CHI St. Vincent North
2215 Wildwood Avenue, Sherwood, AR · CommonSpirit Health · · NPI 1629011002
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Shoulder MRI (with contrast) CPT 73222 | $1,192.46 | $4,691.00 | $584.00 – $2,827.78 | 9 |
| Shoulder MRI (without contrast) CPT 73221 | $1,036.89 | $4,079.00 | $223.73 – $2,827.78 | 9 |
| Shoulder X-ray CPT 73030 | $116.43 | $458.00 | $33.02 – $251.90 | 8 |
| Shuntogram nonvascular supervision & interpretation CPT 75809 | $271.49 | $1,068.00 | $107.60 – $807.88 | 5 |
| Sialolithotomy 42330 CPT 42330 | $1,135.26 | $4,466.00 | $1,092.62 – $1,092.62 | 1 |
| Sickling rbc CPT 85660 | $17.80 | $70.00 | $4.15 – $17.89 | 9 |
| Signal avg ecg w or without ecg 93278 CPT 93278 | $82.62 | $325.00 | $57.98 – $266.00 | 7 |
| Sinus CT scan (with and without contrast) CPT 70488 | $897.33 | $3,530.00 | $174.94 – $2,117.84 | 9 |
| Sinus CT scan (with contrast) CPT 70487 | $828.95 | $3,261.00 | $174.94 – $2,117.84 | 9 |
| Sinus CT scan (without contrast) CPT 70486 | $760.32 | $2,991.00 | $107.60 – $2,117.84 | 9 |
| Sinus/juglr venogram s&i CPT 75860 | $924.53 | $3,637.00 | $288.84 – $6,438.74 | 5 |
| Sirolimus, oral HCPCS J7520 | $54.62 | $214.85 | $1.31 – $25.95 | 7 |
| Sleep Study (Polysomnography) CPT 95810 | $1,213.81 | $4,775.00 | $276.94 – $2,351.88 | 7 |
| Sleep study unattended CPT 95806 | $152.27 | $599.00 | $152.73 – $1,379.00 | 4 |
| Sling suprapubic suburetheral HCPCS C1771 | $5,483.61 | $21,572.00 | $615.35 – $1,230.70 | 4 |
| Sm-153 lexidron ther HCPCS A9604 | $1,630.19 | $6,413.00 | $4,314.91 – $6,413.00 | 3 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $22.63 | $89.00 | $4.06 – $17.41 | 9 |
| Smear gram stain CPT 87205 | $22.37 | $88.00 | $3.22 – $13.85 | 9 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $19.83 | $78.00 | $4.51 – $19.43 | 9 |
| Smear wet mount CPT 87210 | $17.54 | $69.00 | $4.19 – $13.85 | 9 |
| Sodium 24 hour urine CPT 84300 | $19.83 | $78.00 | $3.82 – $15.75 | 9 |
| Sodium serum/plasma/whole blood CPT 84295 | $25.17 | $99.00 | $3.63 – $15.59 | 9 |
| Special physics consult CPT 77370 | $557.47 | $2,193.00 | $121.54 – $768.00 | 7 |
| Special radiation dosimetry CPT 77331 | $104.48 | $411.00 | $49.94 – $768.00 | 7 |
| Special radiation treatment CPT 77470 | $735.15 | $2,892.00 | $404.97 – $1,731.74 | 7 |
| Special teletx port plan CPT 77321 | $186.08 | $732.00 | $256.20 – $768.00 | 7 |
| Specific gravity body fluid CPT 84315 | $4.07 | $16.00 | $1.86 – $4.22 | 9 |
| Specimen fat stain CPT 89125 | $14.49 | $57.00 | $4.24 – $13.98 | 9 |
| Sperm washing 58323 CPT 58323 | not published | not published | $506.23 – $506.23 | 1 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $461.12 | $1,814.00 | not published | 0 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $157.61 | $620.00 | $88.53 – $350.14 | 6 |
| Split blood or products CPT 86985 | $212.52 | $836.00 | $0.56 – $459.80 | 8 |
| Sputum specimen collection CPT 89220 | $223.19 | $878.00 | $9.66 – $482.90 | 8 |
| Sr-89 stront chlor ther / mci HCPCS A9600 | $1,385.65 | $5,451.00 | $1,841.65 – $4,702.50 | 6 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $83.38 | $328.00 | $105.49 – $328.00 | 4 |
| Stent/athrectomy/fem/pop/unilat 37227 CPT 37227 | $10,230.28 | $40,245.00 | not published | 0 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $14,489.40 | $57,000.00 | $50.00 – $100.00 | 4 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $2,094.13 | $8,238.10 | $52.00 – $104.00 | 4 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $15,201.16 | $59,800.00 | $25.75 – $51.50 | 4 |
| Stent bronch dumon sil 10x40mm HCPCS C1875 | $355.99 | $1,400.41 | $350.11 – $700.21 | 4 |
| Stent placemt retro carotid CPT 37217 | $1,640.10 | $6,452.00 | $567.50 – $567.50 | 3 |
| Stent/tib/peroneal/unilat/initial 37230 CPT 37230 | $5,686.20 | $22,369.00 | not published | 0 |
| Strapping of ankle and/or ft 29540 CPT 29540 | $85.16 | $335.00 | $148.24 – $229.92 | 2 |
| Strapping of chest CPT 29200 | $101.94 | $401.00 | $115.77 – $367.02 | 5 |
| Strapping of elbow or wrist 29260 CPT 29260 | $85.16 | $335.00 | $58.46 – $335.00 | 2 |
| Strapping of hand or finger CPT 29280 | $85.16 | $335.00 | $58.46 – $335.00 | 2 |
| Strapping of hip CPT 29520 | $85.16 | $335.00 | $115.77 – $229.92 | 5 |
| Strapping of knee CPT 29530 | $88.72 | $349.00 | $118.09 – $229.92 | 2 |
| Strapping of toes 29550 CPT 29550 | $85.16 | $335.00 | $58.46 – $229.92 | 2 |
| Strep a ag ia CPT 87430 | $36.61 | $144.00 | $11.76 – $17.65 | 6 |
| Streptomycin injection HCPCS J3000 | $145.94 | $574.10 | $1.99 – $287.05 | 7 |
| Subdural tap fontanelle/sutur infant init 61000 CPT 61000 | not published | not published | $767.79 – $767.79 | 1 |
| Subq njx filling matrl 1cc/< CPT 11950 | not published | not published | $512.55 – $512.55 | 1 |
| Subq njx fil matrl 5.1-10cc CPT 11952 | not published | not published | $512.55 – $512.55 | 1 |
| Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution HCPCS J2865 | $17.25 | $67.85 | $5.53 – $23.04 | 2 |
| Surgical exposure prostate 55860 CPT 55860 | not published | not published | $820.52 – $820.52 | 1 |
| Surgical pathology level 1 gross examination only CPT 88300 | $63.55 | $250.00 | $8.47 – $137.50 | 5 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $63.55 | $250.00 | $16.94 – $137.50 | 5 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $97.62 | $384.00 | $21.04 – $211.20 | 5 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $97.62 | $384.00 | $21.30 – $211.20 | 5 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $423.50 | $1,666.00 | $130.10 – $916.30 | 5 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $889.45 | $3,499.00 | $166.62 – $1,924.45 | 5 |
| Susceptibility agar dilution per agent CPT 87181 | $21.87 | $86.00 | $3.58 – $15.39 | 9 |
| Susceptibility mic per plate CPT 87186 | $27.46 | $108.00 | $6.52 – $18.70 | 9 |
| Suscept studies macrobroth dilution ea CPT 87188 | $19.83 | $78.00 | $5.01 – $15.07 | 9 |
| Svc venogram s&i CPT 75827 | $720.15 | $2,833.00 | $282.55 – $3,163.82 | 5 |
| Sweat collection by iontophoresis CPT 89230 | $104.23 | $410.00 | $2.23 – $225.50 | 8 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $15.77 | $62.00 | $3.32 – $14.28 | 9 |
| System cardiomems hosp electronics HCPCS C2624 | $21,352.80 | $84,000.00 | $21,000.00 – $42,000.00 | 4 |
| System pacing micra av HCPCS C1786 | $11,439.00 | $45,000.00 | $1,450.00 – $2,378.00 | 3 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $7,946.46 | $31,260.63 | $509.36 – $835.35 | 3 |
| T3 (triiodothyronine) free CPT 84481 | $90.50 | $356.00 | $12.77 – $54.91 | 9 |
| T3 (triiodothyronine) total CPT 84480 | $50.08 | $197.00 | $10.70 – $45.97 | 9 |
| T4 (thyroxine) free CPT 84439 | $37.63 | $148.00 | $6.80 – $29.24 | 9 |
| T4 (thyroxine) total CPT 84436 | $34.58 | $136.00 | $5.19 – $20.20 | 9 |
| Tacrolimus therapeutic drug level CPT 80197 | $30.00 | $118.00 | $10.35 – $44.49 | 9 |
| Tattooing/intraderm 6.1-20.0 sq cm 11921 CPT 11921 | not published | not published | $512.55 – $512.55 | 1 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $466.75 | $1,836.12 | $0.40 – $918.06 | 8 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $46.27 | $182.00 | $73.49 – $197.99 | 9 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $26.70 | $105.00 | $46.74 – $203.12 | 9 |
| Tc-99m apcitide diag HCPCS A9504 | $608.31 | $2,393.00 | $200.52 – $550.00 | 5 |
| Tc-99m arcitumomab HCPCS A9568 | $834.54 | $3,283.00 | $809.51 – $1,358.50 | 2 |
| Tc-99m depreotide HCPCS A9536 | $2,085.21 | $8,203.00 | $880.00 – $1,452.80 | 4 |
| Tc-99m exame autol wbc diag per dose HCPCS A9569 | $615.93 | $2,423.00 | $1,040.32 – $2,149.31 | 2 |
| Tc-99m exametazime diag HCPCS A9521 | $611.86 | $2,407.00 | $789.07 – $2,149.31 | 5 |
| Tc-99m labeled rbc HCPCS A9560 | $78.55 | $309.00 | $117.13 – $122.40 | 4 |
| Tc-99m maa HCPCS A9540 | $102.19 | $402.00 | $37.62 – $41.18 | 4 |
| Tc-99m mebrofenin HCPCS A9537 | $51.61 | $203.00 | $69.37 – $86.71 | 4 |
| Tc-99m medronate HCPCS A9503 | $91.77 | $361.00 | $16.30 – $227.00 | 5 |
| Tc-99m mertiatide HCPCS A9562 | $216.84 | $853.00 | $70.98 – $853.00 | 4 |
| Tc-99m oxidronate HCPCS A9561 | $91.77 | $361.00 | $52.30 – $55.18 | 4 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | $48.81 | $192.00 | $18.81 – $31.05 | 4 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $48.81 | $192.00 | $47.22 – $80.32 | 4 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $168.03 | $661.00 | $227.00 – $461.21 | 4 |
| Tc-99m sulfur colloid HCPCS A9541 | $104.48 | $411.00 | $120.04 – $225.00 | 4 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $166.51 | $655.00 | $106.93 – $577.49 | 5 |
| Tca peel dermal 15789 CPT 15789 | not published | not published | $373.34 – $373.34 | 1 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $132.95 | $523.00 | $35.43 – $130.50 | 9 |
| T cells absolute cd 4 count CPT 86361 | $111.85 | $440.00 | $20.20 – $65.26 | 9 |
| T cells total count CPT 86359 | $124.56 | $490.00 | $28.44 – $122.28 | 9 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.