Medical City Lewisville

500 West Main Street, Lewisville, TX 75057 · Acute care hospital · Emergency room

These are Medical City Lewisville'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.

227 of the services we track have a posted price here; 138 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	$5,959.95	$5,959.95	$804.59 – $5,959.95
Emergency room visit, level 1 (minor) CPT 99281	$734.21	$734.21	$99.12 – $734.21
Emergency room visit, level 2 CPT 99282	$1,548.64	$1,548.64	$209.07 – $1,548.64
Emergency room visit, level 3 (moderate) CPT 99283	$2,429.69	$2,429.69	$328.01 – $2,429.69
Emergency room visit, level 4 CPT 99284	$3,315.29	$3,315.29	$447.56 – $3,315.29
Emergency room visit, level 5 (most severe) CPT 99285	$4,194.81	$4,194.81	$566.30 – $4,194.81
Simple wound repair (stitches), 2.5 cm or less CPT 12001	not posted		$202.56 – $202.56

Office visits

Service	Cash price	Gross charge	Insurer rates (min – max)
New patient office visit, about 15 to 29 minutes CPT 99202	$402.16	$402.16	$141.73 – $275.74
New patient office visit, about 30 minutes CPT 99203	$476.46	$476.46	$33.35 – $476.46
New patient office visit, about 45 minutes CPT 99204	$608.55	$608.55	$360.75 – $701.81
New patient office visit, about 60 minutes CPT 99205	$681.67	$681.67	$470.77 – $915.87
Office consultation, about 40 minutes CPT 99243	not posted		$267.60 – $520.61
Office consultation, about 60 minutes CPT 99244	not posted		$430.13 – $836.79
Office visit, established patient, about 10 to 19 minutes CPT 99212	$402.16	$402.16	$28.15 – $402.16
Office visit, established patient, about 20 to 29 minutes CPT 99213	$476.46	$476.46	$142.72 – $277.66
Office visit, established patient, about 30 to 39 minutes CPT 99214	$608.55	$608.55	$220.03 – $428.05
Office visit, established patient, about 40 to 54 minutes CPT 99215	$681.67	$681.67	$310.20 – $603.48
Office visit, established patient, brief (often a nurse) CPT 99211	$329.04	$329.04	$25.77 – $50.13
Preventive checkup, new patient, age 18 to 39 CPT 99385	not posted		$66.84 – $532.16
Preventive checkup, new patient, age 40 to 64 CPT 99386	not posted		$81.23 – $647.83

Imaging

Service	Cash price	Gross charge	Insurer rates (min – max)
3D screening mammogram (tomosynthesis), add-on CPT 77063	$260.92	$260.92	$59.12 – $59.12
Abdominal X-ray, 1 view CPT 74018	$1,005.85	$1,005.85	$70.41 – $1,005.85
Ankle X-ray, 3 or more views CPT 73610	$2,040.80	$2,040.80	$142.86 – $2,040.80
Bone density scan (DEXA), hips and spine CPT 77080	$962.91	$962.91	$67.40 – $962.91
Breast ultrasound, one breast, complete CPT 76641	$1,445.20	$1,445.20	$101.16 – $1,445.20
Breast ultrasound, one breast, limited CPT 76642	$1,104.55	$1,104.55	$77.32 – $1,104.55
Chest X-ray, 1 view CPT 71045	$1,082.50	$1,082.50	$75.78 – $1,082.50
Chest X-ray, 2 views CPT 71046	$1,113.17	$1,113.17	$77.92 – $1,113.17
CT angiogram of the chest (checks for lung clots) CPT 71275	$9,979.18	$9,979.18	$698.54 – $9,979.18
CT angiogram of the head CPT 70496	$10,859.96	$10,859.96	$760.20 – $10,859.96
CT scan of the abdomen and pelvis, with contrast CPT 74177	$17,973.45	$17,973.45	$1,258.14 – $17,973.45
CT scan of the abdomen and pelvis, without and with contrast CPT 74178	$23,033.29	$23,033.29	$1,612.33 – $23,033.29
CT scan of the abdomen and pelvis, without contrast CPT 74176	$16,341.48	$16,341.48	$1,143.90 – $16,341.48
CT scan of the abdomen, without contrast CPT 74150	$9,035.91	$9,035.91	$632.51 – $9,035.91
CT scan of the chest, with contrast CPT 71260	$8,200.41	$8,200.41	$574.03 – $8,200.41
CT scan of the chest, without contrast CPT 71250	$7,669.43	$7,669.43	$536.86 – $7,669.43
CT scan of the head, without contrast CPT 70450	$7,016.65	$7,016.65	$491.17 – $7,016.65
CT scan of the neck (cervical spine), without contrast CPT 72125	$9,410.73	$9,410.73	$658.75 – $9,410.73
CT scan of the pelvis, with contrast CPT 72193	$7,813.12	$7,813.12	$546.92 – $7,813.12
CT scan of the sinuses or face, without contrast CPT 70486	$8,659.55	$8,659.55	$606.17 – $8,659.55
Diagnostic mammogram, both breasts CPT 77066	$1,216.18	$1,216.18	$165.73 – $263.00
Diagnostic mammogram, one breast CPT 77065	$1,216.18	$1,216.18	$85.13 – $1,216.18
Foot X-ray, 3 or more views CPT 73630	$1,902.81	$1,902.81	$133.20 – $1,902.81
Hand X-ray, 3 or more views CPT 73130	$2,327.54	$2,327.54	$162.93 – $2,327.54
Knee X-ray, 3 views CPT 73562	$2,017.81	$2,017.81	$141.25 – $2,017.81
Leg or arm vein ultrasound, both sides CPT 93970	$6,807.90	$6,807.90	$476.55 – $6,807.90
Leg or arm vein ultrasound, one side CPT 93971	$3,953.25	$3,953.25	$276.73 – $3,953.25
Lower back X-ray, 2 or 3 views CPT 72100	$1,418.30	$1,418.30	$99.28 – $1,418.30
MRI of both breasts, without and with contrast CPT 77049	$8,248.81	$8,248.81	$395.55 – $635.92
MRI of the abdomen, without and with contrast CPT 74183	$13,717.85	$13,717.85	$960.25 – $13,717.85
MRI of the brain, without and with contrast CPT 70553	$12,768.34	$12,768.34	$893.78 – $12,768.34
MRI of the brain, without contrast CPT 70551	$9,460.69	$9,460.69	$662.25 – $9,460.69
MRI of the knee or other leg joint, without contrast CPT 73721	$13,550.74	$13,550.74	$948.55 – $13,550.74
MRI of the lower back (lumbar spine), without contrast CPT 72148	$9,887.03	$9,887.03	$692.09 – $9,887.03
MRI of the mid back (thoracic spine), without contrast CPT 72146	$9,855.79	$9,855.79	$689.91 – $9,855.79
MRI of the neck (cervical spine), without contrast CPT 72141	$9,526.28	$9,526.28	$666.84 – $9,526.28
MRI of the pelvis, without and with contrast CPT 72197	$12,702.75	$12,702.75	$889.19 – $12,702.75
MRI of the shoulder or other arm joint, without contrast CPT 73221	$13,550.74	$13,550.74	$948.55 – $13,550.74
Neck X-ray, 2 or 3 views CPT 72040	$1,386.09	$1,386.09	$97.03 – $1,386.09
Pelvic ultrasound, complete (not pregnancy) CPT 76856	$3,054.19	$3,054.19	$213.79 – $3,054.19
Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805	$2,951.28	$2,951.28	$206.59 – $2,951.28
Pregnancy ultrasound, under 14 weeks, single baby CPT 76801	$2,761.38	$2,761.38	$193.30 – $2,761.38
Screening mammogram, both breasts CPT 77067	$1,249.51	$1,249.51	$213.49 – $269.89
Shoulder X-ray, 2 or more views CPT 73030	$2,427.20	$2,427.20	$169.90 – $2,427.20
Transvaginal pregnancy ultrasound CPT 76817	$2,477.27	$2,477.27	$173.41 – $2,477.27
Transvaginal ultrasound CPT 76830	$2,477.27	$2,477.27	$173.41 – $2,477.27
Ultrasound of the abdomen, complete CPT 76700	$3,510.79	$3,510.79	$245.76 – $3,510.79
Ultrasound of the neck or thyroid CPT 76536	$2,428.00	$2,428.00	$169.96 – $2,428.00
Wrist X-ray, 3 or more views CPT 73110	$3,278.17	$3,278.17	$229.47 – $3,278.17
X-ray of the lower back, 4 or more views CPT 72110	$2,033.15	$2,033.15	$142.32 – $2,033.15

Lab tests

Service	Cash price	Gross charge	Insurer rates (min – max)
Basic metabolic panel (blood test) CPT 80048	$1,972.74	$1,972.74	$138.09 – $1,972.74
Blood culture CPT 87040	$1,464.14	$1,464.14	$102.49 – $1,464.14
Blood draw (venipuncture) CPT 36415	$160.09	$160.09	$11.21 – $160.09
BNP test (heart failure) CPT 83880	$2,451.33	$2,451.33	$171.59 – $2,451.33
C-reactive protein (CRP) test CPT 86140	$600.33	$600.33	$42.02 – $600.33
Chlamydia test (DNA/NAAT) CPT 87491	$660.36	$660.36	$46.23 – $660.36
Complete blood count (CBC) with differential CPT 85025	not posted		$7.77 – $7.77
Complete blood count (CBC), automated CPT 85027	$875.49	$875.49	$61.28 – $875.49
Comprehensive metabolic panel (blood test) CPT 80053	$2,267.90	$2,267.90	$158.75 – $2,267.90
COVID-19 PCR test CPT 87635	$57.52	$57.52	$53.88 – $53.88
D-dimer test (blood clots) CPT 85379	$1,727.61	$1,727.61	$120.93 – $1,727.61
Drug screen, instrument chemistry CPT 80307	$880.47	$880.47	$61.63 – $880.47
Ferritin (iron stores) test CPT 82728	$977.22	$977.22	$68.41 – $977.22
Free T4 (thyroid) test CPT 84439	$571.99	$571.99	$8.49 – $8.49
General health panel (blood tests) CPT 80050	$5,357.91	$5,357.91	$47.66 – $219.03
Glucose (blood sugar) test CPT 82947	$887.15	$887.15	$62.10 – $887.15
Gonorrhea test (DNA/NAAT) CPT 87591	$660.36	$660.36	$46.23 – $660.36
Hemoglobin A1c test CPT 83036	$313.51	$313.51	$21.95 – $313.51
Hepatitis C antibody test CPT 86803	$1,692.59	$1,692.59	$118.48 – $1,692.59
HIV-1/HIV-2 antigen and antibody test CPT 87389	$2,114.48	$2,114.48	$24.08 – $24.08
Iron test CPT 83540	$1,095.60	$1,095.60	$76.69 – $1,095.60
Kidney function panel CPT 80069	$2,658.12	$2,658.12	$186.07 – $2,658.12
Lipase test (pancreas) CPT 83690	$1,040.56	$1,040.56	$72.84 – $1,040.56
Lipid panel, cholesterol and triglycerides CPT 80061	$1,107.27	$1,107.27	$77.51 – $1,107.27
Liver function panel CPT 80076	$2,436.32	$2,436.32	$170.54 – $2,436.32
Magnesium test CPT 83735	$877.15	$877.15	$61.40 – $877.15
Obstetric blood test panel CPT 80055	not posted		$47.81 – $47.81
Partial thromboplastin time (PTT), clotting test CPT 85730	$878.82	$878.82	$61.52 – $878.82
Pregnancy blood test (hCG), quantitative CPT 84702	$1,399.08	$1,399.08	$97.94 – $1,399.08
Prothrombin time (PT/INR), clotting test CPT 85610	$760.42	$760.42	$53.23 – $760.42
PSA (prostate specific antigen), free CPT 84154	$855.46	$855.46	$19.31 – $19.31
PSA (prostate specific antigen), total CPT 84153	$1,280.71	$1,280.71	$89.65 – $1,280.71
Rapid strep test CPT 87880	not posted		$18.02 – $18.02
Sed rate (ESR) test CPT 85652	$581.97	$581.97	$40.74 – $581.97
TB skin test CPT 86580	$565.30	$565.30	$39.57 – $565.30
Thyroid stimulating hormone (TSH) CPT 84443	$1,744.29	$1,744.29	$122.10 – $1,744.29
Tissue exam by a pathologist (biopsy specimen) CPT 88305	$3,220.10	$3,220.10	$49.76 – $49.76
Troponin test (heart damage) CPT 84484	$1,465.78	$1,465.78	$102.60 – $1,465.78
Urinalysis, automated, with microscope CPT 81001	$782.09	$782.09	$54.75 – $782.09
Urinalysis, automated, without microscope CPT 81003	$440.24	$440.24	$30.82 – $440.24
Urinalysis, manual, with microscope CPT 81000	not posted		$4.02 – $4.02
Urinalysis, manual, without microscope CPT 81002	$440.24	$440.24	$30.82 – $440.24
Urine culture, colony count CPT 87086	$1,552.52	$1,552.52	$108.68 – $1,552.52
Urine pregnancy test CPT 81025	$1,083.92	$1,083.92	$75.87 – $1,083.92
Vitamin B12 test CPT 82607	$528.62	$528.62	$15.08 – $15.08
Vitamin D test CPT 82306	$2,214.54	$2,214.54	$31.08 – $31.08

Heart

Service	Cash price	Gross charge	Insurer rates (min – max)
Carotid artery ultrasound, both sides CPT 93880	$3,111.26	$3,111.26	$217.79 – $3,111.26
ECG tracing only (no interpretation) CPT 93005	$1,604.95	$1,604.95	$112.35 – $1,604.95
Echocardiogram (heart ultrasound), complete with Doppler CPT 93306	$13,365.37	$13,365.37	$372.65 – $1,514.00
Electrocardiogram (ECG/EKG) with interpretation CPT 93000	not posted		$12.23 – $1,514.00
Holter monitor, up to 48 hours CPT 93224	not posted		$55.64 – $1,514.00
Left heart catheterization CPT 93452	$44,773.61	$44,773.61	$6,044.44 – $44,773.61
Left heart catheterization with coronary angiogram CPT 93458	$61,339.50	$61,339.50	$8,280.83 – $61,339.50
Nuclear stress test (heart perfusion imaging) CPT 78452	$20,552.28	$20,552.28	$862.65 – $1,090.56
Treadmill stress test, complete CPT 93015	not posted		$199.21 – $1,514.00

Surgery

Service	Cash price	Insurer rates (min – max)
ACL reconstruction, arthroscopic CPT 29888	not posted	$8,024.00 – $8,024.00
Appendix removal, laparoscopic CPT 44970	not posted	$8,024.00 – $16,960.00
Breast biopsy with ultrasound guidance CPT 19083	not posted	$510.77 – $8,485.00
Carpal tunnel release CPT 64721	not posted	$692.94 – $6,600.00
Colonoscopy with biopsy CPT 45380	not posted	$450.72 – $5,773.00
Colonoscopy with polyp removal (snare) CPT 45385	not posted	$2,467.00 – $3,486.00
Colonoscopy, diagnostic CPT 45378	not posted	$344.93 – $5,773.00
Colposcopy with biopsy CPT 57454	not posted	$64.08 – $307.65
Cystoscopy (bladder scope) CPT 52000	not posted	$250.06 – $3,293.00
Ear tubes, under general anesthesia CPT 69436	not posted	$1,995.00 – $8,910.00
Flexible sigmoidoscopy, diagnostic CPT 45330	not posted	$137.20 – $4,850.00
Gallbladder removal, laparoscopic CPT 47562	not posted	$1,983.29 – $16,960.00
Gastric bypass (weight loss surgery), laparoscopic CPT 43644	not posted	$1,995.00 – $37,859.65
Hysterectomy, laparoscopic, with tubes and/or ovaries CPT 58571	not posted	$2,369.00 – $23,981.00
Hysteroscopy with biopsy or polyp removal CPT 58558	not posted	$3,796.00 – $6,994.68
Inguinal (groin) hernia repair, laparoscopic CPT 49650	not posted	$8,024.00 – $8,024.00
Inguinal (groin) hernia repair, open, age 5 or older CPT 49505	not posted	$1,209.12 – $12,499.00
Kidney stone shock-wave lithotripsy CPT 50590	not posted	$1,200.05 – $16,960.00
Knee arthroscopy, meniscus trim (meniscectomy) CPT 29881	not posted	$1,142.68 – $10,300.00
Lower colon endoscopy with ultrasound CPT 45391	not posted	$450.72 – $5,773.00
Nasal endoscopy, diagnostic CPT 31231	not posted	$484.09 – $5,773.00
Prostate biopsy CPT 55700	not posted	$2,214.00 – $2,299.00
Prostate removal, laparoscopic or robotic CPT 55866	not posted	$1,995.00 – $25,750.00
Removal of a breast lump, open surgery CPT 19120	not posted	$5,381.00 – $8,910.00
Rotator cuff repair, arthroscopic CPT 29827	not posted	$2,518.45 – $16,960.00
Screening colonoscopy, average risk HCPCS G0121	not posted	$323.57 – $410.63
Screening colonoscopy, high risk HCPCS G0105	not posted	$3,293.00 – $5,773.00
Septoplasty (nasal septum repair) CPT 30520	not posted	$930.95 – $12,499.00
Shoulder arthroscopy, bone shaving (decompression) CPT 29826	not posted	$1,580.00 – $8,485.00
Sleeve gastrectomy (weight loss surgery), laparoscopic CPT 43775	not posted	$8,024.00 – $8,024.00
Tonsil and adenoid removal, under age 12 CPT 42820	not posted	$3,796.00 – $13,581.48
Total hip replacement CPT 27130	not posted	$1,995.00 – $83,066.96
Total knee replacement CPT 27447	not posted	$12,000.00 – $70,440.00
Upper endoscopy (EGD) with biopsy CPT 43239	not posted	$4,568.00 – $5,773.00
Upper endoscopy (EGD), diagnostic CPT 43235	not posted	$368.44 – $368.44
Vasectomy CPT 55250	not posted	$685.44 – $6,600.00

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		$2,152.00 – $50,489.70
Fetal non-stress test CPT 59025	$1,658.01	$1,658.01	$116.06 – $1,658.01
IUD insertion CPT 58300	not posted		$1,572.00 – $2,222.00
Vaginal birth after a prior C-section (VBAC), routine care CPT 59610	not posted		$1,995.00 – $47,784.37
Vaginal delivery, routine care including prenatal and postpartum CPT 59400	not posted		$6,587.00 – $6,587.00

Hospital stays

Service	Cash price	Insurer rates (min – max)
Alcohol or drug use disorder, without rehab, without major complications MS-DRG 897	not posted	$1,023.00 – $10,705.33
C-section, without complications MS-DRG 788	not posted	$649.00 – $649.00
Chest pain MS-DRG 313	not posted	$1,023.00 – $1,023.00
COPD flare-up, with major complications MS-DRG 190	not posted	$1,023.00 – $12,549.47
COPD flare-up, without complications MS-DRG 192	not posted	$8,576.29 – $8,730.81
Fainting (syncope) MS-DRG 312	not posted	$10,425.65 – $10,613.50
Gastrointestinal bleeding, with complications MS-DRG 378	not posted	$1,023.00 – $11,508.10
Heart failure, with major complications MS-DRG 291	not posted	$13,745.80 – $13,993.47
Heart failure, without complications MS-DRG 293	not posted	$1,023.00 – $1,023.00
Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216	not posted	$82,202.68 – $83,683.81
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470	not posted	$18,941.88 – $19,283.18
Irregular heartbeat, without complications MS-DRG 310	not posted	$7,964.93 – $8,108.45
Kidney failure, with complications MS-DRG 683	not posted	$1,023.00 – $10,647.93
Kidney or urinary tract infection, without major complications MS-DRG 690	not posted	$1,023.00 – $10,104.29
Neck (cervical) spinal fusion, without complications MS-DRG 473	not posted	$1,196.00 – $23,484.77
Normal newborn care MS-DRG 795	not posted	$5,014.50 – $5,104.85
Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641	not posted	$9,673.34 – $9,847.63
Pneumonia, with complications MS-DRG 194	not posted	$9,896.45 – $10,074.77
Pneumonia, with major complications MS-DRG 193	not posted	$13,992.27 – $14,244.38
Pneumonia, without complications MS-DRG 195	not posted	$1,023.00 – $8,620.12
Psychoses (inpatient psychiatric stay) MS-DRG 885	not posted	$14,655.97 – $14,920.05
Sepsis, with major complications MS-DRG 871	not posted	$1,023.00 – $19,394.69
Sepsis, without major complications MS-DRG 872	not posted	$1,023.00 – $11,857.41
Skin infection (cellulitis), without major complications MS-DRG 603	not posted	$995.00 – $4,798.00
Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392	not posted	$1,023.00 – $1,023.00
Stroke, with complications or clot-busting drug MS-DRG 65	not posted	$11,542.83 – $11,750.81
Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743	not posted	$1,196.00 – $13,640.05
Vaginal delivery, without complications MS-DRG 807	not posted	$8,835.65 – $8,994.85
Weight loss surgery, without complications MS-DRG 621	not posted	$19,500.00 – $26,000.00

Pain and spine

Service	Cash price	Insurer rates (min – max)
Large joint injection or drainage (knee, shoulder, hip) CPT 20610	not posted	$29.36 – $4,850.00
Lower back nerve root injection with imaging guidance CPT 64483	not posted	$357.81 – $4,850.00
Lower back spinal injection (epidural), with imaging guidance CPT 62323	not posted	$258.92 – $712.64
Lower back spinal injection (epidural), without imaging CPT 62322	not posted	$258.92 – $892.95

Eye

Service	Cash price	Insurer rates (min – max)
Cataract removal with lens implant CPT 66984	not posted	$892.44 – $18,490.00
Eye exam, new patient, comprehensive CPT 92004	not posted	$318.81 – $620.23
Laser treatment of clouding after cataract surgery (YAG) CPT 66821	not posted	$218.75 – $5,773.00

Eye and ear

Service	Cash price	Gross charge	Insurer rates (min – max)
Hearing test, comprehensive CPT 92557	not posted		$380.46 – $740.17

Sleep

Service	Cash price	Gross charge	Insurer rates (min – max)
Home sleep apnea test CPT 95806	$1,734.42	$1,734.42	$246.78 – $1,006.00
Sleep study with CPAP titration CPT 95811	$17,383.05	$17,383.05	$1,927.00 – $3,130.00
Sleep study, overnight in a sleep lab CPT 95810	$16,470.44	$16,470.44	$796.00 – $2,680.03

Lungs

Service	Cash price	Gross charge	Insurer rates (min – max)
Spirometry (breathing test) CPT 94010	$1,917.44	$1,917.44	$380.46 – $740.17

Therapy

Service	Cash price	Gross charge	Insurer rates (min – max)
Manual therapy, 15 minutes CPT 97140	$329.73	$329.73	$23.08 – $329.73
Physical therapy evaluation, low complexity CPT 97161	$326.47	$326.47	$92.62 – $462.72
Physical therapy evaluation, moderate complexity CPT 97162	$459.02	$459.02	$83.60 – $220.14
Physical therapy, therapeutic exercise, 15 minutes CPT 97110	$240.82	$240.82	$16.86 – $240.82
Therapeutic activities, 15 minutes CPT 97530	$263.44	$263.44	$18.44 – $263.44

Infusions and injections

Service	Cash price	Gross charge	Insurer rates (min – max)
Injection under the skin or into a muscle CPT 96372	$308.21	$308.21	$21.57 – $308.21
IV hydration, each additional hour CPT 96361	$1,208.29	$1,208.29	$84.58 – $1,208.29
IV hydration, first hour CPT 96360	$1,208.29	$1,208.29	$84.58 – $1,208.29
IV push injection of a drug, first CPT 96374	$414.17	$414.17	$28.99 – $414.17
IV push injection, each additional drug CPT 96375	$414.17	$414.17	$28.99 – $414.17

Drugs

Service	Cash price	Gross charge	Insurer rates (min – max)
Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696	$1,702.27	$1,702.27	$1,276.70 – $1,276.70
Dexamethasone injection, per 1 mg HCPCS J1100	$75.78	$75.78	$5.30 – $75.78
Fentanyl injection, per 0.1 mg HCPCS J3010	$162.84	$162.84	$122.13 – $122.13
Hydromorphone (Dilaudid) injection, up to 4 mg HCPCS J1170	$68.00	$68.00	$4.76 – $68.00
Ketorolac (Toradol) injection, per 15 mg HCPCS J1885	$157.44	$157.44	$11.02 – $157.44
Midazolam (Versed) injection, per 1 mg HCPCS J2250	$590.25	$590.25	$41.32 – $590.25
Morphine injection, up to 10 mg HCPCS J2270	$52.40	$52.40	$3.67 – $52.40
Ondansetron (Zofran) injection, per 1 mg HCPCS J2405	$497.44	$497.44
Propofol injection, per 10 mg HCPCS J2704	$317.95	$317.95	$238.46 – $238.46
Saline IV solution, 1000 ml HCPCS J7030	$792.18	$792.18	$55.45 – $792.18

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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