SSM Health St. Mary's Hospital - Centralia
400 North Pleasant Avenue, Centralia, IL · SSM Health · · NPI 1083617245
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 |
|---|---|---|---|---|
| X-ray exam of eye sockets CPT 70200 | $504.90 | $918.00 | $112.03 – $117.63 | 3 |
| X-ray exam of femur 1 CPT 73551 | $105.05 | $191.00 | $93.26 – $97.92 | 3 |
| X-ray exam of jaw joint CPT 70328 | $218.90 | $398.00 | $93.26 – $97.92 | 3 |
| X-ray exam of jaw joint CPT 70332 | not published | not published | $255.69 – $268.47 | 3 |
| X-ray exam of mastoids CPT 70120 | not published | not published | $112.03 – $117.63 | 3 |
| X-ray exam of middle ear CPT 70134 | not published | not published | $585.55 – $614.83 | 3 |
| X-ray exam of penis CPT 74445 | not published | not published | $112.03 – $117.63 | 3 |
| X-ray exam of perineum CPT 74775 | not published | not published | $255.69 – $268.47 | 3 |
| X-ray exam of salivary gland CPT 70380 | not published | not published | $93.26 – $97.92 | 3 |
| X-ray exam of sinuses CPT 70210 | $108.35 | $197.00 | $93.26 – $97.92 | 3 |
| X-ray exam of tear duct CPT 70170 | not published | not published | $255.69 – $268.47 | 3 |
| X-ray exam of teeth CPT 70300 | not published | not published | $93.26 – $97.92 | 3 |
| X-ray exam of teeth CPT 70310 | not published | not published | $255.69 – $268.47 | 3 |
| X-ray exam si joints CPT 72200 | $422.95 | $769.00 | $112.03 – $117.63 | 3 |
| X-ray exam thorac spine4/>vw CPT 72074 | $613.25 | $1,115.00 | $112.03 – $117.63 | 3 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $264.00 | $480.00 | $93.26 – $97.92 | 3 |
| X-ray facial bones complete > 3 views CPT 70150 | $633.60 | $1,152.00 | $112.03 – $117.63 | 3 |
| X-ray femur >=2 views (both sides) CPT 73552 | $285.45 | $519.00 | $93.26 – $97.92 | 3 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $400.95 | $729.00 | $93.26 – $97.92 | 3 |
| X-ray foot 2 views (both sides) CPT 73620 | $332.20 | $604.00 | $93.26 – $97.92 | 3 |
| X-ray forearm 2 views (both sides) CPT 73090 | $360.80 | $656.00 | $93.26 – $97.92 | 3 |
| X-ray hand 2 views (both sides) CPT 73120 | $325.60 | $592.00 | $112.03 – $117.63 | 3 |
| X-ray head for orthodontia CPT 70350 | not published | not published | $93.26 – $97.92 | 3 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | $322.85 | $587.00 | $93.26 – $97.92 | 3 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $548.35 | $997.00 | $112.03 – $117.63 | 3 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $336.60 | $612.00 | $112.03 – $117.63 | 3 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | $424.05 | $771.00 | $112.03 – $117.63 | 3 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $655.05 | $1,191.00 | $112.03 – $117.63 | 3 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $285.45 | $519.00 | $93.26 – $97.92 | 3 |
| X-ray humerus >= 2 views left CPT 73060 | $410.30 | $746.00 | $93.26 – $97.92 | 3 |
| X-ray joint survey 1 view CPT 77077 | $184.80 | $336.00 | $112.03 – $117.63 | 3 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $377.30 | $686.00 | $93.26 – $97.92 | 3 |
| X-ray knee 3 views (both sides) CPT 73562 | $487.85 | $887.00 | $93.26 – $97.92 | 3 |
| X-ray knee ap standing bilateral CPT 73565 | $512.60 | $932.00 | $93.26 – $97.92 | 3 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $326.15 | $593.00 | $93.26 – $97.92 | 3 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $355.85 | $647.00 | $112.03 – $117.63 | 3 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $846.45 | $1,539.00 | $112.03 – $117.63 | 3 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $882.20 | $1,604.00 | $112.03 – $117.63 | 3 |
| X-ray male genital tract CPT 74440 | not published | not published | $255.69 – $268.47 | 3 |
| X-ray mandible complete > 4 views CPT 70110 | $532.95 | $969.00 | $112.03 – $117.63 | 3 |
| X-ray mandible ltd <4 views CPT 70100 | $427.35 | $777.00 | $93.26 – $97.92 | 3 |
| X-ray nasal bones complete > 3 views CPT 70160 | $493.35 | $897.00 | $93.26 – $97.92 | 3 |
| X-ray neck soft tissue CPT 70360 | $373.45 | $679.00 | $93.26 – $97.92 | 3 |
| X-ray nose to rectum for foreign body child CPT 76010 | $354.20 | $644.00 | $93.26 – $97.92 | 3 |
| X-ray of mammary ducts CPT 77054 | $925.10 | $1,682.00 | $255.69 – $268.47 | 3 |
| X-ray optic foramina CPT 70190 | $99.55 | $181.00 | $93.26 – $97.92 | 3 |
| X-ray pelvis 1-2 views CPT 72170 | $349.25 | $635.00 | $112.03 – $117.63 | 3 |
| X-ray pelvis complete > 3 views CPT 72190 | $379.50 | $690.00 | $112.03 – $117.63 | 3 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $955.90 | $1,738.00 | $373.86 – $392.55 | 3 |
| X-ray ribs 2 views left CPT 71100 | $460.35 | $837.00 | $93.26 – $97.92 | 3 |
| X-ray ribs 3 views bilateral CPT 71110 | $397.10 | $722.00 | $112.03 – $117.63 | 3 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $460.35 | $837.00 | $112.03 – $117.63 | 3 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $775.50 | $1,410.00 | $112.03 – $117.63 | 3 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $461.45 | $839.00 | $112.03 – $117.63 | 3 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $440.55 | $801.00 | $93.26 – $97.92 | 3 |
| X-ray scapula complete (both sides) CPT 73010 | $315.15 | $573.00 | $112.03 – $117.63 | 3 |
| X-ray sella turcica CPT 70240 | $99.55 | $181.00 | $93.26 – $97.92 | 3 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $279.40 | $508.00 | $93.26 – $97.92 | 3 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $432.85 | $787.00 | $93.26 – $97.92 | 3 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $998.80 | $1,816.00 | $585.55 – $614.83 | 3 |
| X-ray skull < 4 views CPT 70250 | $493.35 | $897.00 | $112.03 – $117.63 | 3 |
| X-ray skull > 4 views complete CPT 70260 | $585.75 | $1,065.00 | $112.03 – $117.63 | 3 |
| X-ray slg plne bdy sect without urogr CPT 76100 | $906.95 | $1,649.00 | $112.03 – $117.63 | 3 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $1,031.80 | $1,876.00 | $187.96 – $197.36 | 3 |
| X-ray small intestine follow-through study CPT 74248 | $935.00 | $1,700.00 | not published | 0 |
| X-ray spine single view CPT 72020 | $401.50 | $730.00 | $93.26 – $97.92 | 3 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $444.95 | $809.00 | $93.26 – $97.92 | 3 |
| X-ray sternum > 2 views CPT 71120 | $343.20 | $624.00 | $93.26 – $97.92 | 3 |
| X-ray surgical specimen CPT 76098 | $706.75 | $1,285.00 | $585.55 – $614.83 | 3 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $670.45 | $1,219.00 | $187.96 – $197.36 | 3 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $435.60 | $792.00 | $93.26 – $97.92 | 3 |
| X-ray thoracic spine 2 views CPT 72070 | $427.90 | $778.00 | $112.03 – $117.63 | 3 |
| X-ray thoracic spine 3 views CPT 72072 | $583.55 | $1,061.00 | $112.03 – $117.63 | 3 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | $130.90 | $238.00 | $93.26 – $97.92 | 3 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $606.10 | $1,102.00 | $93.26 – $97.92 | 3 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $785.40 | $1,428.00 | $112.03 – $117.63 | 3 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $453.20 | $824.00 | $93.26 – $97.92 | 3 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $366.30 | $666.00 | $93.26 – $97.92 | 3 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $838.20 | $1,524.00 | $187.96 – $197.36 | 3 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $838.20 | $1,524.00 | $187.96 – $197.36 | 3 |
| X-ray wrist 2 views (both sides) CPT 73100 | $350.35 | $637.00 | $93.26 – $97.92 | 3 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | $180.40 | $328.00 | $187.96 – $197.36 | 3 |
| Xylose absorption test blood &/or urine CPT 84620 | $135.30 | $246.00 | $12.91 – $13.56 | 3 |
| Yersinia antibody CPT 86793 | $95.70 | $174.00 | $13.19 – $13.85 | 3 |
| Zika virus dna/rna amp probe CPT 87662 | $95.70 | $174.00 | $51.31 – $53.88 | 3 |
| Zika virus igm antibody CPT 86794 | not published | not published | $16.85 – $17.69 | 3 |
| Zrsr2 gene common variants CPT 81360 | not published | not published | $193.25 – $202.91 | 3 |
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.