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 |
|---|---|---|---|---|
| Injection, edaravone, 1 mg HCPCS J1301 | not published | not published | $6.43 – $11.63 | 8 |
| Injection epidural blood patch or clot CPT 62273 | $2,622.84 | $4,768.80 | $703.13 – $2,277.00 | 10 |
| Injection eye drug CPT 67028 | not published | not published | $329.02 – $2,277.00 | 10 |
| Injection for arthrography wrist (both sides) CPT 25246 | $167.64 | $304.80 | $1,351.00 – $2,277.00 | 2 |
| Injection for bladder x-ray CPT 51600 | $372.90 | $678.00 | $1,351.00 – $2,277.00 | 2 |
| Injection for hip x-ray CPT 27095 | not published | not published | $1,351.00 – $2,277.00 | 2 |
| Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides) CPT 23350 | $145.86 | $265.20 | $1,351.00 – $2,277.00 | 2 |
| Injection for spleen x-ray CPT 38200 | not published | not published | $1,351.00 – $2,277.00 | 2 |
| Injection for tear sac x-ray CPT 68850 | not published | not published | $1,351.00 – $2,277.00 | 2 |
| Injection for ureter x-ray CPT 50684 | not published | not published | $1,351.00 – $2,277.00 | 2 |
| Injection for ureter x-ray CPT 50690 | $154.44 | $280.80 | $1,351.00 – $2,277.00 | 2 |
| Injection, fulvestrant HCPCS J9395 | not published | not published | $7.06 – $7.06 | 1 |
| Injection glatiramer acetate HCPCS J1595 | not published | not published | $181.86 – $181.86 | 1 |
| Injection, inclisiran, 1 mg HCPCS J1306 | not published | not published | $12.83 – $23.23 | 8 |
| Injection into brain canal CPT 61026 | not published | not published | $703.13 – $2,277.00 | 10 |
| Injection into brain canal CPT 61055 | $543.18 | $987.60 | $305.76 – $2,277.00 | 10 |
| Injection into hemorrhoid(s) CPT 46500 | not published | not published | $926.34 – $2,277.00 | 9 |
| Injection into spinal artery CPT 62294 | not published | not published | $881.03 – $2,277.00 | 10 |
| Injection into vocal cord CPT 31513 | not published | not published | $389.60 – $2,277.00 | 10 |
| Injection intraop add-on CPT 48400 | not published | not published | $2,277.00 – $3,233.00 | 2 |
| Injection, isavuconazonium HCPCS J1833 | not published | not published | $1.02 – $1.85 | 8 |
| Injection jaw joint x-ray CPT 21116 | not published | not published | $1,351.00 – $2,277.00 | 2 |
| Injection jugular CPT 36299 | not published | not published | $1,351.00 – $2,277.00 | 2 |
| Injection, necitumumab, 1 mg HCPCS J9295 | not published | not published | $5.70 – $10.32 | 8 |
| Injection of HIV prep drug HCPCS G0012 | not published | not published | $24.05 – $129.81 | 8 |
| Injection of sinus tract CPT 20500 | not published | not published | $1,545.54 – $2,797.36 | 9 |
| Injection,onabotulinumtoxina HCPCS J0585 | not published | not published | $6.47 – $11.71 | 8 |
| Injection, peramivir HCPCS J2547 | not published | not published | $1.67 – $3.02 | 8 |
| Injection px peyronie ds CPT 54200 | not published | not published | $248.88 – $2,277.00 | 10 |
| Injection radioactive tracer sentinel node (both sides) CPT 38792 | $207.90 | $378.00 | $398.21 – $2,277.00 | 10 |
| Injection, renflexis HCPCS Q5104 | not published | not published | $26.47 – $47.91 | 8 |
| Injection, ruconest HCPCS J0596 | not published | not published | $36.75 – $68.10 | 8 |
| Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides) HCPCS G0260 | $2,622.84 | $4,768.80 | $703.13 – $1,272.64 | 8 |
| Injection(s) anesthetic agent(s) and/or steroid femoral nerve left CPT 64447 | not published | not published | $703.13 – $2,277.00 | 10 |
| Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 | $1,116.06 | $2,029.20 | $703.13 – $2,277.00 | 10 |
| Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides) CPT 64483 | $5,031.84 | $9,148.80 | $881.03 – $2,277.00 | 10 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level CPT 64491 | $524.04 | $952.80 | $1,351.00 – $2,277.00 | 2 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level CPT 64490 | $4,561.92 | $8,294.40 | $881.03 – $2,277.00 | 10 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance CPT 64494 | $707.52 | $1,286.40 | $1,351.00 – $2,277.00 | 2 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level CPT 64493 | $3,051.84 | $5,548.80 | $881.03 – $2,277.00 | 10 |
| Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance CPT 62321 | $1,626.90 | $2,958.00 | $703.13 – $2,277.00 | 10 |
| Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance CPT 62323 | $1,425.60 | $2,592.00 | $703.13 – $2,277.00 | 10 |
| Injection, siltuximab HCPCS J2860 | not published | not published | $165.33 – $313.32 | 8 |
| Injection(s) tendon sheath/ligament aponeurosis single (both sides) CPT 20550 | $53.06 | $96.48 | $305.76 – $2,277.00 | 10 |
| Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 | $646.14 | $1,174.80 | $305.76 – $2,277.00 | 10 |
| Injection(s) trigger point(s) single/multiple >= 3 muscle(s) CPT 20553 | $939.84 | $1,708.80 | $305.76 – $2,277.00 | 10 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug CPT 96375 | $218.35 | $397.00 | $37.34 – $84.42 | 8 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 | $234.30 | $426.00 | $25.02 – $25.02 | 1 |
| Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug CPT 96374 | $284.90 | $518.00 | $94.96 – $383.48 | 8 |
| Injection therapeutic/prophylactic/diagnostic subcutaneous/im CPT 96372 | $240.35 | $437.00 | $43.53 – $129.81 | 8 |
| Injection treatment of eye CPT 66020 | not published | not published | $1,325.00 – $4,160.79 | 10 |
| Injection treatment of eye CPT 66030 | not published | not published | $1,325.00 – $4,160.79 | 10 |
| Injection treatment of nerve CPT 64605 | not published | not published | $1,325.00 – $3,520.58 | 10 |
| Injection treatment of nerve CPT 64610 | not published | not published | $1,325.00 – $3,520.58 | 10 |
| Injection treatment of nerve CPT 64681 | not published | not published | $881.03 – $2,277.00 | 10 |
| Injection treatment of nose CPT 30200 | not published | not published | $537.23 – $2,277.00 | 10 |
| Inject sacroiliac joint CPT 27096 | not published | not published | $1,351.00 – $2,277.00 | 2 |
| Inject/treat eye socket CPT 67500 | not published | not published | $316.17 – $2,277.00 | 9 |
| Inject/treat eye socket CPT 67505 | not published | not published | $316.17 – $2,277.00 | 10 |
| Inject/treat eye socket CPT 67515 | not published | not published | $316.17 – $2,277.00 | 10 |
| Inj efgart-alfa 2mg hya-qvfc HCPCS J9334 | not published | not published | $34.07 – $61.66 | 9 |
| Inj eflapegrastim-xnst 0.1mg HCPCS J1449 | not published | not published | $23.47 – $69.41 | 8 |
| Inj., emapalumab-lzsg, 1 mg HCPCS J9210 | not published | not published | $390.62 – $707.00 | 9 |
| Inj., emicizumab-kxwh 0.5 mg HCPCS J7170 | not published | not published | $55.14 – $104.46 | 8 |
| Inj epidural sgl cerv-thor without img CPT 62320 | $1,115.40 | $2,028.00 | $703.13 – $2,277.00 | 10 |
| Inj epidural sgl lumb-sacral without img CPT 62322 | $1,288.32 | $2,342.40 | $881.03 – $2,277.00 | 10 |
| Inj, evinacumab-dgnb, 5mg HCPCS J1305 | not published | not published | $196.55 – $355.74 | 8 |
| Inj., evomela, 1 mg HCPCS J9246 | not published | not published | $17.94 – $32.48 | 8 |
| Inj, exagamglogene autotem HCPCS J3392 | not published | not published | $2,288,251.68 – $4,141,632.00 | 8 |
| Inj, factor x, (human), 1iu HCPCS J7175 | not published | not published | $9.90 – $17.92 | 8 |
| Inj, faricimab-svoa, 0.1mg HCPCS J2777 | not published | not published | $32.20 – $58.29 | 8 |
| Inj. fe derisomaltose 10 mg HCPCS J1437 | not published | not published | $20.96 – $37.94 | 8 |
| Inj fensolvi 0.25 mg HCPCS J1951 | not published | not published | $144.51 – $261.56 | 8 |
| Inj., fibryga, 1 mg HCPCS J7177 | not published | not published | $1.18 – $2.22 | 8 |
| Inj fluphenazine hcl 1.25 mg HCPCS J2679 | not published | not published | $8.15 – $8.15 | 1 |
| Inj, focinvez, 1mg HCPCS J1434 | not published | not published | $2.44 – $4.42 | 8 |
| Inj for ext venography CPT 36005 | $82.56 | $150.10 | $1,351.00 – $2,277.00 | 2 |
| Inj for mammo ductogram CPT 19030 | $265.98 | $483.60 | $1,351.00 – $2,277.00 | 2 |
| Inj, fosaprepitant (teva) HCPCS J1456 | not published | not published | $0.04 – $0.06 | 8 |
| Inj fosnetupitant, palonoset HCPCS J1454 | not published | not published | $501.08 – $906.93 | 8 |
| Inj, fulvestrant (fresenius) HCPCS J9394 | not published | not published | $13.00 – $48.80 | 8 |
| Inj, fulvestrant (teva) HCPCS J9393 | not published | not published | $22.47 – $75.01 | 8 |
| Inj givosiran 0.5 mg HCPCS J0223 | not published | not published | $120.25 – $217.65 | 9 |
| Inj glofitamab gxbm, 2.5 mg HCPCS J9286 | not published | not published | $2,848.92 – $5,156.42 | 9 |
| Inj glycopyrrolate fres kabi HCPCS J1598 | not published | not published | $2.14 – $2.14 | 1 |
| Inj, granisetron, xr, 0.1 mg HCPCS J1627 | not published | not published | $3.20 – $5.79 | 8 |
| Inj., guselkumab, 1 mg HCPCS J1628 | not published | not published | $66.55 – $120.46 | 8 |
| Inj, hemgenix, per tx dose HCPCS J1411 | not published | not published | $3,671,147.02 – $6,644,610.00 | 8 |
| Inj. herceptin hylecta, 10mg HCPCS J9356 | not published | not published | $58.02 – $105.02 | 8 |
| Inj herzuma 10 mg HCPCS Q5113 | not published | not published | $54.64 – $98.90 | 8 |
| Inj hrt cath w/s&i nonsel p-art angrp CPT 93568 | not published | not published | $79.71 – $1,351.00 | 2 |
| Inj hrt cath w/s&i sel hrt ang CPT 93563 | $1,146.36 | $2,084.30 | $100.29 – $1,351.00 | 2 |
| Inj hrt cath w/s&i sel hrt art CPT 93564 | not published | not published | $102.80 – $1,351.00 | 2 |
| Inj hrt cath w/s&i sel left vent CPT 93565 | $1,146.36 | $2,084.30 | $77.87 – $1,351.00 | 2 |
| Inj hrt cath w/s&i sel right vent CPT 93566 | not published | not published | $77.87 – $1,351.00 | 2 |
| Inj human fibrinogen con nos HCPCS J7178 | not published | not published | $1.48 – $2.68 | 8 |
| Inj hydroxocobalamin IV 25mg HCPCS J3424 | not published | not published | $5.41 – $9.80 | 8 |
| Inj., ibalizumab-uiyk, 10 mg HCPCS J1746 | not published | not published | $79.07 – $143.12 | 8 |
| Inj, idacio, 1 mg HCPCS Q5144 | not published | not published | $15.92 – $15.92 | 1 |
| Inj imip 4 cilas 4 releb 2mg HCPCS J0742 | not published | not published | $2.65 – $2.65 | 1 |
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.