Stonesprings Hospital Center
24440 Stone Springs Boulevard, Dulles, VA 20166 · Acute care hospital · Emergency room
These are Stonesprings Hospital Center'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.
220 of the services we track have a posted price here; 117 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 | $5,416.31 | $5,416.31 | $2,820.00 – $4,392.00 |
| Emergency room visit, level 1 (minor) CPT 99281 | $1,089.87 | $1,089.87 | $773.81 – $773.81 |
| Emergency room visit, level 2 CPT 99282 | $1,662.91 | $1,662.91 | $1,180.67 – $1,180.67 |
| Emergency room visit, level 3 (moderate) CPT 99283 | $3,148.78 | $3,148.78 | $982.42 – $2,676.46 |
| Emergency room visit, level 4 CPT 99284 | $3,613.45 | $3,613.45 | $2,565.55 – $2,565.55 |
| Emergency room visit, level 5 (most severe) CPT 99285 | $5,012.60 | $5,012.60 | $1,563.93 – $4,260.71 |
| Simple wound repair (stitches), 2.5 cm or less CPT 12001 | not posted | $2,550.00 – $2,550.00 |
Office visits
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Office visit, established patient, about 10 to 19 minutes CPT 99212 | $242.75 | $242.75 | |
| Preventive checkup, new patient, age 18 to 39 CPT 99385 | not posted | $51.48 – $68.64 | |
| Preventive checkup, new patient, age 40 to 64 CPT 99386 | not posted | $62.54 – $83.39 |
Imaging
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| 3D screening mammogram (tomosynthesis), add-on CPT 77063 | $64.55 | $64.55 | $17.23 – $144.96 |
| Abdominal X-ray, 1 view CPT 74018 | $1,080.87 | $1,080.87 | $84.99 – $92.08 |
| Ankle X-ray, 3 or more views CPT 73610 | $2,279.61 | $2,279.61 | $433.13 – $1,937.67 |
| Bone density scan (DEXA), hips and spine CPT 77080 | $1,588.20 | $1,588.20 | $36.26 – $39.29 |
| Breast ultrasound, one breast, complete CPT 76641 | $2,761.30 | $2,761.30 | $524.65 – $2,347.11 |
| Breast ultrasound, one breast, limited CPT 76642 | $2,278.18 | $2,278.18 | $1,617.51 – $1,617.51 |
| Chest X-ray, 1 view CPT 71045 | $963.03 | $963.03 | $99.29 – $364.95 |
| Chest X-ray, 2 views CPT 71046 | $1,056.20 | $1,056.20 | $133.83 – $364.95 |
| CT angiogram of the chest (checks for lung clots) CPT 71275 | $5,980.91 | $5,980.91 | $1,892.00 – $2,344.90 |
| CT angiogram of the head CPT 70496 | $3,427.81 | $3,427.81 | $401.74 – $401.74 |
| CT scan of the abdomen and pelvis, with contrast CPT 74177 | $8,828.07 | $8,828.07 | $828.27 – $828.27 |
| CT scan of the abdomen and pelvis, without and with contrast CPT 74178 | $10,434.61 | $10,434.61 | $1,892.00 – $4,903.60 |
| CT scan of the abdomen and pelvis, without contrast CPT 74176 | $7,772.27 | $7,772.27 | $517.79 – $517.79 |
| CT scan of the abdomen, without contrast CPT 74150 | $3,995.02 | $3,995.02 | $1,292.39 – $1,892.00 |
| CT scan of the chest, with contrast CPT 71260 | $4,497.10 | $4,497.10 | $854.45 – $3,822.54 |
| CT scan of the chest, without contrast CPT 71250 | $3,510.52 | $3,510.52 | $245.18 – $245.18 |
| CT scan of the head, without contrast CPT 70450 | $3,122.52 | $3,122.52 | $245.18 – $245.18 |
| CT scan of the neck (cervical spine), without contrast CPT 72125 | $4,447.72 | $4,447.72 | $245.18 – $245.18 |
| CT scan of the pelvis, with contrast CPT 72193 | $5,155.57 | $5,155.57 | $401.74 – $401.74 |
| CT scan of the sinuses or face, without contrast CPT 70486 | $4,106.87 | $4,106.87 | $1,109.26 – $1,892.00 |
| Diagnostic mammogram, both breasts CPT 77066 | $1,292.85 | $1,292.85 | $245.64 – $1,098.92 |
| Diagnostic mammogram, one breast CPT 77065 | $1,168.12 | $1,168.12 | $829.37 – $829.37 |
| Foot X-ray, 3 or more views CPT 73630 | $2,236.58 | $2,236.58 | $424.95 – $1,901.09 |
| Hand X-ray, 3 or more views CPT 73130 | $1,701.57 | $1,701.57 | $1,208.11 – $1,208.11 |
| Knee X-ray, 3 views CPT 73562 | not posted | $170.17 – $184.37 | |
| Leg or arm vein ultrasound, both sides CPT 93970 | $3,448.30 | $3,448.30 | $888.72 – $1,005.25 |
| Leg or arm vein ultrasound, one side CPT 93971 | $1,808.99 | $1,808.99 | $565.00 – $684.33 |
| Lower back X-ray, 2 or 3 views CPT 72100 | $1,036.74 | $1,036.74 | $120.22 – $130.25 |
| MRI of both breasts, without and with contrast CPT 77049 | not posted | $635.92 – $635.92 | |
| MRI of the abdomen, without and with contrast CPT 74183 | $11,123.29 | $11,123.29 | $1,992.00 – $4,986.36 |
| MRI of the brain, without and with contrast CPT 70553 | $11,569.87 | $11,569.87 | $1,992.00 – $5,062.54 |
| MRI of the brain, without contrast CPT 70551 | $7,306.38 | $7,306.38 | $1,992.00 – $2,369.93 |
| MRI of the knee or other leg joint, without contrast CPT 73721 | $9,860.15 | $9,860.15 | $1,873.43 – $8,381.13 |
| MRI of the lower back (lumbar spine), without contrast CPT 72148 | $7,497.38 | $7,497.38 | $517.79 – $517.79 |
| MRI of the mid back (thoracic spine), without contrast CPT 72146 | $7,242.86 | $7,242.86 | $517.79 – $517.79 |
| MRI of the neck (cervical spine), without contrast CPT 72141 | $7,242.86 | $7,242.86 | $517.79 – $517.79 |
| MRI of the pelvis, without and with contrast CPT 72197 | $11,123.29 | $11,123.29 | $1,992.00 – $4,986.36 |
| MRI of the shoulder or other arm joint, without contrast CPT 73221 | $6,900.02 | $6,900.02 | $4,899.01 – $4,899.01 |
| Neck X-ray, 2 or 3 views CPT 72040 | $1,084.99 | $1,084.99 | $159.15 – $182.03 |
| Pelvic ultrasound, complete (not pregnancy) CPT 76856 | $1,275.19 | $1,275.19 | $125.56 – $136.03 |
| Pregnancy ultrasound, 14 weeks or later, single baby CPT 76805 | $2,378.78 | $2,378.78 | $511.27 – $601.65 |
| Pregnancy ultrasound, under 14 weeks, single baby CPT 76801 | $1,131.35 | $1,131.35 | $180.13 – $195.15 |
| Screening mammogram, both breasts CPT 77067 | $1,075.46 | $1,075.46 | $204.34 – $914.14 |
| Shoulder X-ray, 2 or more views CPT 73030 | $2,525.05 | $2,525.05 | $479.76 – $2,146.29 |
| Transvaginal pregnancy ultrasound CPT 76817 | $748.45 | $748.45 | $137.34 – $148.80 |
| Transvaginal ultrasound CPT 76830 | $1,275.19 | $1,275.19 | $125.56 – $136.03 |
| Ultrasound of the abdomen, complete CPT 76700 | $3,089.02 | $3,089.02 | $145.08 – $157.18 |
| Ultrasound of the neck or thyroid CPT 76536 | $1,612.29 | $1,612.29 | $381.58 – $506.91 |
| Wrist X-ray, 3 or more views CPT 73110 | $1,546.67 | $1,546.67 | $1,098.14 – $1,098.14 |
| X-ray of the lower back, 4 or more views CPT 72110 | $1,507.02 | $1,507.02 | $227.82 – $239.12 |
Lab tests
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 | $927.48 | $927.48 | $8.46 – $44.93 |
| Blood culture CPT 87040 | $771.10 | $771.10 | $7.93 – $58.55 |
| Blood draw (venipuncture) CPT 36415 | $94.28 | $94.28 | $3.00 – $15.93 |
| BNP test (heart failure) CPT 83880 | $510.70 | $510.70 | $39.26 – $208.51 |
| C-reactive protein (CRP) test CPT 86140 | $491.98 | $491.98 | $5.18 – $27.51 |
| Chlamydia test (DNA/NAAT) CPT 87491 | $724.32 | $724.32 | $26.95 – $199.10 |
| Complete blood count (CBC) with differential CPT 85025 | not posted | $7.77 – $41.27 | |
| Complete blood count (CBC), automated CPT 85027 | $304.55 | $304.55 | $4.96 – $36.70 |
| Comprehensive metabolic panel (blood test) CPT 80053 | $1,442.29 | $1,442.29 | $8.11 – $59.97 |
| COVID-19 PCR test CPT 87635 | $84.55 | $84.55 | $39.40 – $208.40 |
| D-dimer test (blood clots) CPT 85379 | $815.25 | $815.25 | $7.81 – $45.92 |
| Drug screen, instrument chemistry CPT 80307 | $1,626.36 | $1,626.36 | $47.71 – $248.26 |
| Ferritin (iron stores) test CPT 82728 | $210.25 | $210.25 | $10.46 – $77.26 |
| Free T4 (thyroid) test CPT 84439 | $563.44 | $563.44 | $6.92 – $51.16 |
| General health panel (blood tests) CPT 80050 | not posted | $45.36 – $240.91 | |
| Glucose (blood sugar) test CPT 82947 | $545.49 | $545.49 | $3.93 – $20.87 |
| Gonorrhea test (DNA/NAAT) CPT 87591 | $402.57 | $402.57 | $26.95 – $199.10 |
| Hemoglobin A1c test CPT 83036 | $577.08 | $577.08 | $9.71 – $51.57 |
| Hepatitis C antibody test CPT 86803 | $868.37 | $868.37 | $14.27 – $75.79 |
| HIV-1/HIV-2 antigen and antibody test CPT 87389 | $259.29 | $259.29 | $24.08 – $127.89 |
| Iron test CPT 83540 | $484.14 | $484.14 | $4.96 – $36.74 |
| Kidney function panel CPT 80069 | $1,074.15 | $1,074.15 | $8.68 – $46.10 |
| Lipase test (pancreas) CPT 83690 | $612.47 | $612.47 | $6.89 – $36.59 |
| Lipid panel, cholesterol and triglycerides CPT 80061 | $1,074.15 | $1,074.15 | $10.28 – $76.00 |
| Liver function panel CPT 80076 | $810.01 | $810.01 | $8.17 – $43.39 |
| Magnesium test CPT 83735 | $717.22 | $717.22 | $509.23 – $509.23 |
| Obstetric blood test panel CPT 80055 | not posted | $47.81 – $253.92 | |
| Partial thromboplastin time (PTT), clotting test CPT 85730 | $359.16 | $359.16 | $4.61 – $34.02 |
| Pregnancy blood test (hCG), quantitative CPT 84702 | $1,140.74 | $1,140.74 | $216.74 – $969.63 |
| Prothrombin time (PT/INR), clotting test CPT 85610 | $359.16 | $359.16 | $3.29 – $22.29 |
| PSA (prostate specific antigen), free CPT 84154 | not posted | $18.39 – $97.67 | |
| PSA (prostate specific antigen), total CPT 84153 | $749.40 | $749.40 | $14.12 – $104.34 |
| Rapid strep test CPT 87880 | not posted | $16.53 – $87.79 | |
| Sed rate (ESR) test CPT 85652 | $353.01 | $353.01 | $2.07 – $15.31 |
| TB skin test CPT 86580 | not posted | $24.67 – $131.02 | |
| Thyroid stimulating hormone (TSH) CPT 84443 | $1,032.61 | $1,032.61 | $12.90 – $95.29 |
| Tissue exam by a pathologist (biopsy specimen) CPT 88305 | $1,325.57 | $1,325.57 | $133.34 – $154.73 |
| Troponin test (heart damage) CPT 84484 | $590.77 | $590.77 | $12.47 – $66.23 |
| Urinalysis, automated, with microscope CPT 81001 | $331.12 | $331.12 | $2.44 – $17.99 |
| Urinalysis, automated, without microscope CPT 81003 | $166.11 | $166.11 | $2.25 – $11.95 |
| Urinalysis, manual, with microscope CPT 81000 | not posted | $4.02 – $21.35 | |
| Urinalysis, manual, without microscope CPT 81002 | not posted | $3.48 – $18.48 | |
| Urine culture, colony count CPT 87086 | $744.52 | $744.52 | $141.46 – $632.84 |
| Urine pregnancy test CPT 81025 | $364.40 | $364.40 | $6.61 – $35.89 |
| Vitamin B12 test CPT 82607 | $717.22 | $717.22 | $15.08 – $80.09 |
| Vitamin D test CPT 82306 | $331.12 | $331.12 | $29.60 – $157.21 |
Heart
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Carotid artery ultrasound, both sides CPT 93880 | $2,151.84 | $2,151.84 | $877.23 – $1,035.25 |
| ECG tracing only (no interpretation) CPT 93005 | $704.92 | $704.92 | $75.61 – $75.61 |
| Echocardiogram (heart ultrasound), complete with Doppler CPT 93306 | $7,143.14 | $7,143.14 | $1,119.85 – $1,119.85 |
| Electrocardiogram (ECG/EKG) with interpretation CPT 93000 | not posted | $9.57 – $110.62 | |
| Holter monitor, up to 48 hours CPT 93224 | not posted | $44.13 – $689.98 | |
| Left heart catheterization CPT 93452 | not posted | $10,691.00 – $14,796.00 | |
| Left heart catheterization with coronary angiogram CPT 93458 | not posted | $10,691.00 – $14,796.00 | |
| Nuclear stress test (heart perfusion imaging) CPT 78452 | $7,136.16 | $7,136.16 | $374.00 – $2,478.57 |
| Treadmill stress test, complete CPT 93015 | not posted | $374.00 – $604.00 |
Surgery
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| ACL reconstruction, arthroscopic CPT 29888 | not posted | $5,995.00 – $12,621.00 | |
| Appendix removal, laparoscopic CPT 44970 | not posted | $5,995.00 – $12,207.00 | |
| Breast biopsy with ultrasound guidance CPT 19083 | not posted | $2,747.00 – $4,625.00 | |
| Carpal tunnel release CPT 64721 | not posted | $3,105.00 – $5,569.00 | |
| Colonoscopy with biopsy CPT 45380 | not posted | $2,497.00 – $5,569.00 | |
| Colonoscopy with polyp removal (snare) CPT 45385 | not posted | $2,550.00 – $2,550.00 | |
| Colonoscopy, diagnostic CPT 45378 | not posted | $3,105.00 – $5,569.00 | |
| Colposcopy with biopsy CPT 57454 | not posted | $1,765.00 – $2,685.00 | |
| Cystoscopy (bladder scope) CPT 52000 | not posted | $1,765.00 – $4,081.00 | |
| Ear tubes, under general anesthesia CPT 69436 | not posted | $3,007.00 – $7,947.00 | |
| Flexible sigmoidoscopy, diagnostic CPT 45330 | not posted | $1,765.00 – $2,747.00 | |
| Gallbladder removal, laparoscopic CPT 47562 | not posted | $11,267.00 – $12,207.00 | |
| Gastric bypass (weight loss surgery), laparoscopic CPT 43644 | not posted | $10,915.00 – $12,207.00 | |
| Hysterectomy, laparoscopic, with tubes and/or ovaries CPT 58571 | not posted | $10,915.00 – $14,757.00 | |
| Hysteroscopy with biopsy or polyp removal CPT 58558 | not posted | $3,051.00 – $7,947.00 | |
| Inguinal (groin) hernia repair, laparoscopic CPT 49650 | not posted | $5,126.00 – $6,288.00 | |
| Inguinal (groin) hernia repair, open, age 5 or older CPT 49505 | not posted | $5,081.00 – $9,533.00 | |
| Kidney stone shock-wave lithotripsy CPT 50590 | not posted | $5,081.00 – $11,502.00 | |
| Knee arthroscopy, meniscus trim (meniscectomy) CPT 29881 | not posted | $3,898.00 – $9,533.00 | |
| Lower colon endoscopy with ultrasound CPT 45391 | not posted | $2,497.00 – $5,569.00 | |
| Nasal endoscopy, diagnostic CPT 31231 | not posted | $2,413.00 – $2,614.00 | |
| Prostate biopsy CPT 55700 | not posted | $3,007.00 – $3,991.00 | |
| Prostate removal, laparoscopic or robotic CPT 55866 | not posted | $916.00 – $17,476.00 | |
| Removal of a breast lump, open surgery CPT 19120 | not posted | $3,530.00 – $7,947.00 | |
| Rotator cuff repair, arthroscopic CPT 29827 | not posted | $5,185.00 – $10,994.00 | |
| Screening colonoscopy, average risk HCPCS G0121 | not posted | $3,105.00 – $3,105.00 | |
| Screening colonoscopy, high risk HCPCS G0105 | not posted | $2,413.00 – $3,273.00 | |
| Septoplasty (nasal septum repair) CPT 30520 | not posted | $5,126.00 – $6,288.00 | |
| Shoulder arthroscopy, bone shaving (decompression) CPT 29826 | not posted | $916.00 – $7,947.00 | |
| Sleeve gastrectomy (weight loss surgery), laparoscopic CPT 43775 | not posted | $11,267.00 – $12,207.00 | |
| Tonsil and adenoid removal, under age 12 CPT 42820 | not posted | $3,051.00 – $9,481.00 | |
| Total hip replacement CPT 27130 | not posted | $9,889.00 – $35,438.00 | |
| Total knee replacement CPT 27447 | not posted | $9,889.00 – $35,438.00 | |
| Upper endoscopy (EGD) with biopsy CPT 43239 | not posted | $2,413.00 – $5,569.00 | |
| Upper endoscopy (EGD), diagnostic CPT 43235 | not posted | $1,765.00 – $4,382.00 | |
| Vasectomy CPT 55250 | not posted | $2,497.00 – $7,357.00 |
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 | $3,869.00 – $6,230.00 | |
| Fetal non-stress test CPT 59025 | $1,740.63 | $1,740.63 | $15.45 – $2,550.00 |
| IUD insertion CPT 58300 | not posted | $2,413.00 – $2,614.00 | |
| Vaginal birth after a prior C-section (VBAC), routine care CPT 59610 | not posted | $3,869.00 – $7,275.00 | |
| Vaginal delivery, routine care including prenatal and postpartum CPT 59400 | not posted | $2,550.00 – $2,550.00 |
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 | $1,474.34 – $1,518.57 | |
| C-section, without complications MS-DRG 788 | not posted | $1,275.00 – $5,226.36 | |
| Chest pain MS-DRG 313 | not posted | $8,083.27 – $8,083.27 | |
| COPD flare-up, with major complications MS-DRG 190 | not posted | $12,129.38 – $12,129.38 | |
| COPD flare-up, without complications MS-DRG 192 | not posted | $7,286.57 – $7,286.57 | |
| Fainting (syncope) MS-DRG 312 | not posted | $9,528.07 – $9,528.07 | |
| Gastrointestinal bleeding, with complications MS-DRG 378 | not posted | $11,062.26 – $11,062.26 | |
| Heart failure, with major complications MS-DRG 291 | not posted | $14,300.49 – $14,300.49 | |
| Heart failure, without complications MS-DRG 293 | not posted | $6,260.79 – $6,260.79 | |
| Heart valve or other major heart surgery with cardiac catheterization, with major complications MS-DRG 216 | not posted | $108,855.99 – $108,855.99 | |
| Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 | not posted | $21,363.57 – $21,363.57 | |
| Irregular heartbeat, without complications MS-DRG 310 | not posted | $6,159.11 – $6,159.11 | |
| Kidney failure, with complications MS-DRG 683 | not posted | $9,999.61 – $9,999.61 | |
| Kidney or urinary tract infection, without major complications MS-DRG 690 | not posted | $8,890.03 – $8,890.03 | |
| Neck (cervical) spinal fusion, without complications MS-DRG 473 | not posted | $28,327.21 – $28,327.21 | |
| Normal newborn care MS-DRG 795 | not posted | $1,542.00 – $1,542.00 | |
| Nutrition, fluid or electrolyte disorder, without major complications MS-DRG 641 | not posted | $1,275.00 – $4,847.91 | |
| Pneumonia, with complications MS-DRG 194 | not posted | $6,941.38 – $22,323.00 | |
| Pneumonia, with major complications MS-DRG 193 | not posted | $1,275.00 – $4,766.00 | |
| Pneumonia, without complications MS-DRG 195 | not posted | $7,171.47 – $7,171.47 | |
| Psychoses (inpatient psychiatric stay) MS-DRG 885 | not posted | $1,551.93 – $1,598.49 | |
| Sepsis, with major complications MS-DRG 871 | not posted | $21,869.75 – $21,869.75 | |
| Sepsis, without major complications MS-DRG 872 | not posted | $11,509.22 – $11,509.22 | |
| Skin infection (cellulitis), without major complications MS-DRG 603 | not posted | $9,853.23 – $9,853.23 | |
| Spinal fusion except neck, without major complications MS-DRG 460 | not posted | $42,125.98 – $42,125.98 | |
| Stomach and digestive disorders (gastroenteritis), without major complications MS-DRG 392 | not posted | $8,800.64 – $8,800.64 | |
| Stroke, with complications or clot-busting drug MS-DRG 65 | not posted | $11,357.25 – $11,357.25 | |
| Uterus and ovary surgery for non-cancer conditions, without complications MS-DRG 743 | not posted | $13,080.28 – $13,080.28 | |
| Vaginal delivery, without complications MS-DRG 807 | not posted | $9,836.00 – $9,836.00 | |
| Weight loss surgery, without complications MS-DRG 621 | not posted | $31,682.00 – $31,682.00 |
Pain and spine
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Large joint injection or drainage (knee, shoulder, hip) CPT 20610 | not posted | $968.00 – $2,685.00 | |
| Lower back nerve root injection with imaging guidance CPT 64483 | not posted | $1,765.00 – $4,081.00 | |
| Lower back spinal injection (epidural), with imaging guidance CPT 62323 | not posted | $1,765.00 – $2,747.00 | |
| Lower back spinal injection (epidural), without imaging CPT 62322 | not posted | $1,765.00 – $2,747.00 |
Eye
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Cataract removal with lens implant CPT 66984 | not posted | $3,007.00 – $11,502.00 | |
| Eye exam, new patient, comprehensive CPT 92004 | not posted | $347.51 – $347.51 | |
| Laser treatment of clouding after cataract surgery (YAG) CPT 66821 | not posted | $2,413.00 – $5,569.00 |
Eye and ear
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Hearing test, comprehensive CPT 92557 | not posted | $208.35 – $208.35 |
Sleep
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Home sleep apnea test CPT 95806 | not posted | $864.00 – $2,809.00 | |
| Sleep study with CPAP titration CPT 95811 | not posted | $3,729.63 – $3,729.63 | |
| Sleep study, overnight in a sleep lab CPT 95810 | not posted | $3,412.76 – $3,412.76 |
Lungs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Spirometry (breathing test) CPT 94010 | not posted | $136.60 – $136.60 |
Therapy
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Manual therapy, 15 minutes CPT 97140 | $227.02 | $227.02 | $24.11 – $25.80 |
| Physical therapy evaluation, low complexity CPT 97161 | $881.96 | $881.96 | $72.73 – $123.60 |
| Physical therapy evaluation, moderate complexity CPT 97162 | $881.96 | $881.96 | $85.34 – $91.32 |
| Physical therapy, therapeutic exercise, 15 minutes CPT 97110 | $227.02 | $227.02 | $43.13 – $192.97 |
| Therapeutic activities, 15 minutes CPT 97530 | $227.02 | $227.02 | $43.13 – $192.97 |
Mental health
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Psychotherapy, 30 minutes CPT 90832 | not posted | $594.98 – $594.98 | |
| Psychotherapy, 45 minutes CPT 90834 | not posted | $594.98 – $594.98 | |
| Psychotherapy, 60 minutes CPT 90837 | not posted | $594.98 – $594.98 |
Infusions and injections
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Injection under the skin or into a muscle CPT 96372 | $434.92 | $434.92 | $308.79 – $308.79 |
| IV hydration, each additional hour CPT 96361 | $350.06 | $350.06 | $69.31 – $297.55 |
| IV hydration, first hour CPT 96360 | $1,282.73 | $1,282.73 | $910.74 – $910.74 |
| IV push injection of a drug, first CPT 96374 | $1,212.19 | $1,212.19 | $240.01 – $1,030.36 |
| IV push injection, each additional drug CPT 96375 | $480.10 | $480.10 | $95.06 – $408.08 |
Drugs
| Service | Cash price | Gross charge | Insurer rates (min – max) |
|---|---|---|---|
| Ceftriaxone (Rocephin) injection, per 250 mg HCPCS J0696 | $434.67 | $434.67 | $65.20 – $369.47 |
| Dexamethasone injection, per 1 mg HCPCS J1100 | $66.36 | $66.36 | $47.12 – $47.12 |
| Fentanyl injection, per 0.1 mg HCPCS J3010 | $143.12 | $143.12 | $101.62 – $101.62 |
| Ketorolac (Toradol) injection, per 15 mg HCPCS J1885 | $61.17 | $61.17 | $19.09 – $51.99 |
| Midazolam (Versed) injection, per 1 mg HCPCS J2250 | $66.36 | $66.36 | $9.95 – $56.41 |
| Morphine injection, up to 10 mg HCPCS J2270 | $68.58 | $68.58 | $10.29 – $58.29 |
| Ondansetron (Zofran) injection, per 1 mg HCPCS J2405 | $61.17 | $61.17 | $9.18 – $51.99 |
| Propofol injection, per 10 mg HCPCS J2704 | $209.47 | $209.47 | $148.72 – $148.72 |
| Saline IV solution, 1000 ml HCPCS J7030 | $319.58 | $319.58 | $1.64 – $3.61 |
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.