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 |
|---|---|---|---|---|
| Ghs intermed repair over 30 cm - 12037 CPT 12037 | $1,939.08 | $3,525.60 | $1,778.00 – $3,719.90 | 10 |
| Ghs intro needle/intracath vein - 36000 CPT 36000 | $27.17 | $49.40 | $1,351.00 – $2,277.00 | 2 |
| Ghs irrigate corpora cavernosa for priapism CPT 54220 | $831.60 | $1,512.00 | $248.88 – $2,277.00 | 10 |
| Ghs IV inf sq injection, on-body injector CPT 96377 | $159.50 | $290.00 | $35.88 – $84.42 | 8 |
| Ghs IV infusion bamlanivimab/etesevimab HCPCS M0245 | $463.10 | $842.00 | not published | 0 |
| Ghs IV infusion casirivimab/imdevimab HCPCS M0243 | $671.55 | $1,221.00 | not published | 0 |
| Ghs IV infusion sotrovimab HCPCS M0247 | $665.50 | $1,210.00 | not published | 0 |
| Ghs IV thrombolytics - cerebral CPT 37195 | not published | not published | $329.02 – $2,277.00 | 10 |
| Ghs lac repair mouth.ant tong 2.5cm/less CPT 41250 | $341.88 | $621.60 | $444.98 – $2,277.00 | 10 |
| Ghs layer closure 2.5 cm or less - 12031 CPT 12031 | $1,049.40 | $1,908.00 | $404.93 – $2,277.00 | 9 |
| Ghs layer closure 2.5 cm or less - 12041 CPT 12041 | $636.90 | $1,158.00 | $404.93 – $2,277.00 | 9 |
| Ghs layer closure 2.5cm or less - 12051 CPT 12051 | $891.66 | $1,621.20 | $404.93 – $2,277.00 | 9 |
| Ghs layer closure 2.6 - 5.0 cm - 12052 CPT 12052 | $958.98 | $1,743.60 | $404.93 – $2,277.00 | 9 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $690.36 | $1,255.20 | $404.93 – $2,277.00 | 9 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $998.58 | $1,815.60 | $404.93 – $2,277.00 | 9 |
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $1,226.28 | $2,229.60 | $404.93 – $2,277.00 | 10 |
| Ghs layer closure 7.6 - 12.5 cm - 12044 CPT 12044 | $775.50 | $1,410.00 | $736.19 – $2,277.00 | 10 |
| Ghs layer closure 7.6 - 12.5 cm - 12054 CPT 12054 | $1,038.18 | $1,887.60 | $404.93 – $2,277.00 | 10 |
| Ghs layered repair 12.6 - 20.0 cm -12045 CPT 12045 | $1,145.76 | $2,083.20 | $736.19 – $2,277.00 | 10 |
| Ghs layered repair 12.6 - 20.0 cm -12055 CPT 12055 | $1,077.78 | $1,959.60 | $404.93 – $2,277.00 | 10 |
| Ghs layered repair 20.1 - 30.0 cm -12046 CPT 12046 | $1,368.84 | $2,488.80 | $736.19 – $2,277.00 | 10 |
| Ghs layered repair 20.1 - 30.0 cm -12056 CPT 12056 | $1,117.38 | $2,031.60 | $404.93 – $2,277.00 | 10 |
| Ghs layered repair over 30.0 cm -12047 CPT 12047 | not published | not published | $1,778.00 – $3,719.90 | 10 |
| Ghs layered repair over 3.0 cm -12057 CPT 12057 | not published | not published | $404.93 – $2,277.00 | 10 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | $62.70 | $114.00 | $7.74 – $15.48 | 8 |
| Ghs low level laser therapy CPT 97039 | not published | not published | $21.79 – $21.79 | 1 |
| Ghs mbp CPT 83873 | $358.60 | $652.00 | $15.48 – $30.96 | 8 |
| Ghs moderate sedation < 5 yr, 30 min CPT 99151 | $249.48 | $453.60 | $44.37 – $44.37 | 1 |
| Ghs moderate sedation < 5 yr, 30 min, other CPT 99155 | $211.20 | $384.00 | $173.34 – $173.34 | 1 |
| Ghs moderate sedation, > 5 yr, 30 min, other CPT 99156 | $211.20 | $384.00 | $142.74 – $142.74 | 1 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $96.36 | $175.20 | $18.15 – $18.15 | 1 |
| Ghs moderate sedation ea addtl 15 min, other CPT 99157 | $96.36 | $175.20 | $108.17 – $108.17 | 1 |
| Ghs musc test done w/n test comp CPT 95886 | not published | not published | $77.61 – $77.61 | 1 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | not published | not published | $69.37 – $69.37 | 1 |
| Ghs musc tst done w/n tst non ext CPT 95887 | not published | not published | $75.95 – $75.95 | 1 |
| Ghs myocardial strain img spckl track CPT 93356 | $583.92 | $1,061.67 | $22.38 – $22.38 | 1 |
| Ghs nailbed repair/nail removal CPT 11760 | $368.94 | $670.80 | $736.19 – $2,277.00 | 9 |
| Ghs nerve blk intercostal, ea addtl level CPT 64421 | $2,737.02 | $4,976.40 | $881.03 – $2,277.00 | 10 |
| Ghs nerve blk intercostal, single level CPT 64420 | $708.18 | $1,287.60 | $703.13 – $2,277.00 | 10 |
| Ghs nerve block axillary nerve CPT 64417 | not published | not published | $881.03 – $2,277.00 | 10 |
| Ghs nerve block brachial plexus CPT 64415 | $1,820.28 | $3,309.60 | $881.03 – $2,277.00 | 10 |
| Ghs nerve block celiac plexus CPT 64530 | $1,363.56 | $2,479.20 | $881.03 – $2,277.00 | 10 |
| Ghs nerve block interscaline CPT 64510 | $500.28 | $909.60 | $881.03 – $2,277.00 | 10 |
| Ghs nerve block lumbar or thoracic symp CPT 64520 | $723.36 | $1,315.20 | $881.03 – $2,277.00 | 10 |
| Ghs nerve block sciatic nerve CPT 64445 | $1,503.48 | $2,733.60 | $703.13 – $2,277.00 | 10 |
| Ghs nerve block suprascapular CPT 64418 | $269.68 | $490.32 | $703.13 – $2,277.00 | 10 |
| Ghs ng placement w fluoro guidance CPT 43752 | $673.20 | $1,224.00 | $444.98 – $2,277.00 | 9 |
| Ghs o2 saturation CPT 82810 | not published | not published | $8.79 – $17.59 | 8 |
| Ghs o2 uptake rest & exercise CPT 94680 | not published | not published | $78.71 – $231.99 | 8 |
| Ghs o2 uptake rest & indirect CPT 94690 | not published | not published | $58.76 – $106.36 | 8 |
| Ghs ob unlisted IV or art inj or infusion CPT 96379 | not published | not published | $46.64 – $84.42 | 8 |
| Ghs opcc repair cvp without subq port CPT 36575 | $1,837.44 | $3,340.80 | $624.86 – $2,277.00 | 10 |
| Ghs opcc repair cvp w subq port CPT 36576 | not published | not published | $1,568.02 – $2,838.05 | 10 |
| Ghs optokenetic CPT 92544 | $196.66 | $357.56 | $16.06 – $231.99 | 8 |
| Ghs oscillating trac CPT 92545 | $196.66 | $357.56 | $14.96 – $389.29 | 8 |
| Ghs osteopathic manipulative tx, 1-2 regions CPT 98925 | $91.08 | $165.60 | $21.51 – $38.93 | 8 |
| Ghs osteopathic manipulative tx, 3-4 regions CPT 98926 | not published | not published | $21.51 – $38.93 | 8 |
| Ghs ot dds rom CPT 95851 | not published | not published | $6.57 – $11.90 | 8 |
| Ghs ot group caregiver training CPT 97552 | not published | not published | $9.24 – $16.72 | 8 |
| Ghs ot prosthetic training/15 min CPT 97761 | $72.84 | $132.43 | $36.98 – $66.92 | 8 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $62.67 | $113.95 | $51.07 – $105.59 | 8 |
| Ghs ot work hardening-additional hours CPT 97546 | not published | not published | $90.65 – $90.65 | 1 |
| Ghs pacing - transcutaneous CPT 92953 | $1,259.28 | $2,289.60 | $19.36 – $1,191.62 | 8 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $416.43 | $757.15 | $1,351.00 – $2,277.00 | 2 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $798.60 | $1,452.00 | $1,351.00 – $2,277.00 | 2 |
| Ghs path - pap (papanicolau) smear - vagina CPT 88141 | $38.50 | $70.00 | $19.78 – $55.49 | 2 |
| Ghs peritonsillar abscess i andd CPT 42700 | $523.38 | $951.60 | $235.93 – $2,277.00 | 10 |
| Ghs phenylketonurid CPT 84030 | not published | not published | $4.95 – $9.90 | 8 |
| Ghs picc line insert < 5 CPT 36568 | $129.25 | $235.00 | $1,325.00 – $2,838.05 | 10 |
| Ghs plngl fx pm cl CPT 26725 | $253.44 | $460.80 | $245.71 – $2,277.00 | 9 |
| Ghs plt ct-manual CPT 85032 | not published | not published | $3.88 – $7.76 | 8 |
| Ghs polysom <6 yrs 4/> parameters CPT 95782 | $2,295.15 | $4,173.00 | $855.40 – $1,548.23 | 8 |
| Ghs pos nystagmus CPT 92542 | $171.51 | $311.84 | $16.06 – $239.87 | 8 |
| Ghs ppd (tb intradermal) CPT 86580 | $25.85 | $47.00 | $13.31 – $52.15 | 8 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | not published | not published | $8.69 – $17.39 | 8 |
| Ghs protein, misc fluid CPT 84160 | $73.15 | $133.00 | $5.05 – $10.10 | 8 |
| Ghs protoporphyrins fract CPT 84202 | $209.00 | $380.00 | $12.92 – $25.83 | 8 |
| Ghs pr without cont pulse ox CPT 94625 | $307.56 | $559.20 | $34.21 – $106.36 | 8 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | not published | not published | $11.03 – $22.05 | 8 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | not published | not published | $227.14 – $227.14 | 1 |
| Ghs quinidine CPT 80194 | $72.05 | $131.00 | $13.14 – $26.28 | 8 |
| Ghs refill of implantable pump CPT 95990 | $450.78 | $819.60 | $156.43 – $595.51 | 8 |
| Ghs removal intranasal foreign body CPT 30300 | $112.20 | $204.00 | $132.53 – $2,277.00 | 9 |
| Ghs removal pharyngeal foreign body CPT 42809 | $81.84 | $148.80 | $444.98 – $2,277.00 | 10 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $4,790.28 | $8,709.60 | $1,601.73 – $2,899.06 | 10 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | $9,694.08 | $17,625.60 | $2,277.00 – $5,899.11 | 10 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | not published | not published | $14.30 – $28.60 | 8 |
| Ghs reticulocyte count CPT 85044 | not published | not published | $3.88 – $7.76 | 8 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $132.55 | $241.00 | $12.52 – $25.04 | 8 |
| Ghs sedimentation rate CPT 85651 | not published | not published | $3.84 – $7.69 | 8 |
| Ghs semen analysis fert CPT 89320 | $245.30 | $446.00 | $11.08 – $22.16 | 8 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $8.86 – $17.71 | 8 |
| Ghs sensitivity (per antimicro) CPT 87184 | $56.10 | $102.00 | $6.73 – $13.46 | 8 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $891.66 | $1,621.20 | $404.93 – $2,277.00 | 10 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $684.42 | $1,244.40 | $404.93 – $2,277.00 | 10 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $912.12 | $1,658.40 | $404.93 – $2,277.00 | 10 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $741.18 | $1,347.60 | $404.93 – $2,277.00 | 10 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $650.10 | $1,182.00 | $199.85 – $2,277.00 | 9 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $826.98 | $1,503.60 | $199.85 – $2,277.00 | 9 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $657.36 | $1,195.20 | $199.85 – $2,277.00 | 9 |
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.