St. Luke's Patients Medical Center
4600 East Sam Houston Parkway South, Pasadena, TX 77505 · Acute care hospital · Emergency room
These are St. Luke's Patients Medical Center's own posted figures from its standard-charges file dated February 28, 2026. They are not a quote. Source: the hospital's file · its price transparency page.
196 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 | $1,560.51 | $4,458.60 | $296.50 – $5,857.00 |
| Emergency room visit, level 1 (minor) CPT 99281 | $236.60 | $676.00 | $48.79 – $1,085.00 |
| Emergency room visit, level 2 CPT 99282 | $508.20 | $1,452.00 | $48.79 – $1,405.00 |
| Emergency room visit, level 3 (moderate) CPT 99283 | $891.80 | $2,548.00 | $48.79 – $3,983.00 |
| Emergency room visit, level 4 CPT 99284 | $1,351.35 | $3,861.00 | $256.76 – $5,609.00 |
| Emergency room visit, level 5 (most severe) CPT 99285 | $1,753.15 | $5,009.00 | $333.10 – $7,146.00 |
| Simple wound repair (stitches), 2.5 cm or less CPT 12001 | $101.43 | $289.80 | $19.28 – $2,749.00 |
Imaging
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Abdominal X-ray, 1 view CPT 74018 | $472.15 | $1,349.00 | $28.88 – $1,011.75 |
| Ankle X-ray, 3 or more views CPT 73610 | $614.95 | $1,757.00 | $34.91 – $1,317.75 |
| Bone density scan (DEXA), hips and spine CPT 77080 | $405.30 | $1,158.00 | $37.14 – $868.50 |
| Breast ultrasound, one breast, complete CPT 76641 | $1,388.45 | $3,967.00 | $97.76 – $2,975.25 |
| Breast ultrasound, one breast, limited CPT 76642 | $1,101.10 | $3,146.00 | $80.94 – $2,359.50 |
| Chest X-ray, 1 view CPT 71045 | $466.20 | $1,332.00 | $24.44 – $999.00 |
| Chest X-ray, 2 views CPT 71046 | $549.85 | $1,571.00 | $32.06 – $1,178.25 |
| CT angiogram of the chest (checks for lung clots) CPT 71275 | $3,421.25 | $9,775.00 | $166.31 – $7,331.25 |
| CT angiogram of the head CPT 70496 | $3,731.16 | $10,660.44 | $166.31 – $7,995.33 |
| CT scan of the abdomen and pelvis, with contrast CPT 74177 | $5,000.58 | $14,287.35 | $296.48 – $10,715.52 |
| CT scan of the abdomen and pelvis, without and with contrast CPT 74178 | $5,050.85 | $14,431.00 | $332.67 – $10,823.25 |
| CT scan of the abdomen and pelvis, without contrast CPT 74176 | $4,700.85 | $13,431.00 | $178.70 – $10,073.25 |
| CT scan of the abdomen, without contrast CPT 74150 | $2,339.05 | $6,683.00 | $99.51 – $5,012.25 |
| CT scan of the chest, with contrast CPT 71260 | $3,760.40 | $10,744.00 | $163.15 – $8,058.00 |
| CT scan of the chest, without contrast CPT 71250 | $2,970.80 | $8,488.00 | $99.51 – $6,366.00 |
| CT scan of the head, without contrast CPT 70450 | $2,473.10 | $7,066.00 | $99.51 – $5,299.50 |
| CT scan of the neck (cervical spine), without contrast CPT 72125 | $3,200.40 | $9,144.00 | $99.51 – $6,858.00 |
| CT scan of the pelvis, with contrast CPT 72193 | $4,924.15 | $14,069.00 | $166.31 – $10,551.75 |
| CT scan of the sinuses or face, without contrast CPT 70486 | $2,256.63 | $6,447.50 | $99.51 – $4,835.63 |
| Diagnostic mammogram, both breasts CPT 77066 | $771.05 | $2,203.00 | $140.00 – $1,652.25 |
| Diagnostic mammogram, one breast CPT 77065 | $393.40 | $1,124.00 | $132.62 – $843.00 |
| Foot X-ray, 3 or more views CPT 73630 | $620.90 | $1,774.00 | $32.69 – $1,330.50 |
| Hand X-ray, 3 or more views CPT 73130 | $535.15 | $1,529.00 | $35.56 – $1,146.75 |
| Knee X-ray, 3 views CPT 73562 | $595.35 | $1,701.00 | $39.05 – $1,275.75 |
| Leg or arm vein ultrasound, both sides CPT 93970 | $1,796.90 | $5,134.00 | $179.35 – $3,850.50 |
| Leg or arm vein ultrasound, one side CPT 93971 | $1,006.60 | $2,876.00 | $101.54 – $2,157.00 |
| Lower back X-ray, 2 or 3 views CPT 72100 | $714.00 | $2,040.00 | $38.09 – $1,530.00 |
| MRI of the abdomen, without and with contrast CPT 74183 | $4,936.05 | $14,103.00 | $331.07 – $10,577.25 |
| MRI of the brain, without and with contrast CPT 70553 | $4,891.25 | $13,975.00 | $311.70 – $10,481.25 |
| MRI of the brain, without contrast CPT 70551 | $3,000.90 | $8,574.00 | $192.04 – $6,430.50 |
| MRI of the knee or other leg joint, without contrast CPT 73721 | $4,251.10 | $12,146.00 | $198.40 – $9,109.50 |
| MRI of the lower back (lumbar spine), without contrast CPT 72148 | $2,887.45 | $8,249.85 | $187.28 – $6,187.39 |
| MRI of the mid back (thoracic spine), without contrast CPT 72146 | $2,391.20 | $6,832.00 | $186.33 – $5,124.00 |
| MRI of the neck (cervical spine), without contrast CPT 72141 | $3,492.65 | $9,979.00 | $186.66 – $7,484.25 |
| MRI of the pelvis, without and with contrast CPT 72197 | $4,936.05 | $14,103.00 | $329.80 – $10,577.25 |
| MRI of the shoulder or other arm joint, without contrast CPT 73221 | $4,105.50 | $11,730.00 | $198.70 – $8,797.50 |
| Neck X-ray, 2 or 3 views CPT 72040 | $513.10 | $1,466.00 | $37.77 – $1,099.50 |
| Pelvic ultrasound, complete (not pregnancy) CPT 76856 | $1,041.43 | $2,975.50 | $91.47 – $2,231.63 |
| Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805 | $1,088.50 | $3,110.00 | $99.51 – $2,332.50 |
| Pregnancy ultrasound, under 14 weeks, single baby CPT 76801 | $938.35 | $2,681.00 | $99.51 – $2,010.75 |
| Screening mammogram, both breasts CPT 77067 | $312.55 | $893.00 | $140.25 – $669.75 |
| Shoulder X-ray, 2 or more views CPT 73030 | $634.90 | $1,814.00 | $33.34 – $1,360.50 |
| Transvaginal pregnancy ultrasound CPT 76817 | $668.50 | $1,910.00 | $88.25 – $1,432.50 |
| Transvaginal ultrasound CPT 76830 | $719.60 | $2,056.00 | $99.51 – $1,542.00 |
| Ultrasound of the abdomen, complete CPT 76700 | $1,569.78 | $4,485.07 | $99.51 – $3,363.81 |
| Ultrasound of the neck or thyroid CPT 76536 | $1,026.20 | $2,932.00 | $99.51 – $2,199.00 |
| Wrist X-ray, 3 or more views CPT 73110 | $539.00 | $1,540.00 | $39.37 – $1,155.00 |
| X-ray of the lower back, 4 or more views CPT 72110 | $926.89 | $2,648.25 | $49.52 – $1,986.19 |
Lab tests
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 | $359.45 | $1,027.00 | $6.75 – $770.25 |
| Blood culture CPT 87040 | $293.30 | $838.00 | $8.24 – $628.50 |
| Blood draw (venipuncture) CPT 36415 | $24.85 | $71.00 | $4.50 – $2,430.00 |
| BNP test (heart failure) CPT 83880 | $152.60 | $436.00 | $31.33 – $327.00 |
| C-reactive protein (CRP) test CPT 86140 | $127.16 | $363.30 | $4.13 – $272.48 |
| Chlamydia test (DNA/NAAT) CPT 87491 | $146.27 | $417.90 | $28.01 – $313.43 |
| Complete blood count (CBC) with differential CPT 85025 | $95.20 | $272.00 | $6.20 – $204.00 |
| Complete blood count (CBC), automated CPT 85027 | $168.70 | $482.00 | $5.16 – $361.50 |
| Comprehensive metabolic panel (blood test) CPT 80053 | $469.70 | $1,342.00 | $8.43 – $1,006.50 |
| COVID-19 PCR test CPT 87635 | $82.85 | $236.70 | $40.95 – $236.70 |
| D-dimer test (blood clots) CPT 85379 | $184.10 | $526.00 | $8.12 – $394.50 |
| Drug screen, instrument chemistry CPT 80307 | $156.10 | $446.00 | $49.59 – $334.50 |
| Ferritin (iron stores) test CPT 82728 | $103.27 | $295.05 | $10.88 – $221.29 |
| Free T4 (thyroid) test CPT 84439 | $74.55 | $213.00 | $7.20 – $159.75 |
| Glucose (blood sugar) test CPT 82947 | $72.40 | $206.85 | $3.13 – $155.14 |
| Gonorrhea test (DNA/NAAT) CPT 87591 | $148.11 | $423.15 | $28.01 – $317.37 |
| Hemoglobin A1c test CPT 83036 | $89.60 | $256.00 | $7.75 – $192.00 |
| Hepatitis C antibody test CPT 86803 | $77.69 | $221.95 | $11.39 – $166.47 |
| Iron test CPT 83540 | $91.51 | $261.45 | $5.16 – $196.09 |
| Lipase test (pancreas) CPT 83690 | $159.87 | $456.75 | $5.50 – $342.57 |
| Lipid panel, cholesterol and triglycerides CPT 80061 | $154.00 | $440.00 | $10.69 – $330.00 |
| Liver function panel CPT 80076 | $326.55 | $933.00 | $6.52 – $699.75 |
| Magnesium test CPT 83735 | $159.25 | $455.00 | $5.35 – $341.25 |
| Partial thromboplastin time (PTT), clotting test CPT 85730 | $177.80 | $508.00 | $4.80 – $381.00 |
| Pregnancy blood test (hCG), quantitative CPT 84702 | $134.40 | $384.00 | $12.01 – $288.00 |
| Prothrombin time (PT/INR), clotting test CPT 85610 | $177.80 | $508.00 | $3.42 – $381.00 |
| PSA (prostate specific antigen), total CPT 84153 | $108.11 | $308.88 | $14.68 – $231.66 |
| TB skin test CPT 86580 | $13.23 | $37.80 | $22.31 – $41.32 |
| Thyroid stimulating hormone (TSH) CPT 84443 | $180.95 | $517.00 | $13.40 – $387.75 |
| Tissue exam by a pathologist (biopsy specimen) CPT 88305 | $415.80 | $1,188.00 | $53.52 – $891.00 |
| Troponin test (heart damage) CPT 84484 | $162.05 | $463.00 | $9.95 – $347.25 |
| Urinalysis, automated, with microscope CPT 81001 | $141.86 | $405.30 | $2.53 – $303.98 |
| Urinalysis, automated, without microscope CPT 81003 | $64.40 | $184.00 | $1.80 – $138.00 |
| Urinalysis, manual, without microscope CPT 81002 | $13.23 | $37.80 | $2.77 – $28.35 |
| Urine culture, colony count CPT 87086 | $188.90 | $539.70 | $6.44 – $404.78 |
| Urine pregnancy test CPT 81025 | $167.65 | $479.00 | $6.87 – $359.25 |
| Vitamin B12 test CPT 82607 | $70.93 | $202.65 | $12.04 – $151.99 |
| Vitamin D test CPT 82306 | $95.80 | $273.70 | $23.62 – $205.28 |
Heart
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Carotid artery ultrasound, both sides CPT 93880 | $1,661.80 | $4,748.00 | $181.89 – $3,561.00 |
| ECG tracing only (no interpretation) CPT 93005 | $469.35 | $1,341.00 | $59.50 – $1,005.75 |
| Echocardiogram (heart ultrasound), complete with Doppler CPT 93306 | $3,033.80 | $8,668.00 | $100.00 – $6,501.00 |
| Left heart catheterization CPT 93452 | $3,621.24 | $10,346.40 | $688.04 – $28,954.00 |
| Left heart catheterization with coronary angiogram CPT 93458 | $7,570.50 | $21,630.00 | $1,438.40 – $28,954.00 |
| Nuclear stress test (heart perfusion imaging) CPT 78452 | $5,327.35 | $15,221.00 | $416.15 – $11,415.75 |
Surgery
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| ACL reconstruction, arthroscopic CPT 29888 | not posted | $1,233.00 – $11,485.34 | |
| Appendix removal, laparoscopic CPT 44970 | $2,524.41 | $7,212.60 | $479.64 – $10,059.00 |
| Breast biopsy with ultrasound guidance CPT 19083 | $2,045.61 | $5,844.60 | $462.13 – $9,029.00 |
| Carpal tunnel release CPT 64721 | $1,465.70 | $4,187.70 | $626.94 – $7,221.00 |
| Colonoscopy with biopsy CPT 45380 | $1,521.45 | $4,347.00 | $407.80 – $7,221.00 |
| Colonoscopy with polyp removal (snare) CPT 45385 | $1,460.82 | $4,173.75 | $407.80 – $7,221.00 |
| Colonoscopy, diagnostic CPT 45378 | $1,375.92 | $3,931.20 | $312.07 – $7,221.00 |
| Colposcopy with biopsy CPT 57454 | not posted | $54.41 – $5,160.00 | |
| Cystoscopy (bladder scope) CPT 52000 | not posted | $226.24 – $30,902.00 | |
| Ear tubes, under general anesthesia CPT 69436 | not posted | $399.61 – $9,029.00 | |
| Flexible sigmoidoscopy, diagnostic CPT 45330 | not posted | $109.08 – $5,160.00 | |
| Gallbladder removal, laparoscopic CPT 47562 | not posted | $1,732.00 – $18,054.00 | |
| Gastric bypass (weight loss surgery), laparoscopic CPT 43644 | not posted | $1,357.95 – $30,120.00 | |
| Hysterectomy, laparoscopic, with tubes and/or ovaries CPT 58571 | not posted | $1,997.00 – $20,636.00 | |
| Hysteroscopy with biopsy or polyp removal CPT 58558 | not posted | $1,010.34 – $9,029.00 | |
| Inguinal (groin) hernia repair, laparoscopic CPT 49650 | not posted | $1,528.00 – $10,059.00 | |
| Inguinal (groin) hernia repair, open, age 5 or older CPT 49505 | not posted | $1,093.96 – $10,059.00 | |
| Kidney stone shock-wave lithotripsy CPT 50590 | $7,211.82 | $20,605.20 | $1,085.76 – $30,902.00 |
| Knee arthroscopy, meniscus trim (meniscectomy) CPT 29881 | $1,865.75 | $5,330.70 | $1,033.86 – $10,059.00 |
| Lower colon endoscopy with ultrasound CPT 45391 | not posted | $407.80 – $7,221.00 | |
| Nasal endoscopy, diagnostic CPT 31231 | not posted | $59.33 – $2,749.00 | |
| Prostate biopsy CPT 55700 | $907.83 | $2,593.80 | $620.16 – $7,221.00 |
| Prostate removal, laparoscopic or robotic CPT 55866 | not posted | $1,732.00 – $16,153.17 | |
| Removal of a breast lump, open surgery CPT 19120 | not posted | $915.48 – $9,029.00 | |
| Rotator cuff repair, arthroscopic CPT 29827 | not posted | $1,732.00 – $11,485.34 | |
| Screening colonoscopy, average risk HCPCS G0121 | $1,376.20 | $3,932.00 | $312.07 – $7,221.00 |
| Screening colonoscopy, high risk HCPCS G0105 | $1,376.20 | $3,932.00 | $312.07 – $7,221.00 |
| Septoplasty (nasal septum repair) CPT 30520 | not posted | $842.29 – $10,059.00 | |
| Shoulder arthroscopy, bone shaving (decompression) CPT 29826 | not posted | $1,233.00 – $9,029.00 | |
| Sleeve gastrectomy (weight loss surgery), laparoscopic CPT 43775 | $1,800.01 | $5,142.86 | $342.01 – $30,120.00 |
| Tonsil and adenoid removal, under age 12 CPT 42820 | not posted | $1,233.00 – $9,313.02 | |
| Total hip replacement CPT 27130 | not posted | $1,997.00 – $22,849.36 | |
| Total knee replacement CPT 27447 | not posted | $1,997.00 – $22,849.36 | |
| Upper endoscopy (EGD) with biopsy CPT 43239 | $1,326.31 | $3,789.45 | $318.20 – $7,221.00 |
| Upper endoscopy (EGD), diagnostic CPT 43235 | $1,002.54 | $2,864.40 | $318.20 – $5,160.00 |
| Vasectomy CPT 55250 | not posted | $620.16 – $7,221.00 |
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 | $1,810.97 – $4,636.07 | |
| Fetal non-stress test CPT 59025 | not posted | $14.99 – $2,749.00 | |
| IUD insertion CPT 58300 | not posted | $41.63 – $2,749.00 | |
| Vaginal birth after a prior C-section (VBAC), routine care CPT 59610 | not posted | $1,713.93 – $4,387.66 | |
| Vaginal delivery, routine care including prenatal and postpartum CPT 59400 | not posted | $1,633.38 – $4,181.45 |
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 | $6,124.00 – $20,777.00 | |
| C-section, without complications MS-DRG 788 | not posted | $6,280.19 – $21,307.00 | |
| Chest pain MS-DRG 313 | not posted | $4,952.24 – $16,801.00 | |
| COPD flare-up, with major complications MS-DRG 190 | not posted | $7,795.57 – $26,448.00 | |
| COPD flare-up, without complications MS-DRG 192 | not posted | $4,492.69 – $15,242.00 | |
| Fainting (syncope) MS-DRG 312 | not posted | $6,048.34 – $20,520.00 | |
| Gastrointestinal bleeding, with complications MS-DRG 378 | not posted | $6,843.86 – $23,219.00 | |
| Heart failure, with major complications MS-DRG 291 | not posted | $9,057.58 – $30,729.00 | |
| Heart failure, without complications MS-DRG 293 | not posted | $3,808.93 – $12,922.00 | |
| Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216 | not posted | $66,995.36 – $227,293.00 | |
| Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 | not posted | $13,088.64 – $44,405.00 | |
| Irregular heartbeat, without complications MS-DRG 310 | not posted | $3,883.90 – $13,177.00 | |
| Kidney failure, with complications MS-DRG 683 | not posted | $6,170.51 – $20,934.00 | |
| Kidney or urinary tract infection, without major complications MS-DRG 690 | not posted | $5,571.44 – $18,902.00 | |
| Neck (cervical) spinal fusion, without complications MS-DRG 473 | not posted | $16,433.86 – $55,755.00 | |
| Normal newborn care MS-DRG 795 | not posted | $1,386.96 – $4,705.00 | |
| Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641 | not posted | $5,424.27 – $18,403.00 | |
| Pneumonia, with complications MS-DRG 194 | not posted | $5,692.23 – $19,312.00 | |
| Pneumonia, with major complications MS-DRG 193 | not posted | $9,147.13 – $31,033.00 | |
| Pneumonia, without complications MS-DRG 195 | not posted | $4,322.62 – $14,665.00 | |
| Psychoses (inpatient psychiatric stay) MS-DRG 885 | not posted | $9,785.07 – $33,197.00 | |
| Sepsis, with major complications MS-DRG 871 | not posted | $13,620.38 – $46,209.00 | |
| Sepsis, without major complications MS-DRG 872 | not posted | $7,156.93 – $24,281.00 | |
| Skin infection (cellulitis), without major complications MS-DRG 603 | not posted | $6,114.28 – $20,744.00 | |
| Spinal fusion except neck, without major complications MS-DRG 460 | not posted | $42,725.00 – $42,725.00 | |
| Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392 | not posted | $5,416.64 – $18,377.00 | |
| Stroke, with complications or clot-busting drug MS-DRG 65 | not posted | $7,059.05 – $23,949.00 | |
| Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743 | not posted | $8,321.06 – $28,231.00 | |
| Vaginal delivery, without complications MS-DRG 807 | not posted | $4,423.97 – $15,009.00 | |
| Weight loss surgery, without complications MS-DRG 621 | not posted | $10,147.43 – $34,427.00 |
Pain and spine
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Large joint injection or drainage (knee, shoulder, hip) CPT 20610 | $334.95 | $957.00 | $23.28 – $5,160.00 |
| Lower back nerve root injection with imaging guidance CPT 64483 | $624.33 | $1,783.80 | $323.73 – $5,160.00 |
| Lower back spinal injection (epidural), with imaging guidance CPT 62323 | $2,127.30 | $6,078.00 | $249.72 – $5,160.00 |
| Lower back spinal injection (epidural), without imaging CPT 62322 | $1,234.17 | $3,526.20 | $249.72 – $5,160.00 |
Eye
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Cataract removal with lens implant CPT 66984 | $2,734.57 | $7,813.05 | $807.44 – $12,381.00 |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 | not posted | $197.91 – $7,221.00 |
Sleep
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Sleep study with CPAP titration CPT 95811 | $3,497.20 | $9,992.00 | $100.00 – $7,494.00 |
| Sleep study, overnight in a sleep lab CPT 95810 | $2,838.81 | $8,110.86 | $100.00 – $6,083.15 |
Lungs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Spirometry (breathing test) CPT 94010 | $224.28 | $640.80 | $100.00 – $979.00 |
Therapy
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Manual therapy, 15 minutes CPT 97140 | $109.90 | $314.00 | $41.57 – $520.00 |
| Physical therapy evaluation, low complexity CPT 97161 | $203.70 | $582.00 | $100.00 – $480.00 |
| Physical therapy evaluation, moderate complexity CPT 97162 | $271.60 | $776.00 | $100.00 – $582.00 |
| Physical therapy, therapeutic exercise, 15 minutes CPT 97110 | $107.45 | $307.00 | $45.77 – $230.25 |
| Therapeutic activities, 15 minutes CPT 97530 | $100.80 | $288.00 | $59.45 – $480.00 |
Infusions and injections
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Injection under the skin or into a muscle CPT 96372 | $306.25 | $875.00 | $71.29 – $656.25 |
| IV hydration, each additional hour CPT 96361 | $197.72 | $564.90 | $19.99 – $423.68 |
| IV hydration, first hour CPT 96360 | $520.80 | $1,488.00 | $56.30 – $1,116.00 |
| IV push injection of a drug, first CPT 96374 | $306.25 | $875.00 | $57.87 – $656.25 |
| IV push injection, each additional drug CPT 96375 | $306.25 | $875.00 | $24.73 – $656.25 |
Drugs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696 | $75.34 | $215.25 | ? – $161.44 |
| Dexamethasone injection, per 1 mg HCPCS J1100 | $9.56 | $27.30 | ? – $27.30 |
| Ketorolac (Toradol) injection, per 15 mg HCPCS J1885 | $9.93 | $28.35 | ? – $28.35 |
| Midazolam (Versed) injection, per 1 mg HCPCS J2250 | $8.46 | $24.15 | ? – $24.15 |
| Morphine injection, up to 10 mg HCPCS J2270 | $18.38 | $52.50 | ? – $52.50 |
| Ondansetron (Zofran) injection, per 1 mg HCPCS J2405 | $36.75 | $105.00 | ? – $78.75 |
| Saline IV solution, 1000 ml HCPCS J7030 | $9.56 | $27.30 | $3.57 – $27.30 |
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.