SSM Health St. Mary's Hospital - Jefferson City
2505 Mission Drive, Jefferson City, MO · SSM Health · · NPI 1518065523
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 clavicle complete (both sides) CPT 73000 | $308.88 | $561.60 | $35.29 – $156.90 | 8 |
| X-ray colon abdominal radiograph(s) & delayed images single contrast study CPT 74270 | $590.04 | $1,072.80 | $174.72 – $316.23 | 8 |
| X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study CPT 74280 | $1,032.90 | $1,878.00 | $174.72 – $316.23 | 8 |
| X-ray elbow 2 views (both sides) CPT 73070 | $190.30 | $346.00 | $35.29 – $156.90 | 8 |
| X-ray elbow >= 3 views (both sides) CPT 73080 | $253.55 | $461.00 | $42.43 – $156.90 | 8 |
| Xray endovasc thor ao repr CPT 75956 | $349.14 | $634.80 | $659.41 – $659.41 | 1 |
| Xray endovasc thor ao repr CPT 75957 | $349.14 | $634.80 | $562.57 – $562.57 | 1 |
| X-ray esophogram chest radiograph(s) & delayed images single contrast study CPT 74220 | $422.95 | $769.00 | $115.54 – $316.23 | 8 |
| X-ray exam entire spi 4/5 vw CPT 72083 | not published | not published | $80.76 – $188.49 | 8 |
| X-ray exam entire spi 6/> vw CPT 72084 | not published | not published | $97.48 – $188.49 | 8 |
| X-ray exam of arm infant CPT 73092 | $229.02 | $416.40 | $41.33 – $188.49 | 8 |
| X-ray exam of eye sockets CPT 70200 | $401.28 | $729.60 | $50.69 – $188.49 | 8 |
| X-ray exam of femur 1 CPT 73551 | $101.20 | $184.00 | $31.19 – $156.90 | 8 |
| X-ray exam of jaw joint CPT 70328 | not published | not published | $38.59 – $156.90 | 8 |
| X-ray exam of jaw joint CPT 70332 | not published | not published | $75.40 – $430.18 | 8 |
| X-ray exam of mastoids CPT 70120 | $302.28 | $549.60 | $45.73 – $188.49 | 8 |
| X-ray exam of middle ear CPT 70134 | not published | not published | $50.69 – $985.13 | 8 |
| X-ray exam of penis CPT 74445 | not published | not published | $77.63 – $188.49 | 8 |
| X-ray exam of perineum CPT 74775 | not published | not published | $100.48 – $430.18 | 8 |
| X-ray exam of salivary gland CPT 70380 | not published | not published | $50.69 – $156.90 | 8 |
| X-ray exam of sinuses CPT 70210 | $275.22 | $500.40 | $38.04 – $156.90 | 8 |
| X-ray exam of tear duct CPT 70170 | not published | not published | $56.04 – $430.18 | 8 |
| X-ray exam of teeth CPT 70300 | not published | not published | $15.51 – $156.90 | 8 |
| X-ray exam of teeth CPT 70310 | not published | not published | $51.77 – $430.18 | 8 |
| X-ray exam si joints CPT 72200 | $216.48 | $393.60 | $35.84 – $188.49 | 8 |
| X-ray exam thorac spine4/>vw CPT 72074 | $324.50 | $590.00 | $56.72 – $188.49 | 8 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $281.16 | $511.20 | $35.29 – $156.90 | 8 |
| X-ray facial bones complete > 3 views CPT 70150 | $409.86 | $745.20 | $50.69 – $188.49 | 8 |
| X-ray fallopian tube CPT 74742 | not published | not published | $92.77 – $92.77 | 1 |
| X-ray femur >=2 views (both sides) CPT 73552 | $253.55 | $461.00 | $36.96 – $156.90 | 8 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $199.65 | $363.00 | $45.73 – $156.90 | 8 |
| X-ray foot 2 views (both sides) CPT 73620 | $151.80 | $276.00 | $34.19 – $156.90 | 8 |
| X-ray forearm 2 views (both sides) CPT 73090 | $225.50 | $410.00 | $33.64 – $156.90 | 8 |
| X-ray hand 2 views (both sides) CPT 73120 | $166.65 | $303.00 | $33.09 – $188.49 | 8 |
| X-ray head for orthodontia CPT 70350 | $168.30 | $306.00 | $19.90 – $156.90 | 8 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | $209.00 | $380.00 | $35.29 – $156.90 | 8 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $386.10 | $702.00 | $60.01 – $188.49 | 8 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $357.50 | $650.00 | $45.03 – $188.49 | 8 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | $447.15 | $813.00 | $54.26 – $188.49 | 8 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $558.80 | $1,016.00 | $65.19 – $188.49 | 8 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $246.84 | $448.80 | $32.35 – $156.90 | 8 |
| X-ray humerus >= 2 views left CPT 73060 | $270.60 | $492.00 | $34.74 – $156.90 | 8 |
| X-ray joint survey 1 view CPT 77077 | $121.44 | $220.80 | $40.23 – $188.49 | 8 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $190.30 | $346.00 | $36.94 – $156.90 | 8 |
| X-ray knee 3 views (both sides) CPT 73562 | $253.55 | $461.00 | $47.38 – $156.90 | 8 |
| X-ray knee ap standing bilateral CPT 73565 | $235.62 | $428.40 | $44.63 – $156.90 | 8 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $186.78 | $339.60 | $34.19 – $156.90 | 8 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $378.84 | $688.80 | $51.77 – $188.49 | 8 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $456.06 | $829.20 | $56.17 – $188.49 | 8 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $475.86 | $865.20 | $79.81 – $188.49 | 8 |
| X-ray male genital tract CPT 74440 | not published | not published | $108.95 – $430.18 | 8 |
| X-ray mandible complete > 4 views CPT 70110 | $378.84 | $688.80 | $46.28 – $188.49 | 8 |
| X-ray mandible ltd <4 views CPT 70100 | $79.86 | $145.20 | $43.53 – $156.90 | 8 |
| X-ray nasal bones complete > 3 views CPT 70160 | $293.70 | $534.00 | $42.43 – $156.90 | 8 |
| X-ray neck soft tissue CPT 70360 | $317.46 | $577.20 | $33.09 – $156.90 | 8 |
| X-ray nose to rectum for foreign body child CPT 76010 | not published | not published | $30.34 – $156.90 | 8 |
| X-ray of mammary ducts CPT 77054 | not published | not published | $95.20 – $430.18 | 8 |
| X-ray optic foramina CPT 70190 | not published | not published | $43.53 – $156.90 | 8 |
| X-ray pelvis 1-2 views CPT 72170 | $253.55 | $461.00 | $33.64 – $188.49 | 8 |
| X-ray pelvis complete > 3 views CPT 72190 | $255.20 | $464.00 | $54.52 – $188.49 | 8 |
| Xray place dist ext thor ao CPT 75959 | $349.14 | $634.80 | $327.63 – $327.63 | 1 |
| Xray place prox ext thor ao CPT 75958 | $349.14 | $634.80 | $375.20 – $375.20 | 1 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $848.76 | $1,543.20 | $180.71 – $628.99 | 8 |
| X-ray ribs 2 views left CPT 71100 | $244.75 | $445.00 | $36.39 – $156.90 | 8 |
| X-ray ribs 3 views bilateral CPT 71110 | $401.28 | $729.60 | $46.28 – $188.49 | 8 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $287.10 | $522.00 | $44.63 – $188.49 | 8 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $450.78 | $819.60 | $63.33 – $188.49 | 8 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $300.96 | $547.20 | $42.98 – $188.49 | 8 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $316.80 | $576.00 | $34.74 – $156.90 | 8 |
| X-ray scapula complete (both sides) CPT 73010 | $285.78 | $519.60 | $38.59 – $188.49 | 8 |
| X-ray sella turcica CPT 70240 | not published | not published | $34.74 – $156.90 | 8 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $145.75 | $265.00 | $27.60 – $156.90 | 8 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $378.84 | $688.80 | $45.18 – $156.90 | 8 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $362.34 | $658.80 | $57.83 – $985.13 | 8 |
| X-ray skull < 4 views CPT 70250 | $440.22 | $800.40 | $42.43 – $188.49 | 8 |
| X-ray skull > 4 views complete CPT 70260 | $447.48 | $813.60 | $51.24 – $188.49 | 8 |
| X-ray slg plne bdy sect without urogr CPT 76100 | $747.78 | $1,359.60 | $104.14 – $188.49 | 8 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $648.12 | $1,178.40 | $133.69 – $316.23 | 8 |
| X-ray small intestine follow-through study CPT 74248 | not published | not published | $78.10 – $78.10 | 1 |
| X-ray spine single view CPT 72020 | $246.84 | $448.80 | $27.05 – $156.90 | 8 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $308.88 | $561.60 | $44.63 – $156.90 | 8 |
| X-ray sternum > 2 views CPT 71120 | $293.70 | $534.00 | $36.94 – $156.90 | 8 |
| X-ray surgical specimen CPT 76098 | $488.66 | $888.48 | $18.24 – $985.13 | 8 |
| X-ray swallowing function w/ciner/videoradiography neck radiographs(s)&delayed images contrast study CPT 74230 | $468.60 | $852.00 | $109.50 – $316.23 | 8 |
| X-ray temporomandibular joint open/closed mouth bilateral CPT 70330 | $267.30 | $486.00 | $61.13 – $156.90 | 8 |
| X-ray thoracic spine 2 views CPT 72070 | $165.00 | $300.00 | $38.59 – $188.49 | 8 |
| X-ray thoracic spine 3 views CPT 72072 | $302.50 | $550.00 | $44.63 – $188.49 | 8 |
| X-ray thoracolumbar spine >=2 views CPT 72080 | $269.94 | $490.80 | $42.43 – $156.90 | 8 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $285.78 | $519.60 | $40.99 – $156.90 | 8 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 2-3 views CPT 72082 | $324.72 | $590.40 | $74.42 – $188.49 | 8 |
| X-ray tibia/fibula 2 views (both sides) CPT 73590 | $250.80 | $456.00 | $32.54 – $156.90 | 8 |
| X-ray toe(s) > 2 views (both sides) CPT 73660 | $200.64 | $364.80 | $40.78 – $156.90 | 8 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images double contrast CPT 74246 | $989.34 | $1,798.80 | $159.50 – $316.23 | 8 |
| X-ray upper gastrointestinal tract scout abdominal radiographs delayed images single contrast study CPT 74240 | $653.40 | $1,188.00 | $134.77 – $316.23 | 8 |
| X-ray wrist 2 views (both sides) CPT 73100 | $203.50 | $370.00 | $39.15 – $156.90 | 8 |
| X-ray xm phrnx&/crv esoph c+ CPT 74210 | not published | not published | $102.34 – $316.23 | 8 |
| Xtrnl ecg rec>48hr<7d CPT 93241 | not published | not published | $317.70 – $317.70 | 1 |
| Xtrnl ecg rec up to 48 hrs CPT 93224 | not published | not published | $157.04 – $157.04 | 1 |
| Xylose absorption test blood &/or urine CPT 84620 | not published | not published | $11.62 – $23.24 | 8 |
| Xyntha inj HCPCS J7185 | not published | not published | $1.36 – $2.47 | 8 |
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.