HSHS St. Anthony's Memorial Hospital
101 Coles Centre Dr., Mattoon, IL · Hshs · · NPI 1306800602
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 |
|---|---|---|---|---|
| Lap insert tunnel ip cath CPT 49324 | not published | not published | not published | 0 |
| Lap revision perm ip cath CPT 49325 | not published | not published | not published | 0 |
| Lap sleeve gastrectomy CPT 43775 | not published | not published | not published | 0 |
| Largsc w/rmvl foreign bdy(s) CPT 31577 | $940.32 | $1,306.00 | $448.89 – $1,306.00 | 14 |
| Laryngoscopy w/bx & op scope CPT 31536 | not published | not published | not published | 0 |
| Lb with mastopexy 15839 CPT 15839 | not published | not published | not published | 0 |
| Lead acuity x4 spiral l 86cm HCPCS C1900 | $3,672.00 | $5,100.00 | $2,700.00 – $2,700.00 | 1 |
| Lead capillary CPT 83655 | $94.32 | $131.00 | $9.08 – $131.00 | 14 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $1,944.00 | $2,700.00 | $1,200.00 – $1,200.00 | 1 |
| Left compres band <3"/yd HCPCS A6448 | $82.08 | $114.00 | $114.00 – $114.00 | 1 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $1,296.72 | $1,801.00 | $153.26 – $1,801.00 | 14 |
| Lens, intraocular (new tech) HCPCS C1780 | $2,376.00 | $3,300.00 | $450.00 – $450.00 | 1 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $730.80 | $1,015.00 | $0.01 – $0.01 | 1 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $324.00 | $450.00 | $375.00 – $375.00 | 1 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $2.22 | $3.09 | $0.07 – $0.88 | 3 |
| Levetiracetam therapeutic drug level CPT 80177 | $120.24 | $167.00 | $8.95 – $167.00 | 14 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $35.28 | $49.00 | $3.56 – $30.33 | 3 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $111.75 | $155.21 | $9.87 – $138.92 | 3 |
| Liberta rc ipg HCPCS C1820 | $26,820.00 | $37,250.00 | $37,250.00 – $37,250.00 | 1 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $2.59 | $3.60 | $0.08 – $0.16 | 3 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $0.04 | $0.06 | $0.02 – $0.06 | 3 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | not published | not published | not published | 0 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $229.32 | $318.50 | $4.52 – $68.60 | 3 |
| Lipase CPT 83690 | $94.32 | $131.00 | $3.99 – $131.00 | 14 |
| Lip exc/transverse wedge/w closure 40510 CPT 40510 | not published | not published | not published | 0 |
| Lipoprotein blood high res frac & quant CPT 83701 | $126.00 | $175.00 | $20.78 – $175.00 | 14 |
| Lipoprotein blood quant CPT 83704 | $61.20 | $85.00 | $20.78 – $85.00 | 14 |
| Lipoprotein direct measurement hdl CPT 83718 | $131.76 | $183.00 | $3.99 – $183.00 | 14 |
| Lipoprotein direct measurement ldl CPT 83721 | $110.16 | $153.00 | $3.99 – $153.00 | 14 |
| Lithium therapeutic drug level CPT 80178 | $87.12 | $121.00 | $6.61 – $121.00 | 14 |
| Liver Function Test CPT 80076 | $167.76 | $233.00 | $6.67 – $233.00 | 14 |
| Liver/spleen imag static only CPT 78215 | $901.44 | $1,252.00 | $458.82 – $1,252.00 | 14 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | not published | 0 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $20.12 | $27.95 | $2.33 – $20.85 | 3 |
| Low cost skin substitute app HCPCS C5271 | $1,595.52 | $2,216.00 | $1,767.04 – $2,216.00 | 3 |
| Low cost skin substitute app HCPCS C5273 | $5,344.56 | $7,423.00 | $1,767.04 – $7,423.00 | 3 |
| Low cost skin substitute app HCPCS C5275 | $1,595.52 | $2,216.00 | $1,767.04 – $2,216.00 | 3 |
| Low cost skin substitute app HCPCS C5277 | $1,595.52 | $2,216.00 | $1,767.04 – $2,216.00 | 3 |
| Low cost skin substitute app HCPCS C5272 | $544.32 | $756.00 | $756.00 – $756.00 | 3 |
| Low cost skin substitute app HCPCS C5274 | $3,416.40 | $4,745.00 | $1,767.04 – $4,745.00 | 3 |
| Low cost skin substitute app HCPCS C5276 | $544.32 | $756.00 | $756.00 – $756.00 | 3 |
| Low cost skin substitute app HCPCS C5278 | $1,019.52 | $1,416.00 | $1,416.00 – $1,416.00 | 3 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $4,466.88 | $6,204.00 | $201.31 – $6,204.00 | 15 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $3,897.36 | $5,413.00 | $276.64 – $5,413.00 | 15 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $2,952.00 | $4,100.00 | $97.12 – $4,100.00 | 15 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $5,198.40 | $7,220.00 | $370.49 – $7,220.00 | 15 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $4,050.00 | $5,625.00 | $370.49 – $5,625.00 | 15 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $3,633.12 | $5,046.00 | $102.28 – $5,046.00 | 15 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $635.76 | $883.00 | $44.81 – $883.00 | 14 |
| Lumbar diskogram s&i CPT 72295 | $2,998.08 | $4,164.00 | $508.85 – $4,856.87 | 14 |
| Lung Function Test (Spirometry) CPT 94010 | $166.32 | $231.00 | $52.41 – $537.05 | 14 |
| Lung perfusion imaging CPT 78580 | $886.32 | $1,231.00 | $458.82 – $1,231.00 | 14 |
| Lymphatics/lymph node imaging CPT 78195 | $1,761.12 | $2,446.00 | $623.17 – $2,446.00 | 14 |
| Lymphocyte transformation mitogen CPT 86353 | $372.96 | $518.00 | $30.13 – $518.00 | 14 |
| Macro exam dissect molec study ea CPT 88387 | $169.20 | $235.00 | $29.34 – $235.00 | 3 |
| Macroscopic exam arthropod CPT 87168 | $55.44 | $77.00 | $4.27 – $77.00 | 14 |
| Macroscopic exam parasite CPT 87169 | $19.44 | $27.00 | $4.31 – $27.00 | 14 |
| Magnesium CPT 83735 | $72.00 | $100.00 | $3.99 – $100.00 | 14 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $43.67 | $60.65 | $0.68 – $2.28 | 3 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $131.04 | $182.00 | $52.41 – $330.92 | 14 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $150.48 | $209.00 | $52.41 – $330.92 | 14 |
| Mapping io sentinel lymph node CPT 38900 | not published | not published | not published | 0 |
| Marker biop eviva buckle ss HCPCS A4648 | $71.28 | $99.00 | $99.00 – $99.00 | 1 |
| Mastectomy form HCPCS L8020 | $221.04 | $307.00 | $284.12 – $659.44 | 13 |
| Mastectomy partial CPT 19301 | not published | not published | not published | 0 |
| Mast mod rad CPT 19307 | not published | not published | not published | 0 |
| Mast simple complete CPT 19303 | not published | not published | not published | 0 |
| Matrion 1 sq cm HCPCS Q4201 | not published | not published | not published | 0 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $97.92 | $136.00 | $8.82 – $136.00 | 14 |
| Mayo aathr protein s free CPT 85306 | $79.20 | $110.00 | $3.27 – $110.00 | 14 |
| Mayo activated protein c resistance assay CPT 85307 | $69.12 | $96.00 | $4.38 – $96.00 | 14 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $279.36 | $388.00 | $8.95 – $388.00 | 14 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $126.00 | $175.00 | $10.33 – $175.00 | 3 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $127.44 | $177.00 | $10.33 – $177.00 | 3 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $101.52 | $141.00 | $8.82 – $141.00 | 14 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $64.08 | $89.00 | $10.33 – $89.00 | 3 |
| Mayo alpha 1 antitrypsin CPT 82103 | $160.56 | $223.00 | $8.82 – $223.00 | 14 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $102.96 | $143.00 | $8.95 – $143.00 | 14 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $349.20 | $485.00 | $10.33 – $485.00 | 3 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $574.56 | $798.00 | $34.38 – $798.00 | 14 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $932.40 | $1,295.00 | $34.38 – $1,295.00 | 14 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | $892.08 | $1,239.00 | $121.56 – $1,239.00 | 14 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $3,481.92 | $4,836.00 | $1,160.00 – $4,836.00 | 14 |
| Mayo androstenedione CPT 82157 | $200.16 | $278.00 | $9.74 – $278.00 | 14 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $146.88 | $204.00 | $8.82 – $204.00 | 14 |
| Mayo antithrombin iii antigen CPT 85301 | $48.96 | $68.00 | $3.27 – $68.00 | 14 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $101.52 | $141.00 | $8.50 – $141.00 | 14 |
| Mayo avwpr vw factor activity CPT 85397 | $310.32 | $431.00 | $18.69 – $431.00 | 14 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | $215.28 | $299.00 | $31.63 – $299.00 | 14 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $174.24 | $242.00 | $10.33 – $242.00 | 3 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $68.40 | $95.00 | $8.50 – $95.00 | 14 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $433.44 | $602.00 | $121.56 – $602.00 | 14 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | $531.36 | $738.00 | $121.56 – $738.00 | 14 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $70.56 | $98.00 | $8.50 – $98.00 | 14 |
| Mayo bnzu sedative hypnotics definitive urine CPT 80368 | $51.84 | $72.00 | $10.33 – $72.00 | 3 |
| Mayo bordetella pertussis antibody igg CPT 86615 | $113.76 | $158.00 | $8.50 – $158.00 | 14 |
| Mayo brcmg brucella antibody igm CPT 86622 | $74.88 | $104.00 | $8.50 – $104.00 | 14 |
| Mayo c1 esterase inhibitor CPT 83883 | $155.52 | $216.00 | $8.50 – $216.00 | 14 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $35.28 | $49.00 | $10.33 – $47.00 | 3 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $331.92 | $461.00 | $8.82 – $461.00 | 14 |
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.