 |
| MRI of the knee or other leg joint, without contrast CPT 73721 | $2,209.22 | $3,682.04 | $208.84 – $2,761.53 |
| MRI of the lower back (lumbar spine), without contrast CPT 72148 | $2,190.02 | $3,650.03 | $197.14 – $2,737.52 |
| MRI of the mid back (thoracic spine), without contrast CPT 72146 | $2,034.41 | $3,390.69 | $196.14 – $2,699.00 |
| MRI of the neck (cervical spine), without contrast CPT 72141 | $2,266.09 | $3,776.81 | $196.48 – $2,832.61 |
| MRI of the pelvis, without and with contrast CPT 72197 | $3,742.20 | $6,237.00 | $333.49 – $4,677.75 |
| MRI of the shoulder or other arm joint, without contrast CPT 73221 | $1,788.37 | $2,980.61 | $209.16 – $2,699.00 |
| Neck X-ray, 2 or 3 views CPT 72040 | $325.79 | $542.99 | $39.76 – $407.24 |
| Pelvic ultrasound, complete (not pregnancy) CPT 76856 | $761.44 | $1,269.06 | $96.28 – $951.79 |
| Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805 | $590.27 | $983.78 | $99.94 – $737.84 |
| Pregnancy ultrasound, under 14 weeks, single baby CPT 76801 | $660.98 | $1,101.64 | $99.94 – $826.23 |
| Screening mammogram, both breasts CPT 77067 | $227.22 | $378.70 | $56.80 – $419.76 |
| Shoulder X-ray, 2 or more views CPT 73030 | $306.88 | $511.46 | $35.09 – $383.60 |
| Transvaginal pregnancy ultrasound CPT 76817 | $509.00 | $848.33 | $92.89 – $636.25 |
| Transvaginal ultrasound CPT 76830 | $643.21 | $1,072.02 | $99.94 – $804.01 |
| Ultrasound of the abdomen, complete CPT 76700 | $862.90 | $1,438.16 | $99.94 – $1,078.62 |
| Ultrasound of the neck or thyroid CPT 76536 | $630.55 | $1,050.92 | $99.94 – $788.19 |
| Wrist X-ray, 3 or more views CPT 73110 | $309.46 | $515.76 | $41.44 – $386.82 |
| X-ray of the lower back, 4 or more views CPT 72110 | $475.04 | $791.73 | $52.13 – $593.80 |
Lab tests
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 | $149.84 | $249.74 | $7.11 – $187.31 |
| Blood culture CPT 87040 | $204.31 | $340.52 | $8.67 – $255.39 |
| Blood draw (venipuncture) CPT 36415 | $28.65 | $47.75 | $7.16 – $35.81 |
| BNP test (heart failure) CPT 83880 | $906.00 | $1,510.00 | $10.00 – $1,132.50 |
| C-reactive protein (CRP) test CPT 86140 | $101.59 | $169.31 | $4.35 – $126.98 |
| Chlamydia test (DNA/NAAT) CPT 87491 | $165.34 | $275.56 | $10.00 – $206.67 |
| Complete blood count (CBC) with differential CPT 85025 | $110.18 | $183.63 | $6.53 – $137.72 |
| Complete blood count (CBC), automated CPT 85027 | $89.90 | $149.84 | $5.43 – $112.38 |
| Comprehensive metabolic panel (blood test) CPT 80053 | $235.72 | $392.86 | $8.87 – $294.64 |
| COVID-19 PCR test CPT 87635 | $900.00 | $1,500.00 | $35.00 – $1,125.00 |
| D-dimer test (blood clots) CPT 85379 | $148.97 | $248.29 | $8.55 – $186.22 |
| Drug screen, instrument chemistry CPT 80307 | $275.42 | $459.04 | $10.00 – $344.28 |
| Ferritin (iron stores) test CPT 82728 | $149.69 | $249.48 | $10.00 – $187.11 |
| Free T4 (thyroid) test CPT 84439 | $128.73 | $214.55 | $7.58 – $160.91 |
| Glucose (blood sugar) test CPT 82947 | $59.87 | $99.79 | $3.30 – $74.84 |
| Gonorrhea test (DNA/NAAT) CPT 87591 | $162.62 | $271.03 | $10.00 – $203.27 |
| Hemoglobin A1c test CPT 83036 | $111.51 | $185.85 | $8.16 – $139.39 |
| Hepatitis C antibody test CPT 86803 | $152.98 | $254.96 | $10.00 – $191.22 |
| HIV-1/HIV-2 antigen and antibody test CPT 87389 | $145.09 | $241.82 | $10.00 – $181.37 |
| Iron test CPT 83540 | $89.00 | $148.33 | $5.43 – $111.25 |
| Kidney function panel CPT 80069 | $177.37 | $295.62 | $7.29 – $221.72 |
| Lipase test (pancreas) CPT 83690 | $130.62 | $217.70 | $5.79 – $163.28 |
| Lipid panel, cholesterol and triglycerides CPT 80061 | $196.84 | $328.07 | $10.00 – $246.05 |
| Liver function panel CPT 80076 | $193.52 | $322.54 | $6.86 – $241.91 |
| Magnesium test CPT 83735 | $92.35 | $153.91 | $5.63 – $115.43 |
| Obstetric blood test panel CPT 80055 | $253.73 | $422.88 | $10.00 – $317.16 |
| Partial thromboplastin time (PTT), clotting test CPT 85730 | $87.67 | $146.11 | $5.05 – $109.58 |
| Pregnancy blood test (hCG), quantitative CPT 84702 | $181.31 | $302.19 | $10.00 – $226.64 |
| Prothrombin time (PT/INR), clotting test CPT 85610 | $84.55 | $140.91 | $3.60 – $105.68 |
| PSA (prostate specific antigen), free CPT 84154 | $112.80 | $188.00 | $10.00 – $141.00 |
| PSA (prostate specific antigen), total CPT 84153 | $150.44 | $250.73 | $10.00 – $188.05 |
| Rapid strep test CPT 87880 | $259.93 | $433.21 | $10.00 – $324.91 |
| Sed rate (ESR) test CPT 85652 | $67.06 | $111.76 | $2.27 – $83.82 |
| TB skin test CPT 86580 | $60.68 | $101.13 | $10.00 – $118.63 |
| Thyroid stimulating hormone (TSH) CPT 84443 | $171.47 | $285.79 | $10.00 – $214.34 |
| Tissue exam by a pathologist (biopsy specimen) CPT 88305 | $474.00 | $790.00 | $35.00 – $592.50 |
| Troponin test (heart damage) CPT 84484 | $241.65 | $402.75 | $10.00 – $302.06 |
| Urinalysis, automated, with microscope CPT 81001 | $77.87 | $129.78 | $2.66 – $97.33 |
| Urinalysis, automated, without microscope CPT 81003 | $96.30 | $160.50 | $1.89 – $120.38 |
| Urinalysis, manual, with microscope CPT 81000 | $39.33 | $65.55 | $3.38 – $49.16 |
| Urinalysis, manual, without microscope CPT 81002 | $35.80 | $59.67 | $2.92 – $44.75 |
| Urine culture, colony count CPT 87086 | $129.30 | $215.50 | $6.78 – $161.62 |
| Urine pregnancy test CPT 81025 | $97.30 | $162.16 | $7.23 – $121.62 |
| Vitamin B12 test CPT 82607 | $144.45 | $240.75 | $10.00 – $180.56 |
| Vitamin D test CPT 82306 | $236.58 | $394.30 | $10.00 – $295.73 |
Heart
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Carotid artery ultrasound, both sides CPT 93880 | $1,375.99 | $2,293.32 | $187.79 – $1,719.99 |
| ECG tracing only (no interpretation) CPT 93005 | $271.92 | $453.20 | $56.39 – $917.00 |
| Echocardiogram (heart ultrasound), complete with Doppler CPT 93306 | $2,589.56 | $4,315.93 | $416.02 – $3,236.95 |
| Left heart catheterization CPT 93452 | $11,201.25 | $18,668.75 | $2,800.31 – $21,149.00 |
| Left heart catheterization with coronary angiogram CPT 93458 | $15,525.65 | $25,876.08 | $3,098.97 – $21,149.00 |
| Nuclear stress test (heart perfusion imaging) CPT 78452 | $4,393.64 | $7,322.73 | $422.34 – $5,492.05 |
Surgery
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| ACL reconstruction, arthroscopic CPT 29888 | not posted | $3,300.05 – $21,355.56 | |
| Appendix removal, laparoscopic CPT 44970 | not posted | $5,778.93 – $17,256.34 | |
| Breast biopsy with ultrasound guidance CPT 19083 | $3,092.06 | $5,153.43 | $486.45 – $4,016.35 |
| Carpal tunnel release CPT 64721 | not posted | $659.94 – $6,138.08 | |
| Colonoscopy with biopsy CPT 45380 | not posted | $429.26 – $4,779.00 | |
| Colonoscopy with polyp removal (snare) CPT 45385 | not posted | $429.26 – $4,779.00 | |
| Colonoscopy, diagnostic CPT 45378 | not posted | $328.50 – $4,779.00 | |
| Cystoscopy (bladder scope) CPT 52000 | $1,671.23 | $2,785.38 | $238.15 – $2,089.03 |
| Ear tubes, under general anesthesia CPT 69436 | not posted | $420.64 – $7,168.00 | |
| Flexible sigmoidoscopy, diagnostic CPT 45330 | not posted | $130.67 – $4,345.00 | |
| Gallbladder removal, laparoscopic CPT 47562 | not posted | $1,888.85 – $17,256.34 | |
| Gastric bypass (weight loss surgery), laparoscopic CPT 43644 | not posted | $3,059.91 – $22,539.00 | |
| Hysterectomy, laparoscopic, with tubes and/or ovaries CPT 58571 | not posted | $3,110.01 – $30,034.80 | |
| Hysteroscopy with biopsy or polyp removal CPT 58558 | not posted | $1,063.52 – $8,918.22 | |
| Inguinal (groin) hernia repair, laparoscopic CPT 49650 | not posted | $1,888.85 – $17,256.34 | |
| Inguinal (groin) hernia repair, open, age 5 or older CPT 49505 | $6,210.72 | $10,351.20 | $1,151.54 – $8,570.48 |
| Kidney stone shock-wave lithotripsy CPT 50590 | $13,091.90 | $21,819.84 | $1,142.90 – $16,364.88 |
| Knee arthroscopy, meniscus trim (meniscectomy) CPT 29881 | not posted | $1,088.27 – $12,343.00 | |
| Nasal endoscopy, diagnostic CPT 31231 | $469.58 | $782.64 | $68.14 – $586.98 |
| Prostate biopsy CPT 55700 | $2,627.06 | $4,378.44 | $656.77 – $5,045.72 |
| Prostate removal, laparoscopic or robotic CPT 55866 | not posted | $7,038.00 – $30,034.80 | |
| Removal of a breast lump, open surgery CPT 19120 | $4,920.97 | $8,201.62 | $963.66 – $9,442.65 |
| Rotator cuff repair, arthroscopic CPT 29827 | not posted | $2,398.52 – $21,355.56 | |
| Screening colonoscopy, average risk HCPCS G0121 | not posted | $328.50 – $4,779.00 | |
| Screening colonoscopy, high risk HCPCS G0105 | $2,265.62 | $3,776.04 | $328.50 – $4,779.00 |
| Septoplasty (nasal septum repair) CPT 30520 | not posted | $886.62 – $9,350.87 | |
| Shoulder arthroscopy, bone shaving (decompression) CPT 29826 | not posted | $1,896.00 – $12,343.00 | |
| Sleeve gastrectomy (weight loss surgery), laparoscopic CPT 43775 | not posted | $1,970.93 – $22,539.00 | |
| Total hip replacement CPT 27130 | not posted | $7,038.00 – $42,485.53 | |
| Total knee replacement CPT 27447 | not posted | $7,038.00 – $42,485.53 | |
| Upper endoscopy (EGD) with biopsy CPT 43239 | not posted | $334.95 – $4,779.00 | |
| Upper endoscopy (EGD), diagnostic CPT 43235 | not posted | $334.95 – $4,345.00 | |
| Vasectomy CPT 55250 | not posted | $652.80 – $6,324.43 |
Pregnancy and birth
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Fetal non-stress test CPT 59025 | $557.85 | $929.75 | $15.78 – $697.31 |
| IUD insertion CPT 58300 | $378.83 | $631.38 | $94.71 – $536.67 |
Hospital stays
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Alcohol or drug use disorder, without rehab, without major complications MS-DRG 897 | not posted | $1,539.00 – $19,664.37 | |
| C-section, without complications MS-DRG 788 | not posted | $6,354.00 – $27,217.46 | |
| Chest pain MS-DRG 313 | not posted | $2,950.00 – $16,038.00 | |
| COPD flare-up, with major complications MS-DRG 190 | not posted | $2,950.00 – $24,674.02 | |
| COPD flare-up, without complications MS-DRG 192 | not posted | $2,950.00 – $14,300.55 | |
| Fainting (syncope) MS-DRG 312 | not posted | $2,950.00 – $19,414.89 | |
| Gastrointestinal bleeding, with complications MS-DRG 378 | not posted | $2,950.00 – $21,845.09 | |
| Heart failure, with major complications MS-DRG 291 | not posted | $2,950.00 – $31,821.06 | |
| Heart failure, without complications MS-DRG 293 | not posted | $2,950.00 – $12,607.65 | |
| Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216 | not posted | $66,646.35 – $242,482.55 | |
| Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 | not posted | $13,140.85 – $42,966.25 | |
| Irregular heartbeat, without complications MS-DRG 310 | not posted | $2,950.00 – $14,031.71 | |
| Kidney failure, with complications MS-DRG 683 | not posted | $2,950.00 – $19,508.44 | |
| Kidney or urinary tract infection, without major complications MS-DRG 690 | not posted | $2,950.00 – $18,031.61 | |
| Neck (cervical) spinal fusion, without complications MS-DRG 473 | not posted | $16,631.59 – $54,379.96 | |
| Normal newborn care MS-DRG 795 | not posted | $561.00 – $3,367.06 | |
| Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641 | not posted | $2,950.00 – $17,334.40 | |
| Pneumonia, with complications MS-DRG 194 | not posted | $2,950.00 – $17,951.42 | |
| Pneumonia, with major complications MS-DRG 193 | not posted | $2,950.00 – $29,278.26 | |
| Pneumonia, without complications MS-DRG 195 | not posted | $2,950.00 – $13,999.84 | |
| Psychoses (inpatient psychiatric stay) MS-DRG 885 | not posted | $1,539.00 – $31,113.72 | |
| Sepsis, with major complications MS-DRG 871 | not posted | $2,950.00 – $43,269.19 | |
| Sepsis, without major complications MS-DRG 872 | not posted | $2,950.00 – $22,794.01 | |
| Skin infection (cellulitis), without major complications MS-DRG 603 | not posted | $2,950.00 – $19,399.30 | |
| Spinal fusion except neck, without major complications MS-DRG 460 | not posted | $37,499.00 – $37,499.00 | |
| Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392 | not posted | $2,950.00 – $17,365.59 | |
| Stroke, with complications or clot-busting drug MS-DRG 65 | not posted | $2,950.00 – $22,504.43 | |
| Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743 | not posted | $6,566.00 – $27,636.59 | |
| Vaginal delivery, without complications MS-DRG 807 | not posted | $2,950.00 – $19,138.52 | |
| Weight loss surgery, without complications MS-DRG 621 | not posted | $10,276.15 – $33,599.61 |
Pain and spine
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Large joint injection or drainage (knee, shoulder, hip) CPT 20610 | $715.37 | $1,192.29 | $27.96 – $894.22 |
| Lower back nerve root injection with imaging guidance CPT 64483 | $2,251.00 | $3,751.66 | $340.77 – $2,813.74 |
| Lower back spinal injection (epidural), with imaging guidance CPT 62323 | $1,882.52 | $3,137.53 | $262.86 – $2,447.27 |
| Lower back spinal injection (epidural), without imaging CPT 62322 | $1,450.84 | $2,418.06 | $262.86 – $2,362.00 |
Eye
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 | $1,373.11 | $2,288.51 | $208.33 – $1,785.04 |
Sleep
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Home sleep apnea test CPT 95806 | $794.20 | $1,323.67 | $198.55 – $2,062.00 |
| Sleep study with CPAP titration CPT 95811 | $5,236.15 | $8,726.91 | $820.87 – $6,545.18 |
| Sleep study, overnight in a sleep lab CPT 95810 | $4,658.81 | $7,764.68 | $820.87 – $5,823.51 |
Lungs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Spirometry (breathing test) CPT 94010 | $405.67 | $676.12 | $101.42 – $896.51 |
Therapy
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Manual therapy, 15 minutes CPT 97140 | $136.53 | $227.55 | $34.13 – $193.42 |
| Physical therapy evaluation, low complexity CPT 97161 | $237.28 | $395.47 | $59.32 – $560.46 |
| Physical therapy evaluation, moderate complexity CPT 97162 | $285.10 | $475.16 | $71.27 – $560.46 |
| Physical therapy, therapeutic exercise, 15 minutes CPT 97110 | $125.24 | $208.73 | $31.31 – $203.15 |
| Therapeutic activities, 15 minutes CPT 97530 | $122.76 | $204.60 | $30.69 – $263.87 |
Mental health
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Family psychotherapy, with the patient, 50 minutes CPT 90847 | $181.20 | $302.00 | $45.30 – $394.97 |
| Group psychotherapy CPT 90853 | $643.20 | $1,072.00 | $97.11 – $804.00 |
| Psychiatric diagnostic evaluation CPT 90791 | $384.35 | $640.58 | $96.09 – $480.44 |
| Psychotherapy, 30 minutes CPT 90832 | $200.43 | $334.05 | $50.11 – $394.97 |
| Psychotherapy, 45 minutes CPT 90834 | $274.50 | $457.50 | $68.62 – $394.97 |
| Psychotherapy, 60 minutes CPT 90837 | $287.47 | $479.11 | $71.87 – $394.97 |
Infusions and injections
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Injection under the skin or into a muscle CPT 96372 | $192.72 | $321.20 | $48.18 – $391.85 |
| IV hydration, each additional hour CPT 96361 | $190.67 | $317.78 | $42.03 – $238.34 |
| IV hydration, first hour CPT 96360 | $488.60 | $814.34 | $118.38 – $610.75 |
| IV push injection of a drug, first CPT 96374 | $314.60 | $524.33 | $78.65 – $530.97 |
| IV push injection, each additional drug CPT 96375 | $235.24 | $392.06 | $44.76 – $294.05 |
Drugs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696 | $103.80 | $173.00 | ? – $147.05 |
| Dexamethasone injection, per 1 mg HCPCS J1100 | $27.00 | $45.00 | ? – $38.25 |
| Fentanyl injection, per 0.1 mg HCPCS J3010 | $122.40 | $204.00 | $1.28 – $173.40 |
| Hydromorphone (Dilaudid) injection, up to 4 mg HCPCS J1170 | $85.79 | $142.98 | $21.45 – $121.53 |
| Ketorolac (Toradol) injection, per 15 mg HCPCS J1885 | $29.52 | $49.20 | ? – $36.90 |
| Midazolam (Versed) injection, per 1 mg HCPCS J2250 | $2.34 | $3.90 | ? – $3.31 |
| Morphine injection, up to 10 mg HCPCS J2270 | $156.83 | $261.38 | $4.89 – $222.17 |
| Ondansetron (Zofran) injection, per 1 mg HCPCS J2405 | $28.30 | $47.16 | ? – $40.09 |
| Propofol injection, per 10 mg HCPCS J2704 | $108.00 | $180.00 | ? – $153.00 |
| Saline IV solution, 1000 ml HCPCS J7030 | $45.90 | $76.50 | $2.40 – $65.03 |
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.