▸ Hospital · NV · CCN 291300

Mount Grant General Hospital

1ST AND A STREETS, HAWTHORNE, NV, 89415

11 bedsCritical Access Hospitals9

Compliance grade

100/100

Procedures tracked

170

of 209 target codes

Payers

with negotiated rates

Rates published

5,428

last crawl 2026-05-22

▸ Compare with other hospitals All NV hospitals JSON Full cost report on HCRIS.io →

Source MRF: https://roxboroughmemorial.com/wp-content/uploads/2026/04/454246163_RoxboroughMemorialHospital_standardcharges.JSON · JSON

Procedures & rates

Procedure	Type	Code	Payers	Gross	Cash	Neg min	Neg median	Neg max
behavioral
Psychoses	MS-DRG	885	16	—	$13,447	$4,842.58	$13,515	$24,193
Psychiatric diagnostic evaluation	CPT	90791	15	$782.75	$181	$110.62	$190.53	$590
Psychiatric eval with medical services	CPT	90792	15	$700	$181	$110.62	$190.53	$590
Psychotherapy 30 minutes	CPT	90832	15	$588.81	$181	$110.62	$190.53	$429.16
Psychotherapy 45 minutes	CPT	90834	15	$782.75	$181	$110.62	$190.53	$429.16
Psychotherapy 60 minutes	CPT	90837	15	$630.05	$181	$110.62	$190.53	$429.16
Crisis psychotherapy 60 minutes	CPT	90839	15	$630.05	$181	$110.62	$190.53	$429.16
emergency
ED visit level 1	CPT	99281	16	$630	$86	$30	$96.13	$630
ED visit level 2	CPT	99282	17	$988.75	$156	$30	$172.67	$886
ED visit level 3	CPT	99283	17	$1,352.16	$279	$17.39	$300	$886
ED visit level 4	CPT	99284	17	$2,098.99	$426	$17.39	$441.5	$1,008.86
ED visit level 5	CPT	99285	17	$3,043.97	$608	$17.39	$630.13	$1,439.89
Critical care, first hour	CPT	99291	15	$7,020	$844	$334	$878.24	$1,997.19
imaging
CT head without contrast	CPT	70450	16	$1,654.19	$106	$77.5	$112.21	$591.42
CT head with contrast	CPT	70460	16	$2,982.19	$179	$80	$188.28	$711.84
CT head with and without contrast	CPT	70470	16	$3,508.18	$179	$100	$188.28	$872.41
CT neck with contrast	CPT	70491	16	$3,078.75	$179	$82.5	$188.28	$749.31
MRI brain without contrast	CPT	70551	17	$3,808.34	$243	$30	$269	$1,271.15
MRI brain with contrast	CPT	70552	16	$4,392.81	$356	$269	$374.48	$1,471.86
MRI brain with and without contrast	CPT	70553	17	$5,463.41	$356	$30	$372.7	$2,060.6
Chest X-ray single view	CPT	71045	16	$430.61	$88	$8.11	$90.99	$210.39
Chest X-ray 2 views	CPT	71046	17	$501.25	$88	$14.85	$89.98	$210.39
Chest X-ray 3 views	CPT	71047	16	$1,183.69	$88	$18.9	$93.41	$210.39
CT chest without contrast	CPT	71250	17	$3,209.7	$106	$30	$111.68	$741.28
CT chest with contrast	CPT	71260	16	$3,209.7	$179	$87.5	$188.28	$867.06
CT chest with and without contrast	CPT	71270	16	$3,724.36	$179	$103.5	$188.28	$1,059.74
MRI chest without contrast	CPT	71550	16	$3,791.25	$243	$195.14	$269	$1,271.15
MRI chest with contrast	CPT	71551	16	$4,150	$801	$312.2	$841.48	$1,895.37
MRI chest with and without contrast	CPT	71552	16	$5,211.13	$356	$285.32	$427.98	$2,060.6
Lumbosacral spine X-ray	CPT	72100	17	$645.19	$106	$22.5	$106.87	$252.75
CT cervical spine without contrast	CPT	72125	16	$3,041.25	$106	$83.1	$112.21	$741.28
CT thoracic spine without contrast	CPT	72128	16	$2,897.5	$106	$85.5	$112.21	$741.28
CT lumbar spine without contrast	CPT	72131	16	$3,030.4	$106	$85.5	$112.21	$741.28
MRI cervical spine without contrast	CPT	72141	17	$3,949.78	$243	$30	$269	$1,271.15
MRI thoracic spine without contrast	CPT	72146	16	$3,922.5	$243	$187.2	$256.13	$1,271.15
MRI lumbar spine without contrast	CPT	72148	17	$3,950.55	$243	$30	$254.91	$1,271.15
MRI lumbar spine with and without contrast	CPT	72149	16	$4,407.5	$356	$269	$374.48	$1,471.86
MRI cervical spine with and without contrast	CPT	72156	16	$5,579.96	$356	$269	$374.48	$2,060.6
MRI lumbar spine with contrast	CPT	72158	16	$5,552.49	$356	$269	$374.48	$2,060.6
CT pelvis without contrast	CPT	72192	16	$2,695.99	$106	$67.5	$112.21	$727.9
CT pelvis with contrast	CPT	72193	16	$3,150.08	$179	$86.5	$188.28	$832.27
Shoulder X-ray	CPT	73030	17	$588.63	$88	$16.5	$88.96	$210.39
Humerus X-ray	CPT	73060	17	$617.75	$88	$11.5	$88.96	$210.39
Hand X-ray 3 views	CPT	73130	17	$491.88	$88	$11.5	$88.96	$210.39
MRI upper extremity joint without contrast	CPT	73221	17	$5,022.69	$243	$30	$269	$1,271.15
MRI upper extremity joint with and without contrast	CPT	73223	16	$3,904.38	$356	$285.32	$427.98	$2,060.6
Knee X-ray 1-2 views	CPT	73560	16	$506.13	$88	$16.5	$88.96	$210.39
Ankle X-ray 3 views	CPT	73610	16	$499.35	$88	$18.73	$88.96	$210.39
MRI lower extremity joint without contrast	CPT	73721	17	$3,737.5	$243	$30	$269	$1,271.15
MRI lower extremity joint with and without contrast	CPT	73723	16	$5,122.5	$356	$285.32	$427.98	$2,060.6
CT abdomen without contrast	CPT	74150	16	$2,844.31	$106	$77.5	$112.21	$719.87
CT abdomen with contrast	CPT	74160	16	$3,382.99	$179	$90	$188.28	$848.32
CT abdomen with and without contrast	CPT	74170	16	$3,987.5	$179	$111.5	$188.28	$1,027.62
CT abdomen and pelvis without contrast	CPT	74176	16	$1,167.6	$243	$101.07	$256.13	$719.87
CT abdomen and pelvis with contrast	CPT	74177	16	$5,817.5	$356	$192.73	$374.48	$848.32
CT abdomen and pelvis with and without contrast	CPT	74178	16	$6,828.58	$356	$254.7	$374.48	$1,027.62
MRI abdomen without contrast	CPT	74181	16	$3,806.18	$243	$195.14	$269	$1,271.15
MRI abdomen with and without contrast	CPT	74183	17	$5,258.75	$356	$30	$415.5	$2,060.6
Abdominal ultrasound complete	CPT	76700	17	$1,456.88	$106	$30	$111.68	$305.08
Abdominal ultrasound limited	CPT	76705	17	$1,456.88	$106	$30	$111.68	$252.75
Retroperitoneal ultrasound complete	CPT	76770	17	$1,091.15	$106	$30	$111.68	$297.05
Obstetric ultrasound first trimester	CPT	76801	17	$946.86	$106	$30	$111.68	$267.61
Obstetric ultrasound after first trimester	CPT	76805	16	$1,159.44	$106	$46.5	$112.21	$267.61
Obstetric ultrasound with fetal anatomy	CPT	76811	16	$2,978	$243	$91.42	$256.13	$576.91
Transvaginal ultrasound	CPT	76830	17	$937.5	$106	$30	$111.68	$252.75
Pelvic ultrasound complete	CPT	76856	16	$1,418.13	$106	$46.5	$112.21	$252.75
Scrotal ultrasound	CPT	76870	16	$997.08	$106	$44	$112.21	$252.75
Diagnostic mammography unilateral	CPT	77065	17	$455.33	$89	$30	$92.9	$185.79
Diagnostic mammography bilateral	CPT	77066	17	$624.67	$115	$30	$119.23	$238.43
Screening mammography bilateral	CPT	77067	17	$573.88	$94	$30	$98.3	$196.58
EKG tracing only	CPT	93005	16	$386.25	$60	$10.46	$63.32	$195.01
Transthoracic echocardiogram complete	CPT	93306	17	$2,899.48	$558	$30	$583.75	$1,722.55
Transthoracic echocardiogram	CPT	93307	16	$3,327.54	$243	$95	$256.13	$975.03
Stress echocardiogram	CPT	93350	16	$1,667.2	$558	$46.5	$586.54	$1,321.14
inpatient
Intracranial hemorrhage/CVA w MCC	MS-DRG	064	17	—	$18,992	$12,573	$19,555	$34,832
Intracranial hemorrhage/CVA w CC	MS-DRG	065	17	—	$9,958	$5,579.14	$9,958.91	$17,499
Intracranial hemorrhage/CVA w/o CC/MCC	MS-DRG	066	17	—	$7,016	$5,589.05	$7,180.38	$11,854
Respiratory infections & inflammations w MCC	MS-DRG	177	17	—	$14,945	$8,876.85	$14,945	$27,067
COPD w MCC	MS-DRG	190	17	—	$10,838	$7,384.9	$10,838	$19,186
COPD w CC	MS-DRG	191	17	—	$8,448	$5,620.81	$8,487.61	$48,641
COPD w/o CC/MCC	MS-DRG	192	17	—	$6,634	$3,939.3	$6,634.22	$19,389
Simple pneumonia & pleurisy w CC	MS-DRG	194	17	—	$8,113	$5,969.54	$8,113.77	$18,236
Simple pneumonia & pleurisy w/o CC/MCC	MS-DRG	195	17	—	$6,512	$4,191.73	$6,512.35	$27,060
AMI discharged alive w MCC	MS-DRG	280	17	—	$15,319	$7,409.12	$15,598	$27,784
AMI discharged alive w CC	MS-DRG	281	17	—	$9,135	$4,783.06	$9,135.64	$15,919
AMI discharged alive w/o CC/MCC	MS-DRG	282	17	—	$7,366	$3,926.43	$7,366.32	$12,524
Heart failure & shock w MCC	MS-DRG	291	17	—	$12,427	$5,617.67	$12,428	$22,236
Heart failure & shock w CC	MS-DRG	292	17	—	$8,502	$6,154.38	$8,757.91	$29,946
Heart failure & shock w/o CC/MCC	MS-DRG	293	17	—	$5,948	$2,932.73	$5,948.16	$12,777
Cardiac arrhythmia w MCC	MS-DRG	308	17	—	$11,707	$9,062.26	$11,708	$20,854
Cardiac arrhythmia w CC	MS-DRG	309	17	—	$7,480	$4,615.79	$7,480.06	$12,743
Cardiac arrhythmia w/o CC/MCC	MS-DRG	310	17	—	$5,949	$3,655.82	$5,949.06	$10,085
GI hemorrhage w CC	MS-DRG	378	17	—	$9,691	$6,837.09	$9,691.71	$16,986
GI hemorrhage w/o CC/MCC	MS-DRG	379	17	—	$6,529	$3,527.84	$6,529.51	$10,919
Esophagitis/gastroenteritis w/o MCC	MS-DRG	392	17	—	$7,876	$5,153.25	$7,876.35	$35,257
Fractures of femur w/o MCC	MS-DRG	533	16	—	$14,990	$12,641	$15,342	$27,153
Kidney/UTI w MCC	MS-DRG	689	16	—	$11,312	$8,553.54	$11,483	$20,097
Kidney/UTI w/o MCC	MS-DRG	690	16	—	$8,146	$4,673.26	$8,146.26	$14,021
Septicemia or severe sepsis w MV 96+ hrs	MS-DRG	871	17	—	$18,373	$13,287	$18,889	$33,645
Septicemia or severe sepsis w/o MV 96+ hrs	MS-DRG	872	16	—	$10,076	$6,319.82	$10,076	$17,724
lab
Basic metabolic panel (BMP)	CPT	80048	16	$240.39	$8	$6.77	$9.31	$36.58
Electrolyte panel	CPT	80051	16	$246.13	$7	$5.61	$7.36	$30.33
Comprehensive metabolic panel	CPT	80053	17	$341.06	$10	$8.45	$11.66	$45.65
Lipid panel	CPT	80061	17	$277.88	$13	$10.71	$14.4	$59.41
Renal function panel	CPT	80069	16	$262.5	$8	$6.94	$9.55	$37.52
Hepatic function panel	CPT	80076	17	$253.75	$8	$6.54	$9.01	$35.33
Urinalysis non-automated	CPT	81002	16	$52.38	$3	$2.78	$3.65	$15.63
Urinalysis automated	CPT	81003	16	$103	$2	$1.8	$2.48	$10.63
Glucose quantitative	CPT	82947	16	$90.5	$3	$3.14	$4.13	$8.13
Hemoglobin A1c	CPT	83036	17	$311.25	$9	$7	$10.15	$46.28
Thyroid stimulating hormone (TSH)	CPT	84443	16	$527.5	$16	$13.44	$18.48	$81.92
Complete blood count with automated differential	CPT	85025	16	$311.25	$7	$6	$8.08	$34.39
Complete blood count without differential	CPT	85027	16	$398.75	$6	$5.18	$7.12	$31.27
Urine culture bacterial	CPT	87086	17	$300	$8	$6.46	$8.49	$40.65
Urine culture identification	CPT	87088	16	$26	$8	$6.47	$8.49	$26
Tissue exam by pathologist level IV	CPT	88305	16	$1,321.25	$53	$9	$55.93	$187.6
maternity
Fetal non-stress test	CPT	59025	5	$842.44	—	$4.72	$200	$842.44
Vaginal delivery only	CPT	59409	15	$10,336	$3,309	$1,582	$3,425.22	$7,826.85
office
Office visit, new patient, 15-29 min	CPT	99202	3	$626.45	—	$40	$42.4	$45.2
Office visit, new patient, 30-44 minutes	CPT	99203	3	$689	—	$54.25	$57.5	$61.3
Office visit, new patient, 45-59 min	CPT	99204	3	$912.94	—	$90.37	$95.8	$102.12
Office visit, new patient, 60-74 min	CPT	99205	3	$1,249.13	—	$117.54	$124.6	$132.82
Office visit, established patient, 5 min	CPT	99211	3	$403.38	—	$40	$42.4	$45.2
Office visit, established patient, 10-19 min	CPT	99212	4	$626.45	—	$40	$43.8	$59.04
Office visit, established patient, 20-29 minutes	CPT	99213	4	$626.45	—	$30	$41.2	$45.2
Office visit, established patient, 30-39 minutes	CPT	99214	3	$689	—	$54.42	$57.7	$61.49
Office visit, established patient, 40-54 min	CPT	99215	3	$912.94	—	$78.05	$82.7	$88.2
preventive
Upper GI endoscopy diagnostic	CPT	43235	16	$6,843	$927	$132.7	$1,047.77	$3,634
Upper GI endoscopy with biopsy	CPT	43239	16	$6,843	$927	$157.5	$1,047.77	$3,634
Sigmoidoscopy diagnostic	CPT	45330	16	$2,637.09	$950	$56.3	$1,060.05	$2,637.09
Sigmoidoscopy with biopsy	CPT	45331	16	$2,637.09	$950	$67.5	$1,060.05	$2,637.09
Colonoscopy diagnostic	CPT	45378	16	$6,853.15	$950	$191.3	$1,107.59	$3,634
Colonoscopy with biopsy	CPT	45380	16	$6,843	$1,223	$238.9	$1,425.22	$3,634
Colonoscopy with polyp removal	CPT	45385	16	$6,843	$1,223	$284.2	$1,425.22	$3,634
surgery
Total shoulder arthroplasty	CPT	23472	15	$16,893	$17,925	$1,582	$16,893	$16,893
Total hip replacement	CPT	27130	15	$21,513	$13,125	$1,582	$13,782	$21,513
Total knee replacement	CPT	27447	15	$13,113	$13,125	$1,582	$13,113	$13,113
Shoulder arthroscopy with decompression	CPT	29826	5	$5,317.96	—	$1,582	$3,634	$4,816.9
Shoulder arthroscopy with rotator cuff repair	CPT	29827	16	$4,028.95	$7,418	$776	$4,028.95	$4,028.95
Knee arthroscopy with meniscectomy	CPT	29881	16	$7,863	$3,345	$932	$3,512.3	$7,863
ACL reconstruction	CPT	29888	16	$7,886.5	$7,418	$776	$7,418.21	$7,886.5
Major small/large bowel procedures w MCC	MS-DRG	329	17	—	$42,331	$4,724.7	$42,332	$79,614
Major small/large bowel procedures w CC	MS-DRG	330	17	—	$22,478	$3,196.41	$23,153	$41,521
Major small/large bowel procedures w/o CC/MCC	MS-DRG	331	17	—	$16,030	$10,948	$16,365	$29,149
Laparoscopic cholecystectomy w/o CDE w MCC	MS-DRG	418	17	—	$16,109	$10,601	$16,449	$29,299
Laparoscopic cholecystectomy w/o CDE w CC	MS-DRG	419	17	—	$13,168	$10,232	$13,281	$23,656
Laparoscopic cholecystectomy w/o CDE w/o CC/MCC	MS-DRG	420	17	—	$31,595	$7,011.63	$32,543	$60,496
Open appendectomy	CPT	44950	16	$7,743	$6,618	$776	$6,618.35	$7,743
Laparoscopic appendectomy	CPT	44970	16	$7,274.25	$6,180	$776	$6,180.5	$7,274.25
Spinal fusion (non-cervical) w MCC	MS-DRG	459	3	—	—	$19,316	$39,614	$77,400
Spinal fusion (non-cervical) w/o MCC	MS-DRG	460	3	—	—	$11,036	$28,013	$49,101
Major joint replacement w MCC	MS-DRG	469	16	—	$28,219	$23,674	$29,281	$52,537
Major joint replacement w/o MCC	MS-DRG	470	16	—	$18,251	$15,361	$18,778	$33,410
Laparoscopic cholecystectomy	CPT	47562	16	$27,345	$6,180	$776	$6,489.53	$14,617
Hip & femur procedures except major joint w MCC	MS-DRG	480	17	—	$27,128	$22,764	$28,485	$201,035
Hip & femur procedures except major joint w CC	MS-DRG	481	17	—	$19,746	$16,607	$20,733	$168,548
Hip & femur procedures except major joint w/o CC/MCC	MS-DRG	482	17	—	$15,562	$13,118	$16,029	$40,442
Lap inguinal hernia repair	CPT	49650	16	$10,626	$6,180	$776.99	$6,180.5	$10,626
Lap salpingo-oophorectomy	CPT	58661	16	$8,493	$6,180	$776	$6,180.5	$8,493
OR procedure for obesity w MCC	MS-DRG	619	16	—	$26,903	$22,577	$27,894	$50,011
OR procedure for obesity w CC	MS-DRG	620	16	—	$15,284	$12,887	$15,652	$27,718
OR procedure for obesity w/o CC/MCC	MS-DRG	621	16	—	$14,455	$12,195	$14,778	$26,126
Uterine & adnexa procedures w CC/MCC	MS-DRG	743	16	—	$12,038	$9,515.06	$12,232	$21,490
Uterine & adnexa procedures w/o CC/MCC	MS-DRG	744	16	—	$19,336	$16,105	$19,626	$35,491
PCI single major coronary artery	CPT	92920	15	$27,087	$5,818	$1,582	$6,109.56	$13,761
PCI with drug-eluting stent	CPT	92928	15	$52,136	$11,801	$1,582	$11,802	$27,912
PCI bypass graft	CPT	92937	15	$48,762	$11,801	$1,582	$12,274	$27,912
Left heart catheterization	CPT	93452	15	$17,129	$3,314	$1,582	$3,500	$7,838.49
Coronary angiography with cath	CPT	93455	15	$12,272	$3,314	$1,582	$3,500	$7,838.49
Coronary angiography with bypass cath	CPT	93458	15	$15,952	$3,314	$1,582	$3,500	$7,838.49

Rate history available after the next quarterly refresh. We re-crawl all hospital MRFs each quarter to track rate changes over time.

Payer mix (top 19)

Payer	Codes covered	Median rate
UnitedHealthcare	168	$356.65
health partners plan	168	$334
keystone	168	$253.69
Blue Cross Blue Shield	162	$886
Humana	159	$285.32
pa health & wellness	158	$535.25
naphcare	157	$552.81
spartan	157	$374.48
providers partner health plan	157	$367.35
Cigna	157	$843.49
employer direct healthcare	157	$499.31
Auto Insurance	157	$392.32
TRICARE	157	$356.65
Medicare	157	$374.48
worker compensation	146	$403.01
Medicaid	96	$84.8
ubh	43	$11,531
luminary	43	$13,214
keenan	35	$30