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 |
|---|---|---|---|---|
| X-ray exam of mastoids CPT 70120 | not published | not published | $112.03 – $114.27 | 3 |
| X-ray exam of middle ear CPT 70134 | not published | not published | $585.55 – $597.26 | 3 |
| X-ray exam of penis CPT 74445 | not published | not published | $112.03 – $114.27 | 3 |
| X-ray exam of perineum CPT 74775 | not published | not published | $255.69 – $260.80 | 3 |
| X-ray exam of salivary gland CPT 70380 | not published | not published | $93.26 – $95.12 | 3 |
| X-ray exam of sinuses CPT 70210 | not published | not published | $93.26 – $95.12 | 3 |
| X-ray exam of tear duct CPT 70170 | not published | not published | $255.69 – $260.80 | 3 |
| X-ray exam of teeth CPT 70300 | not published | not published | $93.26 – $95.12 | 3 |
| X-ray exam of teeth CPT 70310 | not published | not published | $255.69 – $260.80 | 3 |
| X-ray exam si joints CPT 72200 | $428.40 | $714.00 | $112.03 – $114.27 | 3 |
| X-ray exam thorac spine4/>vw CPT 72074 | $502.20 | $837.00 | $112.03 – $114.27 | 3 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $330.60 | $551.00 | $93.26 – $95.12 | 3 |
| X-ray facial bones complete > 3 views CPT 70150 | $463.20 | $772.00 | $112.03 – $114.27 | 3 |
| X-ray femur >=2 views (both sides) CPT 73552 | $604.20 | $1,007.00 | $93.26 – $95.12 | 3 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $468.60 | $781.00 | $93.26 – $95.12 | 3 |
| X-ray foot 2 views (both sides) CPT 73620 | $604.20 | $1,007.00 | $93.26 – $95.12 | 3 |
| X-ray forearm 2 views (both sides) CPT 73090 | $604.20 | $1,007.00 | $93.26 – $95.12 | 3 |
| X-ray hand 2 views (both sides) CPT 73120 | $742.80 | $1,238.00 | $112.03 – $114.27 | 3 |
| X-ray head for orthodontia CPT 70350 | not published | not published | $93.26 – $95.12 | 3 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | $604.20 | $1,007.00 | $93.26 – $95.12 | 3 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $547.80 | $913.00 | $112.03 – $114.27 | 3 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $583.20 | $972.00 | $112.03 – $114.27 | 3 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | $534.60 | $891.00 | $112.03 – $114.27 | 3 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $615.60 | $1,026.00 | $112.03 – $114.27 | 3 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $411.00 | $685.00 | $93.26 – $95.12 | 3 |
| X-ray humerus >= 2 views left CPT 73060 | $604.20 | $1,007.00 | $93.26 – $95.12 | 3 |
| X-ray joint survey 1 view CPT 77077 | $463.20 | $772.00 | $112.03 – $114.27 | 3 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $604.20 | $1,007.00 | $93.26 – $95.12 | 3 |
| X-ray knee 3 views (both sides) CPT 73562 | $604.20 | $1,007.00 | $93.26 – $95.12 | 3 |
| X-ray knee ap standing bilateral CPT 73565 | $463.20 | $772.00 | $93.26 – $95.12 | 3 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $606.00 | $1,010.00 | $93.26 – $95.12 | 3 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $415.80 | $693.00 | $112.03 – $114.27 | 3 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $478.20 | $797.00 | $112.03 – $114.27 | 3 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $540.60 | $901.00 | $112.03 – $114.27 | 3 |
| X-ray male genital tract CPT 74440 | not published | not published | $255.69 – $260.80 | 3 |
| X-ray mandible complete > 4 views CPT 70110 | $463.20 | $772.00 | $112.03 – $114.27 | 3 |
| X-ray mandible ltd <4 views CPT 70100 | $463.20 | $772.00 | $93.26 – $95.12 | 3 |
| X-ray nasal bones complete > 3 views CPT 70160 | $430.80 | $718.00 | $93.26 – $95.12 | 3 |
| X-ray neck soft tissue CPT 70360 | $373.80 | $623.00 | $93.26 – $95.12 | 3 |
| X-ray nose to rectum for foreign body child CPT 76010 | $373.80 | $623.00 | $93.26 – $95.12 | 3 |
| X-ray of mammary ducts CPT 77054 | $857.40 | $1,429.00 | $255.69 – $260.80 | 3 |
| X-ray optic foramina CPT 70190 | not published | not published | $93.26 – $95.12 | 3 |
| X-ray pelvis 1-2 views CPT 72170 | $430.80 | $718.00 | $112.03 – $114.27 | 3 |
| X-ray pelvis complete > 3 views CPT 72190 | $463.20 | $772.00 | $112.03 – $114.27 | 3 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $1,233.00 | $2,055.00 | $373.86 – $381.34 | 3 |
| X-ray ribs 2 views left CPT 71100 | $430.80 | $718.00 | $93.26 – $95.12 | 3 |
| X-ray ribs 3 views bilateral CPT 71110 | $463.20 | $772.00 | $112.03 – $114.27 | 3 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $430.80 | $718.00 | $112.03 – $114.27 | 3 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $819.00 | $1,365.00 | $112.03 – $114.27 | 3 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $430.80 | $718.00 | $112.03 – $114.27 | 3 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $430.80 | $718.00 | $93.26 – $95.12 | 3 |
| X-ray scapula complete (both sides) CPT 73010 | $923.40 | $1,539.00 | $112.03 – $114.27 | 3 |
| X-ray sella turcica CPT 70240 | not published | not published | $93.26 – $95.12 | 3 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $430.80 | $718.00 | $93.26 – $95.12 | 3 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $463.20 | $772.00 | $93.26 – $95.12 | 3 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $864.00 | $1,440.00 | $585.55 – $597.26 | 3 |
| X-ray skull < 4 views CPT 70250 | $430.80 | $718.00 | $112.03 – $114.27 | 3 |
| X-ray skull > 4 views complete CPT 70260 | $819.00 | $1,365.00 | $112.03 – $114.27 | 3 |
| X-ray slg plne bdy sect without urogr CPT 76100 | $1,165.20 | $1,942.00 | $112.03 – $114.27 | 3 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $732.00 | $1,220.00 | $187.96 – $191.72 | 3 |
| X-ray small intestine follow-through study CPT 74248 | $468.00 | $780.00 | not published | 0 |
| X-ray spine single view CPT 72020 | $324.00 | $540.00 | $93.26 – $95.12 | 3 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $463.20 | $772.00 | $93.26 – $95.12 | 3 |
| X-ray sternum > 2 views CPT 71120 | $463.20 | $772.00 | $93.26 – $95.12 | 3 |
| X-ray surgical specimen CPT 76098 | $477.00 | $795.00 | $585.55 – $597.26 | 3 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $732.00 | $1,220.00 | $187.96 – $191.72 | 3 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $463.20 | $772.00 | $93.26 – $95.12 | 3 |
| X-ray thoracic spine 2 views CPT 72070 | $405.00 | $675.00 | $112.03 – $114.27 | 3 |
| X-ray thoracic spine 3 views CPT 72072 | $465.60 | $776.00 | $112.03 – $114.27 | 3 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | $198.00 | $330.00 | $93.26 – $95.12 | 3 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $260.40 | $434.00 | $93.26 – $95.12 | 3 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $301.80 | $503.00 | $112.03 – $114.27 | 3 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $604.20 | $1,007.00 | $93.26 – $95.12 | 3 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $468.60 | $781.00 | $93.26 – $95.12 | 3 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $867.00 | $1,445.00 | $187.96 – $191.72 | 3 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $867.00 | $1,445.00 | $187.96 – $191.72 | 3 |
| X-ray wrist 2 views (both sides) CPT 73100 | $604.20 | $1,007.00 | $93.26 – $95.12 | 3 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | not published | not published | $187.96 – $191.72 | 3 |
| Xylose absorption test blood &/or urine CPT 84620 | $251.40 | $419.00 | $12.91 – $13.17 | 3 |
| Xyntha inj HCPCS J7185 | not published | not published | $1.49 – $2.28 | 4 |
| Yersinia antibody CPT 86793 | not published | not published | $13.19 – $13.45 | 3 |
| Yttrium y-90 ibritumomab ther HCPCS A9543 | not published | not published | $56,824.55 – $108,036.36 | 4 |
| Ziconotide injection HCPCS J2278 | not published | not published | $10.46 – $14.98 | 4 |
| Zika virus dna/rna amp probe CPT 87662 | $649.20 | $1,082.00 | $51.31 – $52.34 | 3 |
| Zika virus igm antibody CPT 86794 | $424.80 | $708.00 | $16.85 – $17.19 | 3 |
| Ziv-aflibercept 25 mg/ml intravenous solution (wrapper) HCPCS J9400 | not published | not published | $8.61 – $11.24 | 4 |
| Zrsr2 gene common variants CPT 81360 | not published | not published | $193.25 – $197.12 | 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.