HSHS St. Mary's Hospital Medical Center — price list
← Hospital overviewVerified from HSHS St. Mary's Hospital Medical Center’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.
94 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| Allograft vivagen 5cc Inpatient & outpatient | C1763 HCPCS | $4,388 | $2,896 | $2,133 – $4,388 | — | |
| Anchor/screw bn/bn,tis/bn Inpatient & outpatient | C1713 HCPCS | $2,766 | $1,826 | $1,344 – $2,766 | — | |
| Catheter pigtail 14fr x 25cm Inpatient & outpatient | C1729 HCPCS | $167 | $110 | $80.92 – $167 | — | |
| Coll venous bld venipuncture Inpatient & outpatient | 36415 CPT | $50.00 | $33.00 | $1.19 – $50.00 | — | |
| Conn tiss, human(inc fascia) Inpatient & outpatient | C1762 HCPCS | $3,816 | $2,519 | $1,855 – $3,816 | — | |
| Conn tiss, non-human Inpatient & outpatient | C1763 HCPCS | $3,949 | $2,606 | $1,919 – $3,949 | — | |
| Draw blood off venous device Inpatient & outpatient | 36591 CPT | $196 | $129 | $33.22 – $292 | — | |
| Drug test def 1-7 classes Inpatient & outpatient | G0480 HCPCS | $244 | $161 | $63.95 – $257 | — | |
| Drug test prsmv chem anlyzr Inpatient & outpatient | 80307 CPT | $392 | $259 | $62.14 – $392 | — | |
| Graft cardiovascular 100cm 8mm straight 2 velour woven xlong Inpatient & outpatient | C1768 HCPCS | $890 | $587 | $433 – $890 | — | |
| Graft cv 50cm 16mm 2 velur wvn strt Inpatient & outpatient | C1768 HCPCS | $627 | $414 | $305 – $627 | — | |
| Graft duragen matrix 1 x 1 Inpatient & outpatient | C1763 HCPCS | $696 | $460 | $338 – $696 | — | |
| Graft gortex regular 6 mm x 80 cm Inpatient & outpatient | C1768 HCPCS | $1,921 | $1,268 | $934 – $1,921 | — | |
| Graft nerve 30mm 1-2mm avance allograft Inpatient & outpatient | C1762 HCPCS | $8,046 | $5,310 | $3,782 – $8,046 | — | |
| Graft patch hemashield platinum 0.8cmx7.6cm Inpatient & outpatient | C1768 HCPCS | $181 | $119 | $87.82 – $181 | — | |
| Graft patch ptfe felt 6mmx6mm Inpatient & outpatient | C1768 HCPCS | $185 | $122 | $89.89 – $185 | — | |
| Graft sft tis 230+ mm 4+ mm flexigraft semi tendinosus tend Inpatient & outpatient | C1762 HCPCS | $2,761 | $1,822 | $1,342 – $2,761 | — | |
| Graft vasc 70cm 4mm thnwl gortx ln ster ltxfr Inpatient & outpatient | C1768 HCPCS | $1,579 | $1,042 | $767 – $1,579 | — | |
| Graft vascular 80cm 6-8mm thin wall taper gore-tex line sterile latex free Inpatient & outpatient | C1768 HCPCS | $2,063 | $1,362 | $1,003 – $2,063 | — | |
| Graft xenosure biologic patch 0.8 x 8cm Inpatient & outpatient | C1768 HCPCS | $338 | $223 | $164 – $338 | — | |
| Graft, vascular Inpatient & outpatient | C1768 HCPCS | $737 | $487 | $358 – $737 | — | |
| Arterial puncture Inpatient & outpatient | 36600 CPT | $196 | $129 | $23.90 – $292 | — | |
| Blood glucose test Inpatient & outpatient | 300 RC | $25.00 | $16.50 | $12.15 – $25.00 | — | |
| Buprenorphine scr/qn urine Inpatient & outpatient | 80306 CPT | $212 | $140 | $17.14 – $212 | — | |
| Cell CT body fluid withdiff Inpatient & outpatient | 89051 CPT | $85.00 | $56.10 | $5.60 – $85.00 | — | |
| Cell CT body fluid withdiff (syn) Inpatient & outpatient | 89051 CPT | $121 | $79.86 | $5.60 – $121 | — | |
| Crutches per pair Inpatient & outpatient | 271 RC | $92.00 | $60.72 | $44.71 – $92.00 | — | |
| Immune complex assay Inpatient & outpatient | 86332 CPT | $252 | $166 | $24.37 – $252 | — | |
| Process fee Inpatient & outpatient | 99080 CPT | $24.00 | $15.84 | $11.66 – $24.00 | — | |
| Resp virus, 3-5 targets Inpatient & outpatient | 87631 CPT | $645 | $426 | $141 – $645 | — |