OSF St Mary Medical Center
3333 North Seminary, Galesburg, IL · Osfhealthcare · · NPI 1164485363
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 |
|---|---|---|---|---|
| Drng ovary abscess perqt 58822 CPT 58822 | not published | not published | $6,223.00 – $6,675.00 | 2 |
| Drng peritoneal abscess open 49020 CPT 49020 | not published | not published | $5,543.00 – $5,672.00 | 2 |
| Drng salivary gland simple 42300 CPT 42300 | not published | not published | $1,662.71 – $5,339.00 | 5 |
| Drng salivary gland submax/subling 42310 CPT 42310 | not published | not published | $577.95 – $1,586.00 | 5 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | $58.20 | $97.00 | not published | 0 |
| Drug admin & hemodynmic meas CPT 93463 | not published | not published | $693.00 – $1,586.00 | 2 |
| Drug assay caffeine CPT 80155 | not published | not published | $38.57 – $39.34 | 3 |
| Drug assay posaconazole CPT 80187 | $161.40 | $269.00 | $27.11 – $27.65 | 3 |
| Drug assay rufinamide CPT 80210 | $107.40 | $179.00 | $27.11 – $27.65 | 3 |
| Drug assay vedolizumab CPT 80280 | $367.80 | $613.00 | $38.57 – $39.34 | 3 |
| Drug assay voriconazole CPT 80285 | $134.40 | $224.00 | $27.11 – $27.65 | 3 |
| Drug asy hydroxychloroquine CPT 80220 | not published | not published | $18.64 – $19.01 | 3 |
| Drug of abuse screen urine CPT 80305 | not published | not published | $12.60 – $12.85 | 3 |
| Drug screen quant tiagabine CPT 80199 | not published | not published | $27.11 – $27.65 | 3 |
| Drug test def 15-21 classes HCPCS G0482 | not published | not published | $198.74 – $202.71 | 3 |
| Drug test def 1-7 classes HCPCS G0480 | not published | not published | $114.43 – $116.72 | 3 |
| Drug test def 22+ classes HCPCS G0483 | not published | not published | $246.92 – $251.86 | 3 |
| Drug test def 8-14 classes HCPCS G0481 | not published | not published | $156.59 – $159.72 | 3 |
| Drug test def simple all cl HCPCS G0659 | not published | not published | $62.14 – $63.38 | 3 |
| Drug test prsmv instrmnt CPT 80306 | $334.20 | $557.00 | $17.14 – $17.48 | 3 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $714.60 | $1,191.00 | $62.14 – $63.38 | 3 |
| Drvvt confirm - quest CPT 85597 | $214.20 | $357.00 | $17.98 – $18.34 | 3 |
| Dstrj extensive retinopathy CPT 67227 | not published | not published | $4,212.96 – $6,675.00 | 5 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | $6,564.60 | $10,941.00 | $2,092.58 – $5,672.00 | 5 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | not published | not published | $435.63 – $1,586.00 | 5 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | not published | not published | $435.63 – $1,586.00 | 5 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | not published | not published | $693.00 – $1,586.00 | 5 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | not published | not published | $693.00 – $1,586.00 | 5 |
| Dstry eye lesn,fdr vssl tech HCPCS G0186 | not published | not published | $589.39 – $3,176.00 | 5 |
| Ductogram sgl duct CPT 77053 | $771.00 | $1,285.00 | $255.69 – $260.80 | 3 |
| Duodenal exclusion CPT 48547 | not published | not published | $5,543.00 – $5,672.00 | 2 |
| Duodenal motility study CPT 91022 | not published | not published | $399.88 – $1,586.00 | 5 |
| Duplex scan bilateral study 93985 CPT 93985 | $1,565.40 | $2,609.00 | $255.69 – $260.80 | 3 |
| Duplex scan unilateral study 93986 CPT 93986 | $1,042.20 | $1,737.00 | $112.03 – $114.27 | 3 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $472.80 | $788.00 | $112.03 – $114.27 | 3 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | $684.60 | $1,141.00 | $231.39 – $236.02 | 3 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $1,066.20 | $1,777.00 | $255.69 – $260.80 | 3 |
| Durvalumab 50 mg/ml intravenous solution HCPCS J9173 | not published | not published | $86.15 – $131.60 | 4 |
| Dxa bone density axl vrt fx CPT 77085 | $368.40 | $614.00 | $112.03 – $114.27 | 3 |
| Dx aly aud oi snd prcsr 1st CPT 92622 | not published | not published | $137.89 – $140.65 | 3 |
| Dx bronchoscope/brush 31623 CPT 31623 | not published | not published | $1,907.37 – $5,339.00 | 5 |
| Dx bronchoscope/lavage 31624 CPT 31624 | not published | not published | $1,907.37 – $5,339.00 | 5 |
| Dx bronchoscope/wash 31622 CPT 31622 | not published | not published | $1,907.37 – $5,339.00 | 5 |
| Dx duod intub w/asp spec 43756 CPT 43756 | not published | not published | $971.94 – $5,339.00 | 5 |
| Dx duod intub w/asp specs CPT 43757 | not published | not published | $971.94 – $5,339.00 | 5 |
| Dx gastr intub w/asp spec CPT 43754 | not published | not published | $231.39 – $1,586.00 | 5 |
| Dx gastr intub w/asp specs CPT 43755 | not published | not published | $137.89 – $1,586.00 | 5 |
| Dx laryngoscopy newborn CPT 31520 | not published | not published | $419.13 – $1,586.00 | 5 |
| Dx laryngoscopy w/oper scope CPT 31526 | not published | not published | $1,907.37 – $5,339.00 | 5 |
| Dynamic cavernosometry CPT 54231 | not published | not published | $267.74 – $5,339.00 | 5 |
| Dynamic surface emg CPT 96002 | not published | not published | $231.39 – $236.02 | 3 |
| Ear and throat examination CPT 92502 | not published | not published | $577.95 – $1,586.00 | 5 |
| Ear canal biopsy 69105 CPT 69105 | not published | not published | $1,662.71 – $5,339.00 | 5 |
| Ear cartilage graft CPT 21235 | not published | not published | $4,157.00 – $6,470.68 | 5 |
| Ear irrigation 69209 CPT 69209 | $280.20 | $467.00 | $63.22 – $1,586.00 | 5 |
| Ear protector evaluation CPT 92596 | not published | not published | $40.03 – $40.83 | 3 |
| Ecallantide injection HCPCS J1290 | not published | not published | $578.75 – $875.69 | 4 |
| Ecg 12 lead tracing only CPT 93005 | $252.00 | $420.00 | $63.22 – $64.48 | 3 |
| Ecg/1-3 leads/tracing only 93041 CPT 93041 | not published | not published | $63.22 – $64.48 | 3 |
| Ecg < 30 days transmission & analysis CPT 93271 | $541.20 | $902.00 | not published | 0 |
| Ecg external < 48 hours recording CPT 93225 | $541.20 | $902.00 | $142.58 – $145.43 | 3 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $541.20 | $902.00 | $63.22 – $64.48 | 3 |
| Ecg external > 48 hours up to 7 days recording CPT 93242 | $190.80 | $318.00 | $40.03 – $40.83 | 3 |
| Ecg external >7 days up to 15 days recording CPT 93246 | $318.00 | $530.00 | $40.03 – $40.83 | 3 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $3,265.20 | $5,442.00 | $585.55 – $597.26 | 3 |
| Echocardiography doppler color flow mapping CPT 93325 | $554.40 | $924.00 | not published | 0 |
| Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler HCPCS C8929 | not published | not published | $840.06 – $856.87 | 3 |
| Echocardiography transthoracic 2d followup/limited CPT 93308 | $792.00 | $1,320.00 | $255.69 – $260.80 | 3 |
| Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast HCPCS C8924 | not published | not published | $373.86 – $381.34 | 3 |
| Echocardiograpy doppler follow up/limited study CPT 93321 | $393.00 | $655.00 | not published | 0 |
| Echo exam of eye CPT 76516 | not published | not published | $112.03 – $114.27 | 3 |
| Echo exam of eye CPT 76519 | not published | not published | $112.03 – $114.27 | 3 |
| Echo exam of eye CPT 76529 | not published | not published | $93.26 – $95.12 | 3 |
| Echo exam of eye thickness CPT 76514 | not published | not published | $30.99 – $31.61 | 3 |
| Echo exam of fetal heart CPT 76825 | not published | not published | $585.55 – $597.26 | 3 |
| Echo exam of fetal heart CPT 76826 | not published | not published | $255.69 – $260.80 | 3 |
| Echo exam of fetal heart CPT 76827 | not published | not published | $112.03 – $114.27 | 3 |
| Echo exam of fetal heart CPT 76828 | not published | not published | $112.03 – $114.27 | 3 |
| Echo exam uterus 76831- CPT 76831 | not published | not published | $255.69 – $260.80 | 3 |
| Echograp trans r pros study CPT 76873 | not published | not published | $112.03 – $114.27 | 3 |
| Echo guide for artery repair CPT 76936 | not published | not published | $231.39 – $236.02 | 3 |
| Echo stress CPT 93350 | $1,378.80 | $2,298.00 | $585.55 – $597.26 | 3 |
| Echo tee cngntl wo ctrst probe plcmnt CPT 93316 | not published | not published | $585.55 – $597.26 | 3 |
| Echo tee probe placement image acquisition interpretation & report CPT 93312 | $2,535.60 | $4,226.00 | $585.55 – $597.26 | 3 |
| Echo transesophageal CPT 93313 | not published | not published | $585.55 – $597.26 | 3 |
| Echo transesophageal CPT 93315 | not published | not published | $585.55 – $597.26 | 3 |
| Echo transesophageal intraop CPT 93318 | not published | not published | $585.55 – $597.26 | 3 |
| Echo transthoracic CPT 93303 | $1,458.60 | $2,431.00 | $585.55 – $597.26 | 3 |
| Echo transthoracic CPT 93304 | $1,135.80 | $1,893.00 | $585.55 – $597.26 | 3 |
| Echo tte 2d comp wo ctrst wo clr/dplr CPT 93307 | $1,294.20 | $2,157.00 | $255.69 – $260.80 | 3 |
| Ecmo/ecls daily mgmt artery 33949 CPT 33949 | not published | not published | $5,543.00 – $5,672.00 | 2 |
| Ecmo/ecls daily mgmt-venous 33948 CPT 33948 | not published | not published | $5,543.00 – $5,672.00 | 2 |
| Ecmo/ecls initiation artery 33947 CPT 33947 | not published | not published | $5,543.00 – $5,672.00 | 2 |
| Ecmo/ecls initiation venous 33946 CPT 33946 | not published | not published | $5,543.00 – $5,672.00 | 2 |
| Ecmo/ecls insj cent cannula 0-5yrs 33955 CPT 33955 | not published | not published | $5,543.00 – $5,672.00 | 2 |
| Ecmo/ecls insj cent cannula 6yrs&older 33956 CPT 33956 | not published | not published | $5,543.00 – $5,672.00 | 2 |
| Ecmo/ecls insj prph cannula 0-5yrs opn 33953 CPT 33953 | not published | not published | $5,543.00 – $5,672.00 | 2 |
| Ecmo/ecls insj prph cannula 0-5yrs perq 33951 CPT 33951 | not published | not published | $5,543.00 – $5,672.00 | 2 |
| Ecmo/ecls insj prph cannula 6yrs&older opn 33954 CPT 33954 | not published | not published | $5,543.00 – $5,672.00 | 2 |
| Ecmo/ecls insj prph cannula 6yrs&older perq 33952 CPT 33952 | not published | not published | $5,543.00 – $5,672.00 | 2 |
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.