Springfield Memorial Hospital — price list
← Hospital overviewVerified from Springfield Memorial 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.
157 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| 00187-4303-05 - amobarbital 0.5 gm Inj Inpatient | J0300 HCPCS | $3,332 | $3,332 | $1,333 – $3,332 | — | |
| 00187-4303-05 - amobarbital 0.5 gm Inj Outpatient | J0300 HCPCS | $3,332 | $3,332 | $750 – $3,332 | — | |
| 13533-0800-20 - immune globulin intravenous and su Inpatient | J1561 HCPCS | $3,839 | $3,839 | $1,535 – $3,839 | — | |
| 13533-0800-20 - immune globulin intravenous and su Outpatient | J1561 HCPCS | $3,839 | $3,839 | $864 – $3,839 | — | |
| 55566-2300-00 - desmopressin 4 mcg/mL Inj Inpatient | J2597 HCPCS | $195 | $195 | $78.05 – $195 | — | |
| 55566-2300-00 - desmopressin 4 mcg/mL Inj Outpatient | J2597 HCPCS | $195 | $195 | $43.90 – $195 | — | |
| 61364-0181-03 - peramivir 10 mg/mL 20mL vial Inpatient | J2547 HCPCS | $1,267 | $1,267 | $507 – $1,267 | — | |
| 61364-0181-03 - peramivir 10 mg/mL 20mL vial Outpatient | J2547 HCPCS | $1,267 | $1,267 | $285 – $1,267 | — | |
| 63323-0593-03 - glucagon 1 mg Inj Inpatient | J1611 HCPCS | $451 | $451 | $180 – $451 | — | |
| 63323-0593-03 - glucagon 1 mg Inj Outpatient | J1611 HCPCS | $451 | $451 | $101 – $451 | — | |
| 66220-0160-10 - conivaptan 20 mg/100 mL-D5 Sol Inpatient | C9488 HCPCS | $4,051 | $4,051 | $1,620 – $4,051 | — | |
| 66220-0160-10 - conivaptan 20 mg/100 mL-D5 Sol Outpatient | C9488 HCPCS | $4,051 | $4,051 | $911 – $4,051 | — | |
| 67919-0030-01 - ceftolozane-tazobactam 1 g-0.5 g P Inpatient | J0695 HCPCS | $638 | $638 | $255 – $638 | — | |
| 67919-0030-01 - ceftolozane-tazobactam 1 g-0.5 g P Outpatient | J0695 HCPCS | $638 | $638 | $143 – $638 | — | |
| BASEPLATE HA ADAPTER 25MM Inpatient | C1776 HCPCS | $12,938 | $12,938 | $4,438 – $12,938 | — | |
| BASEPLATE HA ADAPTER 25MM Outpatient | C1776 HCPCS | $12,938 | $12,938 | $2,911 – $12,938 | — | |
| BEARING HUMRL XL 44-36 STD Inpatient | C1776 HCPCS | $6,300 | $6,300 | $2,161 – $6,300 | — | |
| BEARING HUMRL XL 44-36 STD Outpatient | C1776 HCPCS | $6,300 | $6,300 | $1,418 – $6,300 | — | |
| Bill Only Opiates Serum /Plasma Inpatient | 80361 CPT | $246 | $246 | $98.40 – $246 | — | |
| Bill Only Opiates Serum /Plasma Outpatient | 80361 CPT | $246 | $246 | $78.72 – $246 | — | |
| BONE CORPECTOMY FIB 50MM Inpatient | C1713 HCPCS | $8,607 | $8,607 | $2,952 – $8,607 | — | |
| BONE CORPECTOMY FIB 50MM Outpatient | C1713 HCPCS | $8,607 | $8,607 | $1,937 – $8,607 | — | |
| FMS-Amniocentesis Dx Inpatient | 59000 CPT | $1,813 | $1,813 | $725 – $1,813 | — | |
| FMS-Amniocentesis Dx Outpatient | 59000 CPT | $1,813 | $1,813 | $294 – $6,866 | — | |
| FMS-EST PT Visit Only Lvl I Inpatient | 99211 CPT | $249 | $249 | $99.60 – $249 | — | |
| FMS-EST PT Visit Only Lvl I Outpatient | 99211 CPT | $249 | $249 | $56.02 – $249 | — | |
| FMS-EST PT Visit Only Lvl II Inpatient | 99212 CPT | $288 | $288 | $115 – $288 | — | |
| FMS-EST PT Visit Only Lvl II Outpatient | 99212 CPT | $288 | $288 | $64.80 – $288 | — | |
| FMS-EST PT Visit Only Lvl III Inpatient | 99213 CPT | $311 | $311 | $124 – $311 | — | |
| GLENOSPHERE STANDARD 36MM Inpatient | C1776 HCPCS | $9,000 | $9,000 | $3,087 – $9,000 | — |