Maple Grove Hospital Corporation
Maple Grove Hospital Corporation in Maple Grove, MN publishes cash prices for 34 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.
9875 Hospital Drive Maple Grove, MN 55369 Collected Sep 22, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT scan of abdomen and pelvis with contrast | $706.71 | $1,341.00 | 47% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT scan of abdomen and pelvis with contrast | $706.71 | $1,341.00 | 47% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT scan head or brain | $549.13 | $1,042.00 | 47% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT scan head or brain | $549.13 | $1,042.00 | 47% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT scan pelvis with contrast | $680.88 | $1,292.00 | 47% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT scan pelvis with contrast | $680.88 | $1,292.00 | 47% |
| Diagnostic mammogram, both breasts CPT 77066 Mammography of both breasts | $307.77 | $584.00 | 47% |
| Diagnostic mammogram, both breasts inpatient CPT 77066 Mammography of both breasts | $307.77 | $584.00 | 47% |
| Diagnostic mammogram, one breast CPT 77065 Mammography of one breast | $248.74 | $472.00 | 47% |
| Diagnostic mammogram, one breast inpatient CPT 77065 Mammography of one breast | $248.74 | $472.00 | 47% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 Magnetic resonance imaging MRI), leg joint | $806.31 | $1,530.00 | 47% |
| MRI of knee or other lower-limb joint, no contrast dye inpatient CPT 73721 Magnetic resonance imaging MRI), leg joint | $806.31 | $1,530.00 | 47% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 Magnetic resonance imaging MRI), leg joint | $1,121.46 | $2,128.00 | 47% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 Magnetic resonance imaging MRI), leg joint | $1,121.46 | $2,128.00 | 47% |
| MRI of the brain, no contrast dye CPT 70551 Magnetic resonance imaging (MRI), brain | $727.26 | $1,380.00 | 47% |
| MRI of the brain, no contrast dye inpatient CPT 70551 Magnetic resonance imaging (MRI), brain | $727.26 | $1,380.00 | 47% |
| MRI of the brain, with and without contrast dye CPT 70553 Magnetic resonance imaging (MRI), brain | $1,040.82 | $1,975.00 | 47% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 Magnetic resonance imaging (MRI), brain | $1,040.82 | $1,975.00 | 47% |
| MRI of the lower back, no contrast dye CPT 72148 Magnetic resonance imaging (MRI), spinal canal, lumbar | $741.49 | $1,407.00 | 47% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 Magnetic resonance imaging (MRI), spinal canal, lumbar | $741.49 | $1,407.00 | 47% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ultrasound of pregnant uterus | $320.42 | $608.00 | 47% |
| Pregnancy ultrasound after 14 weeks, one baby inpatient CPT 76805 Ultrasound of pregnant uterus | $320.42 | $608.00 | 47% |
| Screening mammogram, both breasts CPT 77067 Mammography of both breasts | $243.47 | $462.00 | 47% |
| Screening mammogram, both breasts CPT 77067 Mammography of both breasts | $243.47 | $462.00 | 47% |
| Screening mammogram, both breasts inpatient CPT 77067 Mammography of both breasts | $243.47 | $462.00 | 47% |
| Screening mammogram, both breasts inpatient CPT 77067 Mammography of both breasts | $243.47 | $462.00 | 47% |
| Transvaginal pelvic ultrasound CPT 76830 Ultrasound pelvis through vagina | $194.99 | $370.00 | 47% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 Ultrasound pelvis through vagina | $194.99 | $370.00 | 47% |
| Ultrasound of the abdomen, complete CPT 76700 Ultrasound of abdomen | $328.32 | $623.00 | 47% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 Ultrasound of abdomen | $328.32 | $623.00 | 47% |
| X-ray of the lower back, 4 or more views CPT 72110 X-Ray, spine, lumbosacral; minimum of 4 views | $221.87 | $421.00 | 47% |
| X-ray of the lower back, 4 or more views inpatient CPT 72110 X-Ray, spine, lumbosacral; minimum of 4 views | $221.87 | $421.00 | 47% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Basic metbolic panel | $24.77 | $47.00 | 47% |
| Basic metabolic panel (blood test) inpatient CPT 80048 Basic metbolic panel | $24.77 | $47.00 | 47% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood test, lipids (cholesterol and triglycerides) | $18.44 | $35.00 | 47% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Lipid profile | $22.13 | $42.00 | 47% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Blood test, lipids (cholesterol and triglycerides) | $18.44 | $35.00 | 47% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 Lipid profile | $22.13 | $42.00 | 47% |
| Complete blood count (CBC) with differential CPT 85025 Complete blood cell count (red cells, white blood cell, platelets), automated test | $22.13 | $42.00 | 47% |
| Complete blood count (CBC) with differential inpatient CPT 85025 Complete blood cell count (red cells, white blood cell, platelets), automated test | $22.13 | $42.00 | 47% |
| Complete blood count (CBC), no differential CPT 85027 Complete blood cell count (red cells, white blood cell, platelets), automated test | $19.50 | $37.00 | 47% |
| Complete blood count (CBC), no differential inpatient CPT 85027 Complete blood cell count (red cells, white blood cell, platelets), automated test | $19.50 | $37.00 | 47% |
| Comprehensive metabolic panel (blood test) CPT 80053 Comprehensive metabolic panel | $31.09 | $59.00 | 47% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 Comprehensive metabolic panel | $31.09 | $59.00 | 47% |
| Kidney function blood test panel CPT 80069 Kidney function blood test panel | $11.59 | $22.00 | 47% |
| Kidney function blood test panel inpatient CPT 80069 Kidney function blood test panel | $11.59 | $22.00 | 47% |
| Liver function blood test panel CPT 80076 Liver profile panel | $24.24 | $46.00 | 47% |
| Liver function blood test panel inpatient CPT 80076 Liver profile panel | $24.24 | $46.00 | 47% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 PSA (prostate specific antigen) measurement, free | $17.44 | $33.10 | 47% |
| PSA (prostate-specific antigen) blood test, free inpatient CPT 84154 PSA (prostate specific antigen) measurement, free | $17.44 | $33.10 | 47% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 PSA (prostate specific antigen) measurement, total | $17.44 | $33.10 | 47% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 PSA (prostate specific antigen) measurement, total | $17.44 | $33.10 | 47% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation assessment blood test, plasma or whole blood | $34.86 | $66.14 | 47% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 Coagulation assessment blood test, plasma or whole blood | $34.86 | $66.14 | 47% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Blood test, clotting time | $24.87 | $47.20 | 47% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 Blood test, clotting time | $24.87 | $47.20 | 47% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood test, thyroid stimulating hormone (TSH) | $15.94 | $30.24 | 47% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 Blood test, thyroid stimulating hormone (TSH) | $15.94 | $30.24 | 47% |
| Urinalysis with microscope exam, automated CPT 81001 Urinalysis W/ Microscopic | $14.76 | $28.00 | 47% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 Urinalysis W/ Microscopic | $14.76 | $28.00 | 47% |
| Urinalysis without microscope exam, automated CPT 81003 Urine Macroscopic | $7.38 | $14.00 | 47% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 Urine Macroscopic | $7.38 | $14.00 | 47% |
| Urinalysis without microscope exam, manual CPT 81002 Urinalysis, manual test | $3.16 | $6.00 | 47% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 Urinalysis, manual test | $3.16 | $6.00 | 47% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Lower-back epidural injection, with imaging guidance CPT 62323 Injection of substance into lower spine canal using imaging guidance | $895.90 | $1,700.00 | 47% |
| Lower-back epidural injection, with imaging guidance inpatient CPT 62323 Injection of substance into lower spine canal using imaging guidance | $895.90 | $1,700.00 | 47% |
| Lower-back epidural injection, without imaging guidance CPT 62322 HB Inj Interlaminar/Subarachnoid L/S, W/O Img | $961.25 | $1,824.00 | 47% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 HB Inj Interlaminar/Subarachnoid L/S, W/O Img | $961.25 | $1,824.00 | 47% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level | $1,252.15 | $2,376.00 | 47% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level | $1,252.15 | $2,376.00 | 47% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | $74.83 | $142.00 | 47% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | $74.83 | $142.00 | 47% |
Source file: https://northmemorial.com/wp-content/uploads/2026/04/208316475_maple-grove-hospital-corporation_standardcharges.csv