UCHealth Poudre Valley Hospital — price list

← Hospital overviewVerified from UCHealth Poudre Valley Hospital’s published price file

Includes cash prices, list prices, insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.

How to read these columns

List: The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
Cash: The discounted self-pay price for paying directly, without insurance.
Negotiated: Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.

These are the hospital’s published reference prices, not a personalized estimate of your bill.

173 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
ALDESLEUKIN 22 MILLION UNIT INTRAVENOUS SOLUTION Inpatient	J9015 HCPCS	$55,237	$38,666	$21,338 – $53,580	—
BUPRENORPHINE 2 MG-NALOXONE 0.5 MG SUBLINGUAL FILM Inpatient	J0572 HCPCS	$24.99	$17.50	$9.65 – $24.24	—
CAFFEINE 200 MG TABLET Inpatient	0250 RC	$3.00	$2.10	$1.16 – $2.91	—
CALCIUM ACETATE(PHOSPHATE BINDERS) 667 MG CAPSULE Inpatient	J3490 HCPCS	$13.08	$9.16	$5.05 – $12.69	—
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC Inpatient	306 MS-DRG	—	—	$14,165 – $55,035	—
CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC Inpatient	219 MS-DRG	—	—	$64,663 – $268,165	—
CAROTID ARTERY STENT PROCEDURES WITH CC Inpatient	035 MS-DRG	—	—	$20,907 – $83,488	—
CHOLECALCIFEROL (VITAMIN D3) 10 MCG (400 UNIT) TABLET Inpatient	0250 RC	$3.00	$2.10	$1.16 – $2.91	—
CYCLOSPORINE 100 MG CAPSULE Inpatient	J7502 HCPCS	$220	$154	$84.96 – $213	—
DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IV SOLUTION (COMPONENT) Inpatient	J1100 HCPCS	$16.30	$11.41	$6.30 – $15.81	—
DEXTROSE 5 % AND LACTATED RINGERS INTRAVENOUS SOLUTION Inpatient	J7121 HCPCS	$136	$94.99	$52.42 – $132	—
DEXTROSE 50% INJECTION (COMPONENT) Inpatient	0250 RC	$706	$494	$273 – $684	—
EMPAGLIFLOZIN 10 MG TABLET Inpatient	0250 RC	$213	$149	$82.36 – $207	—
EPIRUBICIN 50 MG/25 ML INTRAVENOUS SOLUTION Inpatient	J9178 HCPCS	$148	$104	$57.13 – $143	—
HB COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT Inpatient	57420 CPT	$820	$574	$317 – $795	—
HB 5-NUCLEOTIDASE Inpatient	83915 CPT	$78.45	$54.92	$30.31 – $76.10	—
HB AEROBIC ISOL DEFINITIVE ID Inpatient	87077 CPT	$78.00	$54.60	$30.13 – $75.66	—
HB AMYLASE ISOENZYME Inpatient	82150 CPT	$345	$241	$133 – $335	—
HB APPL LOW SK GRFT TRNK/ARMS/LEGS <=100 SQ/ INIT 25 SQ CM Inpatient	C5271 HCPCS	$1,800	$1,260	$695 – $1,746	—
HB APPL ON-BODY INJECTOR FOR TIMED SUBQ INJECTION Inpatient	96377 CPT	$81.00	$56.70	$31.29 – $78.57	—
HB BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I Inpatient	50706 CPT	$2,106	$1,474	$814 – $2,043	—
HB BASIC METABOLIC PANEL Inpatient	80048 CPT	$262	$183	$101 – $254	—
HB BIOPSY BONE TROCAR/NEEDLE DEEP Inpatient	20225 CPT	$4,749	$3,324	$1,835 – $4,607	—
HB BLOOD CULTURE ID BY PCR, 6+ TARGETS Inpatient	87154 CPT	$364	$255	$141 – $353	—
HB CERVICAL COLLAR FOAM Inpatient	0270 RC	$84.36	$59.06	$32.59 – $81.83	—
HB CONTROL NASAL HEM ANTERIOR; SIMPLE Inpatient	30901 CPT	$574	$402	$222 – $557	—
HB COVID-19 ANTIBODY TEST Inpatient	86769 CPT	$100	$70.00	$38.63 – $97.00	—
HB DIAZEPAM AND NORDIAZEPAM Inpatient	G0480 HCPCS	$155	$109	$60.05 – $151	—
HB DRAIN EXT AUDITORY CANAL ABSCESS Inpatient	69020 CPT	$1,031	$722	$398 – $1,000	—
HB ECHO TEE 2D CMPLT CONG ANOMALY WO CNTRST Inpatient	93315 CPT	$2,685	$1,880	$1,037 – $2,604	—