St. Dominic Hospital — price list
← Hospital overviewVerified from St. Dominic 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.
570 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| E-z disk 700 mg tablet Outpatient | 100992_ERX CDM | $12.18 | $6.09 | $4.51 – $9.14 | $136 | |
| Flumazenil 0.1 mg/ml vial Outpatient | 10055_ERX CDM | $68.88 | $34.44 | $25.49 – $51.66 | $146 | |
| Goserelin acetate implant, per 3.6 mg Outpatient | 10137_ERX CDM | $4,259 | $2,129 | $160 – $4,515 | $2,115 | |
| Acid Dual Chamber Outpatient | 1049635_SUP CDM | $32,500 | $16,250 | $12,025 – $24,375 | $24,375 | |
| Aidc Other Than Sing/Dual Outpatient | 1049622_SUP CDM | $43,750 | $21,875 | $16,188 – $32,813 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1002602_SUP CDM | $1,286 | $643 | $476 – $964 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1015106_SUP CDM | $2,364 | $1,182 | $875 – $1,773 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1025999_SUP CDM | $412 | $206 | $152 – $309 | $309 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1026023_SUP CDM | $780 | $390 | $289 – $585 | $585 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1026032_SUP CDM | $780 | $390 | $289 – $585 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1026092_SUP CDM | $660 | $330 | $244 – $495 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1029957_SUP CDM | $2,621 | $1,310 | $970 – $1,966 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1036836_SUP CDM | $2,231 | $1,115 | $825 – $1,673 | $1,673 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1036873_SUP CDM | $2,231 | $1,115 | $825 – $1,673 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1036880_SUP CDM | $2,231 | $1,115 | $825 – $1,673 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1036908_SUP CDM | $2,506 | $1,253 | $927 – $1,879 | $745 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1036928_SUP CDM | $2,231 | $1,115 | $825 – $1,673 | $1,673 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1036963_SUP CDM | $2,506 | $1,253 | $927 – $1,879 | $1,879 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1037097_SUP CDM | $2,819 | $1,410 | $1,043 – $2,114 | $2,114 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1037126_SUP CDM | $2,819 | $1,410 | $1,043 – $2,114 | $2,114 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1037141_SUP CDM | $2,231 | $1,115 | $825 – $1,673 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1037263_SUP CDM | $2,231 | $1,115 | $825 – $1,673 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1037314_SUP CDM | $2,231 | $1,115 | $825 – $1,673 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1037317_SUP CDM | $2,819 | $1,410 | $1,043 – $2,114 | $2,114 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1037357_SUP CDM | $2,231 | $1,115 | $825 – $1,673 | $1,673 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1037380_SUP CDM | $1,898 | $949 | $702 – $1,424 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1037402_SUP CDM | $2,506 | $1,253 | $927 – $1,879 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1037409_SUP CDM | $2,506 | $1,253 | $927 – $1,879 | $1,879 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1037528_SUP CDM | $1,648 | $824 | $610 – $1,236 | $732 | |
| Anchor/Screw Bn/Bn Tis/Bn Outpatient | 1037561_SUP CDM | $2,819 | $1,410 | $1,043 – $2,114 | $2,114 |