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 |
|---|---|---|---|---|
| Dexamethasone 4 mg tablet HCPCS J8540 | $1.70 | $6.67 | $0.06 – $3.67 | 3 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $11.79 | $46.37 | $0.11 – $23.19 | 7 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $1,024.61 | $4,030.72 | $80.88 – $2,015.36 | 8 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $73.47 | $289.00 | $9.90 – $72.05 | 9 |
| Diabetes (HbA1c) Test CPT 83036 | $40.17 | $158.00 | $7.32 – $31.48 | 9 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $50.84 | $200.00 | not published | 0 |
| Diagnostic laryngoscopy 31505 CPT 31505 | not published | not published | $265.78 – $265.78 | 1 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $125.07 | $492.00 | $181.80 – $181.80 | 1 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $187.35 | $737.00 | $111.86 – $287.11 | 7 |
| Diagnostic Mammogram (one breast) CPT 77065 | $149.98 | $590.00 | $87.72 – $237.08 | 7 |
| Diagnostic radio unlisted proc CPT 76499 | $78.81 | $310.00 | $63.39 – $182.03 | 5 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $3,554.48 | $13,983.00 | $567.50 – $567.50 | 3 |
| Dialysis one evaluation CPT 90945 | $215.57 | $848.00 | $144.30 – $567.50 | 5 |
| Diffusing capacity CPT 94729 | $69.40 | $273.00 | $42.75 – $180.00 | 6 |
| Digoxin total therapeutic drug level CPT 80162 | $41.69 | $164.00 | $10.01 – $43.04 | 9 |
| Dilate biliary duct/ampulla CPT 47542 | $337.58 | $1,328.00 | $674.19 – $674.19 | 3 |
| Dilate esophagus CPT 43453 | $886.65 | $3,488.00 | not published | 0 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | $1,670.86 | $6,573.00 | $567.50 – $567.50 | 3 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | $1,670.86 | $6,573.00 | $567.50 – $567.50 | 3 |
| Dilate ic vasospasm init CPT 61640 | $3,833.34 | $15,080.00 | not published | 0 |
| Dilate tear duct opening CPT 68801 | not published | not published | $556.86 – $556.86 | 1 |
| Dilate urethra stricture CPT 53600 | not published | not published | $457.71 – $457.71 | 1 |
| Dilate urethra stricture CPT 53601 | not published | not published | $457.71 – $457.71 | 1 |
| Dilate urethra stricture CPT 53621 | not published | not published | $457.71 – $457.71 | 1 |
| Dilation/female urethra/initial 53660 CPT 53660 | not published | not published | $457.71 – $457.71 | 1 |
| Dilation of salivary duct CPT 42660 | not published | not published | $1,092.62 – $1,092.62 | 1 |
| Dilation of urethra CPT 53661 | not published | not published | $457.71 – $457.71 | 1 |
| Dilation salivary duct 42650 CPT 42650 | not published | not published | $1,092.62 – $1,092.62 | 1 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | $1,071.46 | $4,215.00 | $820.52 – $820.52 | 1 |
| Dilator fascial 10fx20cm HCPCS C2627 | $209.97 | $826.00 | $44.18 – $88.36 | 4 |
| Dilat xst trc ndurlgc px CPT 50436 | $251.41 | $989.00 | not published | 0 |
| Dipyridamole injection HCPCS J1245 | $18.35 | $72.16 | $4.16 – $56.34 | 7 |
| Disaccharidases CPT 82657 | $59.49 | $234.00 | $16.72 – $58.54 | 9 |
| Discography cerv/thor spine CPT 72285 | $1,542.74 | $6,069.00 | $164.38 – $3,947.38 | 5 |
| Diverticulectomy/hypophar/esoph 43130 CPT 43130 | not published | not published | $2,626.10 – $2,626.10 | 1 |
| Dlyd plmt xtn prosth ea addl CPT 34711 | $951.98 | $3,745.00 | $674.19 – $674.19 | 3 |
| Dna antibody native/double stranded CPT 86225 | $52.62 | $207.00 | $4.95 – $44.54 | 9 |
| Dna probe chlamydia CPT 87490 | $66.35 | $261.00 | $17.16 – $64.99 | 9 |
| Dna probe gc CPT 87590 | $66.35 | $261.00 | $19.67 – $64.99 | 9 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $10.37 | $40.78 | $4.90 – $48.92 | 7 |
| Doppler echo complete CPT 93320 | $311.15 | $1,224.00 | $31.79 – $1,498.00 | 7 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $766.42 | $3,015.00 | $5,825.00 – $5,825.00 | 1 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $227.51 | $895.00 | $134.59 – $492.25 | 8 |
| Dornhoffer fixed part w/window HCPCS L8614 | $21,031.88 | $82,737.51 | $20,684.38 – $41,368.76 | 4 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | $45.13 | $177.53 | $21.31 – $88.77 | 2 |
| Dpyd gene common variants CPT 81232 | $184.55 | $726.00 | $131.81 – $396.82 | 9 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $125.58 | $494.00 | $354.36 – $354.36 | 1 |
| Drainage ext aud canal abscess 69020 CPT 69020 | $146.42 | $576.00 | $421.86 – $421.86 | 1 |
| Drainage external ear complex 69005 CPT 69005 | $1,220.93 | $4,803.00 | $776.23 – $776.23 | 1 |
| Drainage external ear simple 69000 CPT 69000 | $311.65 | $1,226.00 | $421.86 – $421.86 | 1 |
| Drainage mouth roof lesion CPT 42000 | $267.93 | $1,054.00 | not published | 0 |
| Drainage of arm bursa 23931 CPT 23931 | $446.38 | $1,756.00 | not published | 0 |
| Drainage of kidney lesion CPT 50390 | $997.99 | $3,926.00 | not published | 0 |
| Drainage of nose lesion int 30000 CPT 30000 | $220.65 | $868.00 | $354.36 – $354.36 | 1 |
| Drainage of nose lesion sept 30020 CPT 30020 | $333.77 | $1,313.00 | $354.36 – $354.36 | 1 |
| Drainage of rectal abscess CPT 45005 | $866.32 | $3,408.00 | not published | 0 |
| Drainage of urethra abscess 53060 CPT 53060 | $1,478.69 | $5,817.00 | $115.77 – $2,145.17 | 4 |
| Drain bladder by trocar/cath CPT 51101 | not published | not published | $262.13 – $262.13 | 1 |
| Drain blood from under nail 11740 CPT 11740 | $36.86 | $145.00 | $145.00 – $145.00 | 1 |
| Drain cath image guided visceral pq CPT 49405 | $1,090.01 | $4,288.00 | not published | 0 |
| Drain cerebro spinal fluid 62272 CPT 62272 | $566.36 | $2,228.00 | $655.31 – $655.31 | 1 |
| Drain finger abscess;simple 26010 CPT 26010 | $131.68 | $518.00 | $421.86 – $421.86 | 1 |
| Drain neck/chest lesion 21501 CPT 21501 | $1,590.28 | $6,256.00 | not published | 0 |
| Drain shoulder lesion CPT 23030 | $1,392.77 | $5,479.00 | not published | 0 |
| Drain thigh/knee lesion 27301 CPT 27301 | $739.98 | $2,911.00 | not published | 0 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $169.56 | $667.00 | not published | 0 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $99.40 | $391.00 | $373.34 – $373.34 | 1 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $192.43 | $757.00 | not published | 0 |
| Dressing change not for burn w/anes 15852 CPT 15852 | $49.32 | $194.00 | $111.80 – $111.80 | 1 |
| Drill hole evac+/drg subdural hematoma 61108 CPT 61108 | $1,689.93 | $6,648.00 | $674.19 – $674.19 | 3 |
| Drill hole implt ventricular cath/device 61107 CPT 61107 | $321.31 | $1,264.00 | $115.77 – $115.77 | 3 |
| Drng of eyelid abscess 67700 CPT 67700 | $232.34 | $914.00 | $590.59 – $590.59 | 1 |
| Drng of finger abscess comp 26011 CPT 26011 | $393.76 | $1,549.00 | not published | 0 |
| Drng of hydrocele 55000 CPT 55000 | not published | not published | $388.11 – $388.11 | 1 |
| Drng of scrotum abscess 55100 CPT 55100 | $821.07 | $3,230.00 | not published | 0 |
| Drng salivary gland submax/subling 42310 CPT 42310 | $156.85 | $617.00 | not published | 0 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | $15.32 | $60.26 | $7.24 – $30.13 | 7 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $283.69 | $1,116.00 | $279.00 – $558.00 | 4 |
| Drsg oasis ultr ster 3lyr 7x10 70sqcm -cost per sq cm HCPCS Q4124 | $559.40 | $2,200.61 | $10.38 – $1,100.31 | 7 |
| Drug admin & hemodynmic meas CPT 93463 | $176.93 | $696.00 | $5,825.00 – $5,825.00 | 1 |
| Drug assay caffeine CPT 80155 | $46.78 | $184.00 | $13.87 – $39.73 | 6 |
| Drug of abuse screen urine CPT 80305 | $144.64 | $569.00 | $9.50 – $33.96 | 9 |
| Drug screen quant tiagabine CPT 80199 | $59.49 | $234.00 | $17.71 – $28.47 | 6 |
| Drug test def 15-21 classes HCPCS G0482 | $144.14 | $567.00 | $115.10 – $208.68 | 6 |
| Drug test def 1-7 classes HCPCS G0480 | $263.86 | $1,038.00 | $33.00 – $61.80 | 6 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $209.47 | $824.00 | $21.45 – $181.17 | 9 |
| Drvvt confirm - quest CPT 85597 | $21.36 | $84.00 | $13.56 – $58.27 | 9 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | not published | not published | $373.34 – $373.34 | 1 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | not published | not published | $373.34 – $373.34 | 1 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | not published | not published | $744.59 – $744.59 | 1 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | not published | not published | $744.59 – $744.59 | 1 |
| Ductogram sgl duct CPT 77053 | $228.02 | $897.00 | $86.44 – $517.79 | 5 |
| Duplex scan bilateral study 93985 CPT 93985 | $162.69 | $640.00 | $221.67 – $224.00 | 2 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $115.67 | $455.00 | $101.45 – $478.00 | 5 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $251.66 | $990.00 | $74.91 – $573.72 | 8 |
| Dxa bone density axl vrt fx CPT 77085 | $82.87 | $326.00 | $82.76 – $245.18 | 8 |
| Dx bronchoscope/wash 31622 CPT 31622 | $698.55 | $2,748.00 | not published | 0 |
| Dx gastr intub w/asp specs CPT 43755 | $109.57 | $431.00 | not published | 0 |
| Dx laryngoscopy newborn CPT 31520 | not published | not published | $265.78 – $265.78 | 1 |
| Dynamic cavernosometry CPT 54231 | not published | not published | $820.52 – $820.52 | 1 |
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.