Mary Washington Hospital
1001 Sam Perry Boulevard, Fredericksburg, VA 22401 · Acute care hospital · Emergency room
These are Mary Washington Hospital's own posted figures from its standard-charges file dated December 30, 2024. They are not a quote. Source: the hospital's file · its price transparency page.
217 of the services we track have a posted price here; 145 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 | $1,240.50 | $2,481.00 | $299.00 – $5,302.00 |
| Emergency room visit, level 1 (minor) CPT 99281 | $187.00 | $374.00 | $85.00 – $2,616.00 |
| Emergency room visit, level 2 CPT 99282 | $288.00 | $576.00 | $156.00 – $2,616.00 |
| Emergency room visit, level 3 (moderate) CPT 99283 | $378.00 | $756.00 | $272.00 – $2,616.00 |
| Emergency room visit, level 4 CPT 99284 | $666.00 | $1,332.00 | $299.00 – $2,782.00 |
| Emergency room visit, level 5 (most severe) CPT 99285 | $990.00 | $1,980.00 | $299.00 – $5,361.00 |
| Simple wound repair (stitches), 2.5 cm or less CPT 12001 | $326.50 | $653.00 | $191.00 – $4,450.00 |
Imaging
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| 3D screening mammogram (tomosynthesis), add-on CPT 77063 | not posted | $23.00 – $142.00 | |
| Abdominal X-ray, 1 view CPT 74018 | $106.00 | $212.00 | $77.00 – $288.00 |
| Ankle X-ray, 3 or more views CPT 73610 | $278.00 | $556.00 | $55.00 – $288.00 |
| Bone density scan (DEXA), hips and spine CPT 77080 | $358.50 | $717.00 | $104.00 – $326.00 |
| Breast ultrasound, one breast, complete CPT 76641 | $120.50 | $241.00 | $105.00 – $400.00 |
| Breast ultrasound, one breast, limited CPT 76642 | $120.50 | $241.00 | $87.00 – $362.00 |
| Chest X-ray, 1 view CPT 71045 | $106.00 | $212.00 | $77.00 – $292.00 |
| Chest X-ray, 2 views CPT 71046 | $106.00 | $212.00 | $77.00 – $292.00 |
| CT angiogram of the chest (checks for lung clots) CPT 71275 | $1,290.50 | $2,581.00 | $175.00 – $2,641.00 |
| CT angiogram of the head CPT 70496 | $1,322.00 | $2,644.00 | $175.00 – $2,641.00 |
| CT scan of the abdomen and pelvis, with contrast CPT 74177 | $1,421.50 | $2,843.00 | $234.00 – $3,263.00 |
| CT scan of the abdomen and pelvis, without and with contrast CPT 74178 | $2,588.00 | $5,176.00 | $234.00 – $3,652.00 |
| CT scan of the abdomen and pelvis, without contrast CPT 74176 | $1,068.50 | $2,137.00 | $234.00 – $2,641.00 |
| CT scan of the abdomen, without contrast CPT 74150 | $1,020.50 | $2,041.00 | $105.00 – $2,641.00 |
| CT scan of the chest, with contrast CPT 71260 | $1,151.00 | $2,302.00 | $175.00 – $2,641.00 |
| CT scan of the chest, without contrast CPT 71250 | $565.50 | $1,131.00 | $105.00 – $2,641.00 |
| CT scan of the head, without contrast CPT 70450 | $942.50 | $1,885.00 | $105.00 – $2,641.00 |
| CT scan of the neck (cervical spine), without contrast CPT 72125 | $1,094.00 | $2,188.00 | $105.00 – $2,641.00 |
| CT scan of the pelvis, with contrast CPT 72193 | $1,107.50 | $2,215.00 | $175.00 – $2,641.00 |
| CT scan of the sinuses or face, without contrast CPT 70486 | $942.50 | $1,885.00 | $105.00 – $2,641.00 |
| Diagnostic mammogram, both breasts CPT 77066 | not posted | $65.00 – $357.00 | |
| Diagnostic mammogram, one breast CPT 77065 | not posted | $65.00 – $281.00 | |
| Foot X-ray, 3 or more views CPT 73630 | $281.50 | $563.00 | $54.00 – $288.00 |
| Hand X-ray, 3 or more views CPT 73130 | $247.50 | $495.00 | $54.00 – $288.00 |
| Knee X-ray, 3 views CPT 73562 | $411.50 | $823.00 | $61.00 – $288.00 |
| Leg or arm vein ultrasound, both sides CPT 93970 | $478.00 | $956.00 | $228.00 – $829.00 |
| Leg or arm vein ultrasound, one side CPT 93971 | $314.00 | $628.00 | $105.00 – $829.00 |
| Lower back X-ray, 2 or 3 views CPT 72100 | $288.50 | $577.00 | $67.00 – $288.00 |
| MRI of both breasts, without and with contrast CPT 77049 | not posted | $469.00 – $3,098.00 | |
| MRI of the abdomen, without and with contrast CPT 74183 | $1,886.00 | $3,772.00 | $366.00 – $3,714.00 |
| MRI of the brain, without and with contrast CPT 70553 | $1,832.00 | $3,664.00 | $366.00 – $3,771.00 |
| MRI of the brain, without contrast CPT 70551 | $1,214.50 | $2,429.00 | $234.00 – $1,765.00 |
| MRI of the knee or other leg joint, without contrast CPT 73721 | $2,022.00 | $4,044.00 | $234.00 – $1,723.00 |
| MRI of the lower back (lumbar spine), without contrast CPT 72148 | $1,844.50 | $3,689.00 | $234.00 – $1,932.00 |
| MRI of the mid back (thoracic spine), without contrast CPT 72146 | $1,844.50 | $3,689.00 | $234.00 – $1,951.00 |
| MRI of the neck (cervical spine), without contrast CPT 72141 | $1,499.00 | $2,998.00 | $234.00 – $1,784.00 |
| MRI of the pelvis, without and with contrast CPT 72197 | $1,736.00 | $3,472.00 | $366.00 – $3,714.00 |
| MRI of the shoulder or other arm joint, without contrast CPT 73221 | $1,697.00 | $3,394.00 | $234.00 – $1,723.00 |
| Neck X-ray, 2 or 3 views CPT 72040 | $157.00 | $314.00 | $63.00 – $288.00 |
| Pelvic ultrasound, complete (not pregnancy) CPT 76856 | $297.00 | $594.00 | $105.00 – $439.00 |
| Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805 | $454.50 | $909.00 | $105.00 – $518.00 |
| Pregnancy ultrasound, under 14 weeks, single baby CPT 76801 | $274.00 | $548.00 | $105.00 – $448.00 |
| Screening mammogram, both breasts CPT 77067 | not posted | $65.00 – $270.00 | |
| Shoulder X-ray, 2 or more views CPT 73030 | $376.00 | $752.00 | $49.00 – $288.00 |
| Transvaginal pregnancy ultrasound CPT 76817 | $572.00 | $1,144.00 | $105.00 – $362.00 |
| Transvaginal ultrasound CPT 76830 | $414.00 | $828.00 | $105.00 – $494.00 |
| Ultrasound of the abdomen, complete CPT 76700 | $476.00 | $952.00 | $105.00 – $464.00 |
| Ultrasound of the neck or thyroid CPT 76536 | $406.50 | $813.00 | $105.00 – $498.00 |
| Wrist X-ray, 3 or more views CPT 73110 | $260.00 | $520.00 | $64.00 – $288.00 |
| X-ray of the lower back, 4 or more views CPT 72110 | $393.50 | $787.00 | $77.00 – $344.00 |
Lab tests
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 | $39.00 | $78.00 | $8.00 – $270.00 |
| Blood culture CPT 87040 | $56.50 | $113.00 | $10.00 – $270.00 |
| Blood draw (venipuncture) CPT 36415 | $12.50 | $25.00 | $4.00 – $270.00 |
| BNP test (heart failure) CPT 83880 | $104.50 | $209.00 | $32.00 – $270.00 |
| C-reactive protein (CRP) test CPT 86140 | $28.50 | $57.00 | $5.00 – $270.00 |
| Chlamydia test (DNA/NAAT) CPT 87491 | $105.50 | $211.00 | $35.00 – $270.00 |
| Complete blood count (CBC) with differential CPT 85025 | $36.50 | $73.00 | $7.00 – $270.00 |
| Complete blood count (CBC), automated CPT 85027 | $22.50 | $45.00 | $6.00 – $270.00 |
| Comprehensive metabolic panel (blood test) CPT 80053 | $56.00 | $112.00 | $10.00 – $270.00 |
| COVID-19 PCR test CPT 87635 | $93.50 | $187.00 | $51.00 – $270.00 |
| D-dimer test (blood clots) CPT 85379 | $135.00 | $270.00 | $5.00 – $270.00 |
| Drug screen, instrument chemistry CPT 80307 | $110.50 | $221.00 | $44.00 – $270.00 |
| Ferritin (iron stores) test CPT 82728 | $71.00 | $142.00 | $14.00 – $270.00 |
| Free T4 (thyroid) test CPT 84439 | $45.00 | $90.00 | $9.00 – $270.00 |
| General health panel (blood tests) CPT 80050 | $50.00 | $100.00 | $10.00 – $270.00 |
| Glucose (blood sugar) test CPT 82947 | $39.00 | $78.00 | $4.00 – $270.00 |
| Gonorrhea test (DNA/NAAT) CPT 87591 | $105.50 | $211.00 | $35.00 – $270.00 |
| Hemoglobin A1c test CPT 83036 | $38.50 | $77.00 | $6.00 – $270.00 |
| Hepatitis C antibody test CPT 86803 | $49.50 | $99.00 | $13.00 – $270.00 |
| HIV-1/HIV-2 antigen and antibody test CPT 87389 | $74.00 | $148.00 | $11.00 – $270.00 |
| Iron test CPT 83540 | $27.50 | $55.00 | $6.00 – $270.00 |
| Kidney function panel CPT 80069 | $27.00 | $54.00 | $9.00 – $270.00 |
| Lipase test (pancreas) CPT 83690 | $59.50 | $119.00 | $6.00 – $270.00 |
| Lipid panel, cholesterol and triglycerides CPT 80061 | $61.50 | $123.00 | $10.00 – $270.00 |
| Liver function panel CPT 80076 | $57.00 | $114.00 | $8.00 – $270.00 |
| Magnesium test CPT 83735 | $37.50 | $75.00 | $6.00 – $270.00 |
| Obstetric blood test panel CPT 80055 | not posted | $10.00 – $270.00 | |
| Partial thromboplastin time (PTT), clotting test CPT 85730 | $38.50 | $77.00 | $5.00 – $270.00 |
| Pregnancy blood test (hCG), quantitative CPT 84702 | $125.50 | $251.00 | $15.00 – $270.00 |
| Prothrombin time (PT/INR), clotting test CPT 85610 | $19.00 | $38.00 | $4.00 – $270.00 |
| PSA (prostate specific antigen), free CPT 84154 | $56.50 | $113.00 | $14.00 – $270.00 |
| PSA (prostate specific antigen), total CPT 84153 | $55.00 | $110.00 | $14.00 – $270.00 |
| Rapid strep test CPT 87880 | $30.00 | $60.00 | $11.00 – $270.00 |
| Sed rate (ESR) test CPT 85652 | $6.50 | $13.00 | $3.00 – $270.00 |
| TB skin test CPT 86580 | $14.50 | $29.00 | $12.00 – $270.00 |
| Thyroid stimulating hormone (TSH) CPT 84443 | $78.50 | $157.00 | $15.00 – $270.00 |
| Tissue exam by a pathologist (biopsy specimen) CPT 88305 | $111.50 | $223.00 | $45.00 – $279.00 |
| Troponin test (heart damage) CPT 84484 | $59.00 | $118.00 | $12.00 – $270.00 |
| Urinalysis, automated, with microscope CPT 81001 | $20.00 | $40.00 | $3.00 – $270.00 |
| Urinalysis, automated, without microscope CPT 81003 | $16.00 | $32.00 | $2.00 – $270.00 |
| Urinalysis, manual, with microscope CPT 81000 | not posted | $3.00 – $18.00 | |
| Urinalysis, manual, without microscope CPT 81002 | $6.00 | $12.00 | $3.00 – $270.00 |
| Urine culture, colony count CPT 87086 | $51.00 | $102.00 | $8.00 – $270.00 |
| Urine pregnancy test CPT 81025 | $27.00 | $54.00 | $3.00 – $270.00 |
| Vitamin B12 test CPT 82607 | $53.00 | $106.00 | $15.00 – $270.00 |
| Vitamin D test CPT 82306 | $90.50 | $181.00 | $30.00 – $270.00 |
Heart
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Carotid artery ultrasound, both sides CPT 93880 | $348.50 | $697.00 | $228.00 – $829.00 |
| ECG tracing only (no interpretation) CPT 93005 | $68.50 | $137.00 | $36.00 – $657.00 |
| Echocardiogram (heart ultrasound), complete with Doppler CPT 93306 | $1,193.50 | $2,387.00 | $321.00 – $1,967.00 |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 | not posted | $36.00 – $87.00 | |
| Holter monitor, up to 48 hours CPT 93224 | not posted | $81.00 – $544.00 | |
| Left heart catheterization CPT 93452 | $6,393.00 | $12,786.00 | $320.00 – $13,472.00 |
| Left heart catheterization with coronary angiogram CPT 93458 | $7,083.50 | $14,167.00 | $320.00 – $15,407.00 |
| Nuclear stress test (heart perfusion imaging) CPT 78452 | $2,161.00 | $4,322.00 | $227.00 – $3,201.00 |
| Treadmill stress test, complete CPT 93015 | not posted | $236.00 – $348.00 |
Surgery
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| ACL reconstruction, arthroscopic CPT 29888 | not posted | $3,253.00 – $20,568.00 | |
| Appendix removal, laparoscopic CPT 44970 | not posted | $3,991.00 – $13,009.00 | |
| Breast biopsy with ultrasound guidance CPT 19083 | $1,141.50 | $2,283.00 | $240.00 – $5,866.00 |
| Carpal tunnel release CPT 64721 | not posted | $1,840.00 – $8,286.00 | |
| Colonoscopy with biopsy CPT 45380 | $1,386.50 | $2,773.00 | $499.00 – $5,866.00 |
| Colonoscopy with polyp removal (snare) CPT 45385 | $1,386.50 | $2,773.00 | $499.00 – $5,866.00 |
| Colonoscopy, diagnostic CPT 45378 | $1,386.50 | $2,773.00 | $499.00 – $5,866.00 |
| Colposcopy with biopsy CPT 57454 | $406.00 | $812.00 | $306.00 – $5,866.00 |
| Cystoscopy (bladder scope) CPT 52000 | not posted | $651.00 – $4,450.00 | |
| Ear tubes, under general anesthesia CPT 69436 | not posted | $1,453.00 – $6,705.00 | |
| Flexible sigmoidoscopy, diagnostic CPT 45330 | $907.00 | $1,814.00 | $499.00 – $4,450.00 |
| Gallbladder removal, laparoscopic CPT 47562 | not posted | $5,024.00 – $13,009.00 | |
| Gastric bypass (weight loss surgery), laparoscopic CPT 43644 | not posted | $3,991.00 – $13,009.00 | |
| Hysterectomy, laparoscopic, with tubes and/or ovaries CPT 58571 | not posted | $6,518.00 – $23,208.00 | |
| Hysteroscopy with biopsy or polyp removal CPT 58558 | not posted | $2,979.00 – $8,286.00 | |
| Inguinal (groin) hernia repair, laparoscopic CPT 49650 | not posted | $4,022.00 – $13,009.00 | |
| Inguinal (groin) hernia repair, open, age 5 or older CPT 49505 | not posted | $3,297.00 – $10,712.00 | |
| Kidney stone shock-wave lithotripsy CPT 50590 | $5,887.50 | $11,775.00 | $239.00 – $12,043.00 |
| Knee arthroscopy, meniscus trim (meniscectomy) CPT 29881 | not posted | $3,000.00 – $10,712.00 | |
| Lower colon endoscopy with ultrasound CPT 45391 | $1,386.50 | $2,773.00 | $499.00 – $5,866.00 |
| Nasal endoscopy, diagnostic CPT 31231 | not posted | $189.00 – $5,866.00 | |
| Prostate biopsy CPT 55700 | $3,094.50 | $6,189.00 | $239.00 – $5,866.00 |
| Prostate removal, laparoscopic or robotic CPT 55866 | not posted | $910.00 – $23,208.00 | |
| Removal of a breast lump, open surgery CPT 19120 | not posted | $1,833.00 – $8,594.00 | |
| Rotator cuff repair, arthroscopic CPT 29827 | not posted | $4,573.00 – $16,129.00 | |
| Screening colonoscopy, average risk HCPCS G0121 | $1,386.50 | $2,773.00 | $499.00 – $6,042.00 |
| Screening colonoscopy, high risk HCPCS G0105 | $1,386.50 | $2,773.00 | $499.00 – $6,042.00 |
| Septoplasty (nasal septum repair) CPT 30520 | not posted | $3,068.00 – $8,286.00 | |
| Shoulder arthroscopy, bone shaving (decompression) CPT 29826 | not posted | $910.00 – $6,705.00 | |
| Sleeve gastrectomy (weight loss surgery), laparoscopic CPT 43775 | not posted | $3,991.00 – $13,009.00 | |
| Tonsil and adenoid removal, under age 12 CPT 42820 | not posted | $2,983.00 – $13,203.00 | |
| Total hip replacement CPT 27130 | not posted | $10,939.00 – $29,673.00 | |
| Total knee replacement CPT 27447 | not posted | $10,939.00 – $29,673.00 | |
| Upper endoscopy (EGD) with biopsy CPT 43239 | $1,372.50 | $2,745.00 | $499.00 – $5,866.00 |
| Upper endoscopy (EGD), diagnostic CPT 43235 | $1,372.50 | $2,745.00 | $499.00 – $4,775.00 |
| Vasectomy CPT 55250 | not posted | $1,941.00 – $8,286.00 |
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 | $3,663.00 – $3,919.00 | |
| Fetal non-stress test CPT 59025 | $533.00 | $1,066.00 | $118.00 – $991.00 |
| IUD insertion CPT 58300 | $190.50 | $381.00 | $302.00 – $4,450.00 |
| Vaginal birth after a prior C-section (VBAC), routine care CPT 59610 | not posted | $3,312.00 – $3,544.00 | |
| Vaginal delivery, routine care including prenatal and postpartum CPT 59400 | not posted | $3,312.00 – $3,544.00 |
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 | $1,144.00 – $9,861.00 | |
| C-section, without complications MS-DRG 788 | not posted | $7,113.00 – $12,683.00 | |
| Chest pain MS-DRG 313 | not posted | $5,607.00 – $10,368.00 | |
| COPD flare-up, with major complications MS-DRG 190 | not posted | $8,829.00 – $16,327.00 | |
| COPD flare-up, without complications MS-DRG 192 | not posted | $5,087.00 – $9,407.00 | |
| Fainting (syncope) MS-DRG 312 | not posted | $6,848.00 – $12,664.00 | |
| Gastrointestinal bleeding, with complications MS-DRG 378 | not posted | $7,749.00 – $14,330.00 | |
| Heart failure, with major complications MS-DRG 291 | not posted | $10,256.00 – $18,967.00 | |
| Heart failure, without complications MS-DRG 293 | not posted | $4,315.00 – $7,980.00 | |
| Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216 | not posted | $75,852.00 – $140,269.00 | |
| Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 | not posted | $14,820.00 – $44,717.00 | |
| Irregular heartbeat, without complications MS-DRG 310 | not posted | $4,398.00 – $8,132.00 | |
| Kidney failure, with complications MS-DRG 683 | not posted | $6,987.00 – $12,920.00 | |
| Kidney or urinary tract infection, without major complications MS-DRG 690 | not posted | $6,308.00 – $11,666.00 | |
| Neck (cervical) spinal fusion, without complications MS-DRG 473 | not posted | $18,606.00 – $34,758.00 | |
| Normal newborn care MS-DRG 795 | not posted | $602.00 – $2,126.00 | |
| Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641 | not posted | $6,143.00 – $11,359.00 | |
| Pneumonia, with complications MS-DRG 194 | not posted | $6,445.00 – $11,919.00 | |
| Pneumonia, with major complications MS-DRG 193 | not posted | $10,358.00 – $19,154.00 | |
| Pneumonia, without complications MS-DRG 195 | not posted | $4,895.00 – $9,052.00 | |
| Psychoses (inpatient psychiatric stay) MS-DRG 885 | not posted | $1,144.00 – $15,748.00 | |
| Sepsis, with major complications MS-DRG 871 | not posted | $15,424.00 – $28,522.00 | |
| Sepsis, without major complications MS-DRG 872 | not posted | $8,104.00 – $14,986.00 | |
| Skin infection (cellulitis), without major complications MS-DRG 603 | not posted | $6,924.00 – $12,804.00 | |
| Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392 | not posted | $6,133.00 – $11,342.00 | |
| Stroke, with complications or clot-busting drug MS-DRG 65 | not posted | $7,994.00 – $14,782.00 | |
| Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743 | not posted | $9,421.00 – $17,422.00 | |
| Vaginal delivery, without complications MS-DRG 807 | not posted | $5,008.00 – $9,243.00 | |
| Weight loss surgery, without complications MS-DRG 621 | not posted | $11,489.00 – $37,951.00 |
Pain and spine
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Large joint injection or drainage (knee, shoulder, hip) CPT 20610 | $335.50 | $671.00 | $240.00 – $4,450.00 |
| Lower back nerve root injection with imaging guidance CPT 64483 | $421.00 | $842.00 | $240.00 – $4,450.00 |
| Lower back spinal injection (epidural), with imaging guidance CPT 62323 | $908.50 | $1,817.00 | $240.00 – $4,450.00 |
| Lower back spinal injection (epidural), without imaging CPT 62322 | not posted | $869.00 – $4,450.00 |
Eye
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Cataract removal with lens implant CPT 66984 | not posted | $2,221.00 – $12,878.00 | |
| Eye exam, new patient, comprehensive CPT 92004 | not posted | $126.00 – $298.00 | |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 | not posted | $554.00 – $5,866.00 |
Eye and ear
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Hearing test, comprehensive CPT 92557 | not posted | $110.00 – $352.00 |
Sleep
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Home sleep apnea test CPT 95806 | $277.00 | $554.00 | $149.00 – $666.00 |
| Sleep study with CPAP titration CPT 95811 | $2,616.00 | $5,232.00 | $492.00 – $2,942.00 |
| Sleep study, overnight in a sleep lab CPT 95810 | $2,442.50 | $4,885.00 | $492.00 – $2,758.00 |
Lungs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Spirometry (breathing test) CPT 94010 | $164.00 | $328.00 | $80.00 – $414.00 |
Therapy
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Manual therapy, 15 minutes CPT 97140 | $76.50 | $153.00 | $26.00 – $378.00 |
| Physical therapy evaluation, low complexity CPT 97161 | $125.00 | $250.00 | $98.00 – $378.00 |
| Physical therapy evaluation, moderate complexity CPT 97162 | $125.00 | $250.00 | $98.00 – $378.00 |
| Physical therapy, therapeutic exercise, 15 minutes CPT 97110 | $63.00 | $126.00 | $29.00 – $378.00 |
| Therapeutic activities, 15 minutes CPT 97530 | $49.00 | $98.00 | $36.00 – $378.00 |
Mental health
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Family psychotherapy, with the patient, 50 minutes CPT 90847 | $200.00 | $400.00 | $152.00 – $824.00 |
| Family psychotherapy, without the patient, 50 minutes CPT 90846 | $200.00 | $400.00 | $152.00 – $824.00 |
| Group psychotherapy CPT 90853 | $200.00 | $400.00 | $85.00 – $824.00 |
| Psychiatric diagnostic evaluation CPT 90791 | $200.00 | $400.00 | $152.00 – $823.00 |
| Psychotherapy, 30 minutes CPT 90832 | $200.00 | $400.00 | $152.00 – $823.00 |
| Psychotherapy, 45 minutes CPT 90834 | $200.00 | $400.00 | $152.00 – $823.00 |
| Psychotherapy, 60 minutes CPT 90837 | $200.00 | $400.00 | $152.00 – $823.00 |
Infusions and injections
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Injection under the skin or into a muscle CPT 96372 | $91.50 | $183.00 | $67.00 – $234.00 |
| IV hydration, each additional hour CPT 96361 | $87.00 | $174.00 | $45.00 – $758.00 |
| IV hydration, first hour CPT 96360 | $285.50 | $571.00 | $173.00 – $544.00 |
| IV push injection of a drug, first CPT 96374 | $194.00 | $388.00 | $71.00 – $483.00 |
| IV push injection, each additional drug CPT 96375 | $90.00 | $180.00 | $45.00 – $234.00 |
Drugs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696 | $10.00 | $20.00 | ? – $572.00 |
| Fentanyl injection, per 0.1 mg HCPCS J3010 | not posted | $2.00 – $2.00 | |
| Hydromorphone (Dilaudid) injection, up to 4 mg HCPCS J1170 | $1,123.50 | $2,247.00 | $10.00 – $11.00 |
| Ketorolac (Toradol) injection, per 15 mg HCPCS J1885 | $3.00 | $6.00 | |
| Morphine injection, up to 10 mg HCPCS J2270 | $1.50 | $3.00 | $10.00 – $12.00 |
| Saline IV solution, 1000 ml HCPCS J7030 | not posted | $6.00 – $6.00 |
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.