Essentia Health St Marys Hospital-Superior
Essentia Health St Marys Hospital-Superior in Superior, WI publishes cash prices for 43 common procedures listed here, from its own machine-readable price file updated Jan 1, 2026. Click a procedure to compare it with other hospitals nearby.
Essentia Health St. Mary's Hospital -Superior, 3500 Tower Ave Superior, WI 54880 Collected Sep 23, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT ABDOMEN&PELVIS W/CONTRAST | $2,528.12 | $3,421.00 | 26% |
| CT scan of abdomen and pelvis, with contrast dye inpatient CPT 74177 CT ABDOMEN&PELVIS W/CONTRAST | $2,528.12 | $3,421.00 | 26% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT HEAD/BRAIN W/O DYE | $1,258.52 | $1,703.00 | 26% |
| CT scan of the head or brain, no contrast dye inpatient CPT 70450 CT HEAD/BRAIN W/O DYE | $1,258.52 | $1,703.00 | 26% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT PELVIS W/DYE | $1,469.87 | $1,989.00 | 26% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 CT PELVIS W/DYE | $1,469.87 | $1,989.00 | 26% |
| Diagnostic mammogram, both breasts both sides CPT 77066 DIGITAL MAMM, DIAG, BILAT, TC W/CAD PERF | $399.80 | $541.00 | 26% |
| Diagnostic mammogram, one breast one side CPT 77065 DIGITAL MAMM, DIAG, UNILAT, TC W/CAD PERF | $327.38 | $443.00 | 26% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI LOW EXT JNT WO/CONT TC | $2,103.93 | $2,847.00 | 26% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI,LWREXT,JNT W/O+W/CONT | $2,568.76 | $3,476.00 | 26% |
| MRI of knee or other lower-limb joint, without and then with contrast dye inpatient CPT 73723 MRI,LWREXT,JNT W/O+W/CONT | $2,568.76 | $3,476.00 | 26% |
| MRI of the brain, no contrast dye CPT 70551 MRI BRAIN WO CONTRAST TC | $2,169.70 | $2,936.00 | 26% |
| MRI of the brain, no contrast dye inpatient CPT 70551 MRI BRAIN WO CONTRAST TC | $2,169.70 | $2,936.00 | 26% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI BRAIN W & WO CONTRAST | $2,901.31 | $3,926.00 | 26% |
| MRI of the brain, with and without contrast dye inpatient CPT 70553 MRI BRAIN W & WO CONTRAST | $2,901.31 | $3,926.00 | 26% |
| MRI of the lower back, no contrast dye CPT 72148 MRI L SPINE WO CONTRAST | $2,092.85 | $2,832.00 | 26% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 MRI L SPINE WO CONTRAST | $2,092.85 | $2,832.00 | 26% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 US,PREG. UTERUS,FETAL/MAT.EVAL.,>1ST TRIM.(>/= 14 WKS 0 DYS),TRANSABD;SINGLE/FIRST GEST., TECH | $502.52 | $680.00 | 26% |
| Screening mammogram, both breasts CPT 77067 DIGITAL MAMMOGRAM, SCREEN BIL, TC W/CAD PERF | $337.72 | $457.00 | 26% |
| Sleep study in a lab (polysomnography) CPT 95810 POLYSOMNOGRAPHY, 4 OR MORE | $3,557.55 | $4,814.00 | 26% |
| Transvaginal pelvic ultrasound CPT 76830 US TRANSVAGINAL TC | $417.54 | $565.00 | 26% |
| Ultrasound of the abdomen, complete CPT 76700 US ABDOMEN TC | $611.15 | $827.00 | 26% |
| Ultrasound of the abdomen, complete inpatient CPT 76700 US ABDOMEN TC | $611.15 | $827.00 | 26% |
| X-ray of the lower back, 4 or more views CPT 72110 XRAY LUMBOSACRAL MINIMUM 4 VWS | $343.64 | $465.00 | 26% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 LAB BASIC METABOLIC PANEL | $173.66 | $235.00 | 26% |
| Basic metabolic panel (blood test) inpatient CPT 80048 LAB BASIC METABOLIC PANEL | $173.66 | $235.00 | 26% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 LIPID PROFILE | $108.63 | $147.00 | 26% |
| Cholesterol and triglycerides (lipid panel) blood test inpatient CPT 80061 LIPID PROFILE | $108.63 | $147.00 | 26% |
| Complete blood count (CBC) with differential CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $121.94 | $165.00 | 26% |
| Complete blood count (CBC) with differential inpatient CPT 85025 COMPLETE CBC W/AUTO DIFF WBC | $121.94 | $165.00 | 26% |
| Complete blood count (CBC), no differential CPT 85027 COMPLETE CBC AUTOMATED | $116.02 | $157.00 | 26% |
| Complete blood count (CBC), no differential inpatient CPT 85027 COMPLETE CBC AUTOMATED | $116.02 | $157.00 | 26% |
| Comprehensive metabolic panel (blood test) CPT 80053 COMPREHENSIVE METABOLIC PANEL | $218.00 | $295.00 | 26% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 COMPREHENSIVE METABOLIC PANEL | $218.00 | $295.00 | 26% |
| Kidney function blood test panel CPT 80069 RENAL FUNCTION PANEL | $220.22 | $298.00 | 26% |
| Kidney function blood test panel inpatient CPT 80069 RENAL FUNCTION PANEL | $220.22 | $298.00 | 26% |
| Liver function blood test panel CPT 80076 HEPATIC FUNCTION PANEL | $128.59 | $174.00 | 26% |
| Liver function blood test panel inpatient CPT 80076 HEPATIC FUNCTION PANEL | $128.59 | $174.00 | 26% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 LAB PSA SCREENING | $112.33 | $152.00 | 26% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 ASSAY OF PSA TOTAL | $119.72 | $162.00 | 26% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 LAB PSA SCREENING | $112.33 | $152.00 | 26% |
| PSA (prostate-specific antigen) blood test, total inpatient CPT 84153 ASSAY OF PSA TOTAL | $119.72 | $162.00 | 26% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 THROMBOPLASTIN TIME PARTIAL | $76.12 | $103.00 | 26% |
| Partial thromboplastin time (PTT) clotting test inpatient CPT 85730 THROMBOPLASTIN TIME PARTIAL | $76.12 | $103.00 | 26% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (PT/INR) QW | $48.04 | $65.00 | 26% |
| Prothrombin time (PT/INR) clotting test CPT 85610 PROTHROMBIN TIME (PT/INR) | $48.04 | $65.00 | 26% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (PT/INR) | $48.04 | $65.00 | 26% |
| Prothrombin time (PT/INR) clotting test inpatient CPT 85610 PROTHROMBIN TIME (PT/INR) QW | $48.04 | $65.00 | 26% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 ASSAY THYROID STIM HORMONE | $107.16 | $145.00 | 26% |
| Thyroid-stimulating hormone (TSH) blood test inpatient CPT 84443 ASSAY THYROID STIM HORMONE | $107.16 | $145.00 | 26% |
| Urinalysis with microscope exam, automated CPT 81001 URINALYSIS, AUTO, W/SCOPE | $56.90 | $77.00 | 26% |
| Urinalysis with microscope exam, automated inpatient CPT 81001 URINALYSIS, AUTO, W/SCOPE | $56.90 | $77.00 | 26% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS, AUTO W/O SCOPE QW | $36.21 | $49.00 | 26% |
| Urinalysis without microscope exam, automated CPT 81003 URINALYSIS, AUTO W/O SCOPE | $36.95 | $50.00 | 26% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 URINALYSIS, AUTO W/O SCOPE | $36.95 | $50.00 | 26% |
| Urinalysis without microscope exam, manual CPT 81002 URINALYSIS NONAUTO W/O SCOPE | $22.17 | $30.00 | 26% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 URINALYSIS NONAUTO W/O SCOPE | $22.17 | $30.00 | 26% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy with polyp removal CPT 45385 COLONOSCOPY,REMV LESN,SNARE | $2,469.00 | $3,341.00 | 26% |
| Colonoscopy with tissue sample CPT 45380 COLONOSCOPY,BIOPSY | $2,264.30 | $3,064.00 | 26% |
| Colonoscopy, diagnostic CPT 45378 COLONOSCOPY,FLEX,DIAGNOSTIC | $2,089.15 | $2,827.00 | 26% |
| Colonoscopy, diagnostic inpatient CPT 45378 COLONOSCOPY,FLEX,DIAGNOSTIC | $2,089.15 | $2,827.00 | 26% |
| Lower-back epidural injection, with imaging guidance CPT 62323 INJ LUMBAR/SACRAL WITH IMAGE GUIDANCE | $1,396.71 | $1,890.00 | 26% |
| Lower-back epidural injection, without imaging guidance CPT 62322 INJ LUMBAR/SACRAL W/O IMAGE GUIDANCE | $1,734.43 | $2,347.00 | 26% |
| Lower-back epidural injection, without imaging guidance inpatient CPT 62322 INJ LUMBAR/SACRAL W/O IMAGE GUIDANCE | $1,734.43 | $2,347.00 | 26% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 INJ,FORAMEN,L/S,1 LEVEL(T) | $1,701.92 | $2,303.00 | 26% |
| Upper endoscopy (EGD) with biopsy CPT 43239 UPPER GI ENDOSCOPY,BIOPSY | $2,287.20 | $3,095.00 | 26% |
| Upper endoscopy (EGD) with biopsy inpatient CPT 43239 UPPER GI ENDOSCOPY,BIOPSY | $2,287.20 | $3,095.00 | 26% |
| Upper endoscopy (EGD), diagnostic CPT 43235 UPPER GI ENDOSCOPY,DIAGNOSIS | $2,192.61 | $2,967.00 | 26% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| New patient office visit, about 30 minutes CPT 99203 OFFICE/OUTPT VISIT,NEW,LEVL III | $116.76 | $158.00 | 26% |
| New patient office visit, about 45 minutes CPT 99204 OFFICE/OUTPT VISIT,NEW,LEVL IV | $183.27 | $248.00 | 26% |
| New patient office visit, about 45 minutes inpatient CPT 99204 OFFICE/OUTPT VISIT,NEW,LEVL IV | $183.27 | $248.00 | 26% |
| New patient office visit, about 60 minutes CPT 99205 OFFICE/OUTPT VISIT,NEW,LEVL V | $242.39 | $328.00 | 26% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 THERAPEUTIC EXERCISES | $101.24 | $137.00 | 26% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 THERAPEUTIC EXERCISES | $101.24 | $137.00 | 26% |
| Specialist consultation, moderate complexity or 40+ minutes CPT 99244 OFFICE/OUTP CONSULT,LEVEL IV, MODERATE MDM >= 40 MINUTES | $189.18 | $256.00 | 26% |
Source file: https://www.essentiahealth.org/standard-charges/2026/411811073_Essentia-St-Marys-Superior_standardcharges.csv