St Mary's Hospital
5801 Bremo Rd., Richmond, VA · Bonsecours · · NPI 1962464016
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 |
|---|---|---|---|---|
| Afo, walk boot type, cus fab HCPCS L4631 | $7,483.59 | $12,472.65 | not published | 0 |
| Afo w/ankle joint, prefab HCPCS L1971 | $3,012.77 | $5,021.28 | not published | 0 |
| Ak/knee disartic pelvic band HCPCS L5697 | $369.85 | $616.41 | not published | 0 |
| Ak/knee disartic silesian ba HCPCS L5698 | $459.97 | $766.62 | not published | 0 |
| Ak sleeve susp neoprene/equa HCPCS L5695 | $833.27 | $1,388.78 | not published | 0 |
| Albumin body fluid quantitative each specimen CPT 82042 | $78.60 | $131.00 | not published | 0 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $416.16 | $693.60 | not published | 0 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | $415.71 | $692.85 | not published | 0 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $118.20 | $197.00 | not published | 0 |
| Albumin serum plasma or whole blood CPT 82040 | $110.40 | $184.00 | not published | 0 |
| Albuterol ipratrop non-comp HCPCS J7620 | $6.00 | $10.00 | not published | 0 |
| Albuterol non-comp con HCPCS J7611 | $90.14 | $150.24 | not published | 0 |
| Albuterol non-comp unit HCPCS J7613 | $6.00 | $10.00 | not published | 0 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $67.20 | $112.00 | not published | 0 |
| Alcohol/subs interv 15-30mn HCPCS G0396 | $61.80 | $103.00 | not published | 0 |
| Alkaline phosphatase CPT 84075 | $37.20 | $62.00 | not published | 0 |
| Allergen alpha lactalbumin ige CPT 86008 | $45.60 | $76.00 | not published | 0 |
| Allergen egg white ige CPT 86003 | $45.00 | $75.00 | not published | 0 |
| Allograft 160mg placental salera mini membrane HCPCS Q4168 | $13,177.20 | $21,962.00 | not published | 0 |
| Allograft allowrap 4x4cm dry 16sqcm HCPCS Q4150 | $25,985.12 | $43,308.54 | not published | 0 |
| Allograft amnioexcel plus 17mm disk HCPCS Q4137 | $32,606.57 | $54,344.28 | not published | 0 |
| Allograft dermis 20x25x1mm decell w/matracell arthroflex HCPCS Q4125 | $20,278.65 | $33,797.75 | not published | 0 |
| Allograft ecm allopatch hd dehydr thick 0.8-1.7mmx2x5cm-cost per sq cm HCPCS Q4128 | $92,055.13 | $153,425.21 | not published | 0 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $61,800.97 | $103,001.62 | not published | 0 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $52,299.77 | $87,166.28 | not published | 0 |
| Allograft membrn amnio 1x2cm hu ambriodry HCPCS V2790 | $49,381.15 | $82,301.92 | not published | 0 |
| Allograft umbil cord+amniotic membrane-q4148-cost per sq cm HCPCS Q4148 | $16,188.40 | $26,980.66 | not published | 0 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $18,489.82 | $30,816.36 | not published | 0 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | $3,081.00 | $5,135.00 | not published | 0 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | $399.00 | $665.00 | not published | 0 |
| Alpha-fetoprotein tumor marker CPT 82105 | $181.80 | $303.00 | not published | 0 |
| Alprostadil for injection HCPCS J0270 | $1,513.90 | $2,523.17 | not published | 0 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $78,675.22 | $131,125.37 | not published | 0 |
| Alt/sgpt CPT 84460 | $54.00 | $90.00 | not published | 0 |
| Aluminum - quest CPT 82108 | $95.40 | $159.00 | not published | 0 |
| Amantadine (symmetrel)-sendout CPT 80375 | $105.60 | $176.00 | not published | 0 |
| Amikacin 4 mg/ml intravitreal injection - cnr HCPCS J0278 | $71.52 | $119.20 | not published | 0 |
| Aminocaproic acid 5 g/250 ml 0.9% nacl IV - cnr HCPCS J0281 | $65.09 | $108.48 | not published | 0 |
| Aminolevulinic acid delta CPT 82135 | $95.40 | $159.00 | not published | 0 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | $178.72 | $297.86 | not published | 0 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $45.00 | $75.00 | not published | 0 |
| Ammonia CPT 82140 | $178.80 | $298.00 | not published | 0 |
| Amniocentesisdiagnostic 59000 CPT 59000 | $3,607.80 | $6,013.00 | not published | 0 |
| Amp f/th 1/2 jt/phalanx w/neurect local flap CPT 26952 | $2,481.60 | $4,136.00 | not published | 0 |
| Amphetamine confirm urine -sendout CPT 80324 | $124.20 | $207.00 | not published | 0 |
| Amphotericin b in d5w IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J0285 | $429.12 | $715.20 | not published | 0 |
| Amphotericin b liposomal in d5w IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J0289 | $1,459.12 | $2,431.86 | not published | 0 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $61.69 | $102.81 | not published | 0 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $130.17 | $216.95 | not published | 0 |
| Amputation thru metatarsal CPT 28805 | $62,168.98 | $103,614.97 | $3,282.70 – $3,348.35 | 3 |
| Amputation toe interphalangeal joint CPT 28825 | $10,851.75 | $18,086.25 | $3,282.70 – $3,348.35 | 3 |
| Amputation toe metatarsophalangeal joint CPT 28820 | $10,457.45 | $17,429.08 | $3,282.70 – $3,348.35 | 3 |
| Amylase CPT 82150 | $148.20 | $247.00 | not published | 0 |
| Analysis complx cranial nerve pulse gen prgrmg 95977 CPT 95977 | $181.80 | $303.00 | not published | 0 |
| Analysis gene f2 20210g>a variant CPT 81240 | $683.40 | $1,139.00 | not published | 0 |
| Analysis gene f5 leiden variant CPT 81241 | $775.20 | $1,292.00 | not published | 0 |
| Analysis; simple cranial nerv pulse gen prgrmg 95976 CPT 95976 | $74.40 | $124.00 | not published | 0 |
| Anaplsma phgcytophlm amp prb CPT 87468 | $115.80 | $193.00 | not published | 0 |
| Anca screen with reflex to titer -quest CPT 86021 | $92.40 | $154.00 | not published | 0 |
| An cholangiogram percutaneous compl CPT 47531 | $7,291.80 | $12,153.00 | not published | 0 |
| An fluoro guide for cvp CPT 77001 | $755.40 | $1,259.00 | not published | 0 |
| Angio balloon ctrl dialysis seg add-on CPT 36907 | $18,562.21 | $30,937.02 | $5,582.68 – $5,694.33 | 3 |
| Angiotensin ii 0.5 mg/ml soln 1 ml vial HCPCS J3490 | $1,676.43 | $2,794.05 | not published | 0 |
| Angio trnslmnl balloon same artery ini CPT 37246 | $12,111.00 | $20,185.00 | not published | 0 |
| Angio trnslmnl balloon same vein ini CPT 37248 | $82,239.20 | $137,065.33 | $5,710.17 – $5,824.38 | 3 |
| Anidulafungin injection HCPCS J0348 | $1,706.56 | $2,844.27 | not published | 0 |
| Ankle arthroscopy/surgery CPT 29891 | $15,664.03 | $26,106.72 | $3,282.70 – $3,282.70 | 1 |
| Ankle arthroscopy/surgery CPT 29894 | $21,816.92 | $36,361.53 | $7,279.94 – $7,425.54 | 3 |
| Ankle arthroscopy/surgery CPT 29895 | $16,087.63 | $26,812.72 | $3,282.70 – $3,348.35 | 2 |
| Ankle arthroscopy/surgery CPT 29897 | $32,462.99 | $54,104.98 | $3,282.70 – $3,348.35 | 3 |
| Ankle arthroscopy/surgery CPT 29898 | $81,817.10 | $136,361.83 | $7,279.94 – $7,425.54 | 3 |
| Ankle X-ray CPT 73610 | $569.40 | $949.00 | not published | 0 |
| Annual Physical, Established Patient (age 18-39) CPT 99395 | $213.60 | $356.00 | not published | 0 |
| Annual Physical, Established Patient (age 40-64) CPT 99396 | $213.60 | $356.00 | not published | 0 |
| Annual Physical, New Patient (age 18-39) CPT 99385 | $213.60 | $356.00 | not published | 0 |
| Annual Physical, New Patient (age 40-64) CPT 99386 | $224.40 | $374.00 | not published | 0 |
| Anoscopy and biopsy CPT 46606 | $9,787.65 | $16,312.75 | $1,200.55 – $1,224.56 | 3 |
| Ant colporrhaphy/rpr cyctocele 57240 CPT 57240 | $25,941.55 | $43,235.92 | $5,018.81 – $5,119.18 | 3 |
| Anterior asis pad HCPCS L1250 | $372.98 | $621.64 | not published | 0 |
| Anterior swing band HCPCS L2335 | $1,325.72 | $2,209.54 | not published | 0 |
| Anterior thoracic derotation HCPCS L1260 | $444.80 | $741.34 | not published | 0 |
| Anterior thoracic extension HCPCS L1220 | $1,027.22 | $1,712.03 | not published | 0 |
| Antibody elution rbc reference CPT 86860 | $154.80 | $258.00 | not published | 0 |
| Antibody htlv-i CPT 86687 | $52.20 | $87.00 | not published | 0 |
| Antibody htlv-ii CPT 86688 | $86.40 | $144.00 | not published | 0 |
| Antibody identification platelet antibodies heparin-pf4 igg CPT 86022 | $99.60 | $166.00 | not published | 0 |
| Antibody id rbc panel CPT 86870 | $675.60 | $1,126.00 | not published | 0 |
| Antibody screen rbc CPT 86850 | $124.80 | $208.00 | not published | 0 |
| Antihemophilic factor-vwf 250 unit-600 unit intravenous solution HCPCS J7187 | $18,770.40 | $31,284.00 | not published | 0 |
| Anti-inhibitor HCPCS J7198 | $31,995.00 | $53,325.00 | not published | 0 |
| Anti mog serum - sendout CPT 86362 | $495.00 | $825.00 | not published | 0 |
| Antineutrophil cytoplasmic antibody titer each antibody CPT 86037 | $42.00 | $70.00 | not published | 0 |
| Ant instr 2-3 vert segm 22845 CPT 22845 | $67,866.08 | $113,110.13 | $12,880.66 – $13,138.27 | 3 |
| Ant instrumentation/4-7 vert seg 22846 CPT 22846 | $79,951.28 | $133,252.13 | $12,880.66 – $13,138.27 | 3 |
| Antinuclear antibodies CPT 86038 | $145.20 | $242.00 | not published | 0 |
| Antiphosphatidylserine antibody CPT 86148 | $50.40 | $84.00 | not published | 0 |
| Antistreptolysin o titer CPT 86060 | $130.20 | $217.00 | not published | 0 |
| Antithrombin iii activity CPT 85300 | $77.40 | $129.00 | not published | 0 |
| Antithrombin iii injection HCPCS J7197 | $10,570.20 | $17,617.00 | not published | 0 |
| Apheresis plasma CPT 36514 | $3,548.40 | $5,914.00 | not published | 0 |
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.