Inova Fair Oaks Hospital
3600 Joseph Siewick Drive, Fairfax, VA 22033 · Acute care hospital
These are Inova Fair Oaks Hospital's own posted figures from its standard-charges file dated April 1, 2026. They are not a quote. Source: the hospital's file · its price transparency page.
214 of the services we track have a posted price here; 156 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 | $2,535.00 | $5,070.00 | $842.61 – $6,256.22 |
| Emergency room visit, level 1 (minor) CPT 99281 | $386.00 | $772.00 | $88.05 – $920.00 |
| Emergency room visit, level 2 CPT 99282 | $506.50 | $1,013.00 | $158.36 – $920.00 |
| Emergency room visit, level 3 (moderate) CPT 99283 | $919.50 | $1,839.00 | $276.89 – $2,678.00 |
| Emergency room visit, level 4 CPT 99284 | $1,458.50 | $2,917.00 | $425.82 – $4,435.00 |
| Emergency room visit, level 5 (most severe) CPT 99285 | $1,778.50 | $3,557.00 | $613.10 – $7,643.00 |
| Simple wound repair (stitches), 2.5 cm or less CPT 12001 | $363.00 | $726.00 | $198.70 – $2,561.00 |
Office visits
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| New patient office visit, about 15 to 29 minutes CPT 99202 | $151.50 | $303.00 | $135.08 – $236.34 |
| New patient office visit, about 30 minutes CPT 99203 | $342.50 | $685.00 | $305.37 – $534.30 |
| New patient office visit, about 60 minutes CPT 99205 | $401.50 | $803.00 | $357.98 – $626.34 |
| Office visit, established patient, about 20 to 29 minutes CPT 99213 | $342.50 | $685.00 | $305.37 – $534.30 |
| Office visit, established patient, about 40 to 54 minutes CPT 99215 | $401.50 | $803.00 | $357.98 – $626.34 |
| Office visit, established patient, brief (often a nurse) CPT 99211 | $151.50 | $303.00 | $135.08 – $236.34 |
Imaging
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| 3D screening mammogram (tomosynthesis), add-on CPT 77063 | $91.50 | $183.00 | $54.50 – $142.74 |
| Abdominal X-ray, 1 view CPT 74018 | $256.00 | $512.00 | $80.04 – $399.36 |
| Ankle X-ray, 3 or more views CPT 73610 | $339.00 | $678.00 | $80.04 – $528.84 |
| Bone density scan (DEXA), hips and spine CPT 77080 | $566.00 | $1,132.00 | $106.34 – $882.96 |
| Breast ultrasound, one breast, complete CPT 76641 | $763.00 | $1,526.00 | $106.34 – $1,190.28 |
| Breast ultrasound, one breast, limited CPT 76642 | $496.00 | $992.00 | $88.05 – $773.76 |
| Chest X-ray, 1 view CPT 71045 | $247.00 | $494.00 | $80.04 – $385.32 |
| Chest X-ray, 2 views CPT 71046 | $247.00 | $494.00 | $80.04 – $385.32 |
| CT angiogram of the chest (checks for lung clots) CPT 71275 | $1,030.00 | $2,060.00 | $178.02 – $3,003.10 |
| CT angiogram of the head CPT 70496 | $992.00 | $1,984.00 | $178.02 – $2,969.03 |
| CT scan of the abdomen and pelvis, with contrast CPT 74177 | $1,064.50 | $2,129.00 | $357.13 – $3,787.26 |
| CT scan of the abdomen and pelvis, without and with contrast CPT 74178 | $1,149.00 | $2,298.00 | $357.13 – $4,239.57 |
| CT scan of the abdomen and pelvis, without contrast CPT 74176 | $747.00 | $1,494.00 | $241.72 – $2,771.67 |
| CT scan of the abdomen, without contrast CPT 74150 | $651.50 | $1,303.00 | $106.34 – $1,739.00 |
| CT scan of the chest, with contrast CPT 71260 | $885.50 | $1,771.00 | $178.02 – $1,739.00 |
| CT scan of the chest, without contrast CPT 71250 | $651.50 | $1,303.00 | $106.34 – $1,739.00 |
| CT scan of the head, without contrast CPT 70450 | $627.50 | $1,255.00 | $106.34 – $1,739.00 |
| CT scan of the neck (cervical spine), without contrast CPT 72125 | $660.00 | $1,320.00 | $106.34 – $1,739.00 |
| CT scan of the pelvis, with contrast CPT 72193 | $796.00 | $1,592.00 | $178.02 – $2,698.15 |
| CT scan of the sinuses or face, without contrast CPT 70486 | $628.00 | $1,256.00 | $106.34 – $1,739.00 |
| Diagnostic mammogram, both breasts CPT 77066 | $364.50 | $729.00 | $67.44 – $568.62 |
| Diagnostic mammogram, one breast CPT 77065 | $270.50 | $541.00 | $67.44 – $421.98 |
| Foot X-ray, 3 or more views CPT 73630 | $339.50 | $679.00 | $80.04 – $529.62 |
| Hand X-ray, 3 or more views CPT 73130 | $322.00 | $644.00 | $80.04 – $502.32 |
| Knee X-ray, 3 views CPT 73562 | $301.00 | $602.00 | $80.04 – $469.56 |
| Leg or arm vein ultrasound, both sides CPT 93970 | $1,181.50 | $2,363.00 | $237.75 – $1,843.14 |
| Leg or arm vein ultrasound, one side CPT 93971 | $786.50 | $1,573.00 | $106.34 – $1,240.00 |
| Lower back X-ray, 2 or 3 views CPT 72100 | $575.50 | $1,151.00 | $80.04 – $897.78 |
| MRI of both breasts, without and with contrast CPT 77049 | $1,366.00 | $2,732.00 | $580.28 – $3,650.08 |
| MRI of the abdomen, without and with contrast CPT 74183 | $1,421.00 | $2,842.00 | $357.13 – $4,311.12 |
| MRI of the brain, without and with contrast CPT 70553 | $1,479.00 | $2,958.00 | $357.13 – $4,376.99 |
| MRI of the brain, without contrast CPT 70551 | $833.50 | $1,667.00 | $241.72 – $2,629.00 |
| MRI of the knee or other leg joint, without contrast CPT 73721 | $835.00 | $1,670.00 | $241.72 – $2,629.00 |
| MRI of the lower back (lumbar spine), without contrast CPT 72148 | $835.00 | $1,670.00 | $241.72 – $2,629.00 |
| MRI of the mid back (thoracic spine), without contrast CPT 72146 | $835.00 | $1,670.00 | $241.72 – $2,629.00 |
| MRI of the neck (cervical spine), without contrast CPT 72141 | $835.00 | $1,670.00 | $241.72 – $2,629.00 |
| MRI of the pelvis, without and with contrast CPT 72197 | $1,421.00 | $2,842.00 | $357.13 – $4,311.12 |
| MRI of the shoulder or other arm joint, without contrast CPT 73221 | $835.00 | $1,670.00 | $241.72 – $2,629.00 |
| Neck X-ray, 2 or 3 views CPT 72040 | $320.00 | $640.00 | $80.04 – $499.20 |
| Pelvic ultrasound, complete (not pregnancy) CPT 76856 | $682.50 | $1,365.00 | $106.34 – $1,064.70 |
| Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805 | $708.00 | $1,416.00 | $106.34 – $1,104.48 |
| Pregnancy ultrasound, under 14 weeks, single baby CPT 76801 | $654.00 | $1,308.00 | $106.34 – $1,020.24 |
| Screening mammogram, both breasts CPT 77067 | $345.50 | $691.00 | $67.44 – $538.98 |
| Shoulder X-ray, 2 or more views CPT 73030 | $298.00 | $596.00 | $80.04 – $464.88 |
| Transvaginal pregnancy ultrasound CPT 76817 | $523.50 | $1,047.00 | $106.34 – $816.66 |
| Transvaginal ultrasound CPT 76830 | $575.50 | $1,151.00 | $106.34 – $897.78 |
| Ultrasound of the abdomen, complete CPT 76700 | $867.00 | $1,734.00 | $106.34 – $1,352.52 |
| Ultrasound of the neck or thyroid CPT 76536 | $640.50 | $1,281.00 | $106.34 – $999.18 |
| Wrist X-ray, 3 or more views CPT 73110 | $339.50 | $679.00 | $80.04 – $529.62 |
| X-ray of the lower back, 4 or more views CPT 72110 | $575.50 | $1,151.00 | $80.04 – $897.78 |
Lab tests
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 | $150.50 | $301.00 | $8.46 – $234.78 |
| Blood culture CPT 87040 | $115.00 | $230.00 | $10.32 – $179.40 |
| Blood draw (venipuncture) CPT 36415 | $10.50 | $21.00 | $3.00 – $34.83 |
| BNP test (heart failure) CPT 83880 | $337.50 | $675.00 | $33.33 – $526.50 |
| C-reactive protein (CRP) test CPT 86140 | $78.00 | $156.00 | $5.18 – $121.68 |
| Chlamydia test (DNA/NAAT) CPT 87491 | $245.50 | $491.00 | $35.09 – $382.98 |
| Complete blood count (CBC) with differential CPT 85025 | $100.50 | $201.00 | $7.09 – $156.78 |
| Complete blood count (CBC), automated CPT 85027 | $82.50 | $165.00 | $6.47 – $128.70 |
| Comprehensive metabolic panel (blood test) CPT 80053 | $194.50 | $389.00 | $10.56 – $303.42 |
| COVID-19 PCR test CPT 87635 | $100.00 | $200.00 | $51.31 – $258.70 |
| D-dimer test (blood clots) CPT 85379 | $192.00 | $384.00 | $5.25 – $299.52 |
| Drug screen, instrument chemistry CPT 80307 | $296.50 | $593.00 | $62.14 – $462.54 |
| Ferritin (iron stores) test CPT 82728 | $135.50 | $271.00 | $13.63 – $211.38 |
| Free T4 (thyroid) test CPT 84439 | $97.50 | $195.00 | $9.02 – $152.10 |
| Glucose (blood sugar) test CPT 82947 | $47.00 | $94.00 | $3.93 – $73.32 |
| Gonorrhea test (DNA/NAAT) CPT 87591 | $245.50 | $491.00 | $35.09 – $382.98 |
| Hemoglobin A1c test CPT 83036 | $109.00 | $218.00 | $6.47 – $170.04 |
| Hepatitis C antibody test CPT 86803 | $101.50 | $203.00 | $13.38 – $158.34 |
| HIV-1/HIV-2 antigen and antibody test CPT 87389 | $207.50 | $415.00 | $11.72 – $323.70 |
| Iron test CPT 83540 | $81.00 | $162.00 | $6.47 – $126.36 |
| Kidney function panel CPT 80069 | $188.50 | $377.00 | $8.68 – $294.06 |
| Lipase test (pancreas) CPT 83690 | $109.00 | $218.00 | $6.47 – $170.04 |
| Lipid panel, cholesterol and triglycerides CPT 80061 | $145.00 | $290.00 | $10.76 – $226.20 |
| Liver function panel CPT 80076 | $228.00 | $456.00 | $8.17 – $355.68 |
| Magnesium test CPT 83735 | $78.00 | $156.00 | $6.47 – $121.68 |
| Obstetric blood test panel CPT 80055 | $508.00 | $1,016.00 | $10.76 – $792.48 |
| Partial thromboplastin time (PTT), clotting test CPT 85730 | $79.00 | $158.00 | $5.25 – $123.24 |
| Pregnancy blood test (hCG), quantitative CPT 84702 | $238.50 | $477.00 | $15.05 – $372.06 |
| Prothrombin time (PT/INR), clotting test CPT 85610 | $45.00 | $90.00 | $4.29 – $70.20 |
| PSA (prostate specific antigen), free CPT 84154 | $187.00 | $374.00 | $14.35 – $291.72 |
| PSA (prostate specific antigen), total CPT 84153 | $141.00 | $282.00 | $14.35 – $219.96 |
| Rapid strep test CPT 87880 | $123.50 | $247.00 | $11.72 – $192.66 |
| Sed rate (ESR) test CPT 85652 | $57.50 | $115.00 | $2.70 – $89.70 |
| Thyroid stimulating hormone (TSH) CPT 84443 | $161.50 | $323.00 | $15.74 – $251.94 |
| Tissue exam by a pathologist (biopsy specimen) CPT 88305 | $224.00 | $448.00 | $46.88 – $349.44 |
| Troponin test (heart damage) CPT 84484 | $133.00 | $266.00 | $12.47 – $207.48 |
| Urinalysis, automated, with microscope CPT 81001 | $44.50 | $89.00 | $3.17 – $69.42 |
| Urinalysis, automated, without microscope CPT 81003 | $33.00 | $66.00 | $2.25 – $51.48 |
| Urinalysis, manual, without microscope CPT 81002 | $25.00 | $50.00 | $3.48 – $39.00 |
| Urine culture, colony count CPT 87086 | $77.00 | $154.00 | $8.07 – $120.12 |
| Urine pregnancy test CPT 81025 | $74.50 | $149.00 | $3.50 – $116.22 |
| Vitamin B12 test CPT 82607 | $151.50 | $303.00 | $15.08 – $236.34 |
| Vitamin D test CPT 82306 | $294.00 | $588.00 | $29.60 – $458.64 |
Heart
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Carotid artery ultrasound, both sides CPT 93880 | $941.50 | $1,883.00 | $237.75 – $1,468.74 |
| ECG tracing only (no interpretation) CPT 93005 | $209.00 | $418.00 | $37.44 – $326.04 |
| Echocardiogram (heart ultrasound), complete with Doppler CPT 93306 | $2,229.50 | $4,459.00 | $548.30 – $3,478.02 |
| Left heart catheterization CPT 93452 | $5,586.50 | $11,173.00 | $3,216.41 – $11,224.94 |
| Left heart catheterization with coronary angiogram CPT 93458 | $9,673.00 | $19,346.00 | $3,216.41 – $15,089.88 |
| Nuclear stress test (heart perfusion imaging) CPT 78452 | $3,728.50 | $7,457.00 | $1,305.48 – $5,816.46 |
Surgery
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| ACL reconstruction, arthroscopic CPT 29888 | not posted | $3,508.00 – $19,320.41 | |
| Appendix removal, laparoscopic CPT 44970 | not posted | $3,508.00 – $15,779.20 | |
| Breast biopsy with ultrasound guidance CPT 19083 | $1,974.00 | $3,948.00 | $1,620.24 – $5,689.00 |
| Carpal tunnel release CPT 64721 | not posted | $1,952.77 – $5,281.33 | |
| Colonoscopy with biopsy CPT 45380 | not posted | $1,179.08 – $3,645.00 | |
| Colonoscopy with polyp removal (snare) CPT 45385 | not posted | $1,179.08 – $3,645.00 | |
| Colonoscopy, diagnostic CPT 45378 | $1,443.50 | $2,887.00 | $911.71 – $3,645.00 |
| Colposcopy with biopsy CPT 57454 | $515.50 | $1,031.00 | $304.19 – $3,645.00 |
| Cystoscopy (bladder scope) CPT 52000 | $506.50 | $1,013.00 | $667.47 – $2,678.00 |
| Ear tubes, under general anesthesia CPT 69436 | not posted | $1,481.28 – $5,955.00 | |
| Flexible sigmoidoscopy, diagnostic CPT 45330 | $1,443.50 | $2,887.00 | $911.71 – $2,561.00 |
| Gallbladder removal, laparoscopic CPT 47562 | not posted | $3,469.00 – $15,779.20 | |
| Gastric bypass (weight loss surgery), laparoscopic CPT 43644 | not posted | $7,521.19 – $15,779.20 | |
| Hysterectomy, laparoscopic, with tubes and/or ovaries CPT 58571 | not posted | $3,275.00 – $28,157.43 | |
| Hysteroscopy with biopsy or polyp removal CPT 58558 | not posted | $3,179.53 – $8,599.11 | |
| Inguinal (groin) hernia repair, laparoscopic CPT 49650 | not posted | $3,689.00 – $15,779.20 | |
| Inguinal (groin) hernia repair, open, age 5 or older CPT 49505 | not posted | $3,529.06 – $9,544.44 | |
| Kidney stone shock-wave lithotripsy CPT 50590 | not posted | $3,448.97 – $12,949.16 | |
| Knee arthroscopy, meniscus trim (meniscectomy) CPT 29881 | not posted | $3,125.34 – $8,775.14 | |
| Lower colon endoscopy with ultrasound CPT 45391 | not posted | $1,179.08 – $3,645.00 | |
| Nasal endoscopy, diagnostic CPT 31231 | $372.00 | $744.00 | $194.14 – $3,645.00 |
| Prostate biopsy CPT 55700 | not posted | $2,048.51 – $5,540.24 | |
| Prostate removal, laparoscopic or robotic CPT 55866 | not posted | $943.00 – $28,157.43 | |
| Removal of a breast lump, open surgery CPT 19120 | not posted | $1,909.84 – $10,356.40 | |
| Rotator cuff repair, arthroscopic CPT 29827 | not posted | $3,469.00 – $19,320.41 | |
| Screening colonoscopy, average risk HCPCS G0121 | not posted | $911.71 – $3,645.00 | |
| Screening colonoscopy, high risk HCPCS G0105 | not posted | $911.71 – $3,645.00 | |
| Septoplasty (nasal septum repair) CPT 30520 | not posted | $3,243.07 – $8,770.97 | |
| Sleeve gastrectomy (weight loss surgery), laparoscopic CPT 43775 | not posted | $4,868.90 – $15,779.20 | |
| Tonsil and adenoid removal, under age 12 CPT 42820 | not posted | $3,107.67 – $15,999.06 | |
| Total hip replacement CPT 27130 | not posted | $12,866.82 – $34,798.66 | |
| Total knee replacement CPT 27447 | not posted | $11,913.00 – $34,798.66 | |
| Upper endoscopy (EGD) with biopsy CPT 43239 | $1,484.00 | $2,968.00 | $937.56 – $3,645.00 |
| Upper endoscopy (EGD), diagnostic CPT 43235 | $1,484.00 | $2,968.00 | $937.56 – $2,857.22 |
| Vasectomy CPT 55250 | not posted | $2,048.51 – $6,158.37 |
Pregnancy and birth
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Fetal non-stress test CPT 59025 | $648.00 | $1,296.00 | $201.17 – $1,162.45 |
| IUD insertion CPT 58300 | $1,004.00 | $2,008.00 | $314.28 – $2,561.00 |
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 | $7,742.94 – $23,566.25 | |
| C-section, without complications MS-DRG 788 | not posted | $7,912.95 – $19,393.65 | |
| Chest pain MS-DRG 313 | not posted | $6,467.49 – $19,057.09 | |
| COPD flare-up, with major complications MS-DRG 190 | not posted | $9,562.42 – $29,998.76 | |
| COPD flare-up, without complications MS-DRG 192 | not posted | $5,967.28 – $17,288.69 | |
| Fainting (syncope) MS-DRG 312 | not posted | $7,660.58 – $23,275.08 | |
| Gastrointestinal bleeding, with complications MS-DRG 378 | not posted | $8,526.49 – $26,336.40 | |
| Heart failure, with major complications MS-DRG 291 | not posted | $10,936.09 – $34,855.19 | |
| Heart failure, without complications MS-DRG 293 | not posted | $5,223.02 – $14,657.45 | |
| Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216 | not posted | $74,000.57 – $257,810.32 | |
| Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 | not posted | $15,323.85 – $50,367.46 | |
| Irregular heartbeat, without complications MS-DRG 310 | not posted | $5,304.62 – $14,945.95 | |
| Kidney failure, with complications MS-DRG 683 | not posted | $7,793.56 – $23,745.23 | |
| Kidney or urinary tract infection, without major complications MS-DRG 690 | not posted | $7,141.48 – $21,439.89 | |
| Neck (cervical) spinal fusion, without complications MS-DRG 473 | not posted | $18,965.08 – $63,240.47 | |
| Normal newborn care MS-DRG 795 | not posted | $2,586.73 – $5,337.27 | |
| Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641 | not posted | $6,981.29 – $20,873.58 | |
| Pneumonia, with complications MS-DRG 194 | not posted | $7,272.95 – $21,904.70 | |
| Pneumonia, with major complications MS-DRG 193 | not posted | $11,033.57 – $35,199.79 | |
| Pneumonia, without complications MS-DRG 195 | not posted | $5,782.16 – $16,634.22 | |
| Psychoses (inpatient psychiatric stay) MS-DRG 885 | not posted | $11,727.96 – $37,654.72 | |
| Sepsis, with major complications MS-DRG 871 | not posted | $15,902.64 – $52,413.68 | |
| Sepsis, without major complications MS-DRG 872 | not posted | $8,867.27 – $27,541.15 | |
| Skin infection (cellulitis), without major complications MS-DRG 603 | not posted | $7,732.36 – $23,528.85 | |
| Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392 | not posted | $6,972.98 – $20,844.19 | |
| Stroke, with complications or clot-busting drug MS-DRG 65 | not posted | $8,760.73 – $27,164.50 | |
| Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743 | not posted | $9,806.00 – $32,020.93 | |
| Vaginal delivery, without complications MS-DRG 807 | not posted | $5,892.48 – $13,637.04 | |
| Weight loss surgery, without complications MS-DRG 621 | not posted | $12,122.38 – $39,049.14 |
Pain and spine
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Large joint injection or drainage (knee, shoulder, hip) CPT 20610 | $478.00 | $956.00 | $295.19 – $2,678.00 |
| Lower back nerve root injection with imaging guidance CPT 64483 | $1,508.50 | $3,017.00 | $890.29 – $2,678.00 |
| Lower back spinal injection (epidural), with imaging guidance CPT 62323 | $1,710.00 | $3,420.00 | $692.52 – $2,678.00 |
| Lower back spinal injection (epidural), without imaging CPT 62322 | $1,415.50 | $2,831.00 | $890.29 – $2,678.00 |
Eye
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Cataract removal with lens implant CPT 66984 | not posted | $2,280.73 – $8,119.00 | |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 | not posted | $548.60 – $3,645.00 |
Eye and ear
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Hearing test, comprehensive CPT 92557 | $274.50 | $549.00 | $114.85 – $943.00 |
Sleep
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Home sleep apnea test CPT 95806 | $234.00 | $468.00 | $156.46 – $3,968.00 |
| Sleep study with CPAP titration CPT 95811 | $3,186.00 | $6,372.00 | $1,017.39 – $4,970.16 |
| Sleep study, overnight in a sleep lab CPT 95810 | $3,165.00 | $6,330.00 | $1,017.39 – $4,937.40 |
Lungs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Spirometry (breathing test) CPT 94010 | $298.50 | $597.00 | $83.53 – $1,057.00 |
Therapy
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Manual therapy, 15 minutes CPT 97140 | $127.00 | $254.00 | $30.50 – $582.98 |
| Physical therapy evaluation, low complexity CPT 97161 | $212.00 | $424.00 | $110.07 – $582.98 |
| Physical therapy evaluation, moderate complexity CPT 97162 | $212.50 | $425.00 | $110.07 – $582.98 |
| Physical therapy, therapeutic exercise, 15 minutes CPT 97110 | $124.00 | $248.00 | $32.34 – $582.98 |
| Therapeutic activities, 15 minutes CPT 97530 | $128.00 | $256.00 | $39.33 – $582.98 |
Mental health
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Family psychotherapy, with the patient, 50 minutes CPT 90847 | $350.50 | $701.00 | $160.67 – $546.78 |
| Family psychotherapy, without the patient, 50 minutes CPT 90846 | $462.00 | $924.00 | $160.67 – $720.72 |
| Group psychotherapy CPT 90853 | $142.00 | $284.00 | $92.50 – $398.92 |
| Psychiatric diagnostic evaluation CPT 90791 | $361.00 | $722.00 | $160.67 – $563.16 |
| Psychotherapy, 30 minutes CPT 90832 | $283.00 | $566.00 | $105.68 – $606.71 |
| Psychotherapy, 45 minutes CPT 90834 | $375.50 | $751.00 | $160.67 – $606.71 |
| Psychotherapy, 60 minutes CPT 90837 | $396.00 | $792.00 | $160.67 – $617.76 |
Infusions and injections
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Injection under the skin or into a muscle CPT 96372 | $109.00 | $218.00 | $71.17 – $224.01 |
| IV hydration, each additional hour CPT 96361 | $115.50 | $231.00 | $46.14 – $1,153.60 |
| IV hydration, first hour CPT 96360 | $390.00 | $780.00 | $210.69 – $1,153.60 |
| IV push injection of a drug, first CPT 96374 | $267.00 | $534.00 | $74.35 – $1,153.60 |
| IV push injection, each additional drug CPT 96375 | $232.50 | $465.00 | $46.14 – $1,153.60 |
Drugs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696 | $22.32 | $44.63 | ? – $34.81 |
| Dexamethasone injection, per 1 mg HCPCS J1100 | $4.01 | $8.01 | ? – $6.25 |
| Fentanyl injection, per 0.1 mg HCPCS J3010 | $18.29 | $36.58 | $1.50 – $28.53 |
| Ketorolac (Toradol) injection, per 15 mg HCPCS J1885 | $17.76 | $35.51 | ? – $27.70 |
| Midazolam (Versed) injection, per 1 mg HCPCS J2250 | $11.79 | $23.57 | ? – $18.38 |
| Morphine injection, up to 10 mg HCPCS J2270 | $59.80 | $119.60 | $3.05 – $93.29 |
| Ondansetron (Zofran) injection, per 1 mg HCPCS J2405 | $3.85 | $7.69 | ? – $6.00 |
| Propofol injection, per 10 mg HCPCS J2704 | $10.01 | $20.01 | ? – $15.61 |
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.