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 |
|---|---|---|---|---|
| Low cost skin substitute app HCPCS C5278 | $180.84 | $328.80 | $1,351.00 – $1,351.00 | 1 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $1,302.84 | $2,368.80 | $174.72 – $316.23 | 8 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $1,058.64 | $1,924.80 | $335.41 – $628.99 | 8 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $895.62 | $1,628.40 | $104.14 – $188.49 | 8 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $1,293.60 | $2,352.00 | $347.51 – $628.99 | 8 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $1,086.80 | $1,976.00 | $347.51 – $628.99 | 8 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $983.40 | $1,788.00 | $237.67 – $430.18 | 8 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $363.66 | $661.20 | $41.33 – $188.49 | 8 |
| Lower jaw bone graft CPT 21215 | not published | not published | $2,277.00 – $10,672.90 | 10 |
| Low frequency non-thermal Ultrasound CPT 97610 | $508.73 | $924.96 | $33.60 – $361.72 | 8 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $2,277.00 – $19,164.59 | 10 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $2,277.00 – $19,164.59 | 10 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $2,277.00 – $19,164.59 | 10 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $2,277.00 – $19,164.59 | 10 |
| L/s ratio fetal lung CPT 83661 | not published | not published | $19.79 – $39.58 | 8 |
| Lumbar diskogram s&i CPT 72295 | $6,102.36 | $11,095.20 | $99.59 – $3,520.58 | 8 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $7,302.00 – $31,611.83 | 9 |
| Lumizyme injection HCPCS J0221 | not published | not published | $209.97 – $380.03 | 9 |
| Lung function test (mbc/mvv) CPT 94200 | not published | not published | $33.64 – $106.36 | 8 |
| Lung Function Test (Spirometry) CPT 94010 | $530.65 | $964.82 | $47.38 – $389.29 | 8 |
| Lung perfusion imaging CPT 78580 | $812.46 | $1,477.20 | $339.47 – $720.75 | 8 |
| Lung transplant double CPT 32853 | not published | not published | $2,277.00 – $3,233.00 | 2 |
| Lung transplant single CPT 32851 | not published | not published | $2,277.00 – $3,233.00 | 2 |
| Lung transplant with bypass CPT 32852 | not published | not published | $2,277.00 – $3,233.00 | 2 |
| Lung transplant with bypass CPT 32854 | not published | not published | $2,277.00 – $3,233.00 | 2 |
| Lung volume reduction 32491 CPT 32491 | not published | not published | $2,277.00 – $3,233.00 | 2 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | not published | not published | $214.76 – $388.71 | 8 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | not published | not published | $43.27 – $78.33 | 8 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | not published | not published | $314.03 – $630.37 | 8 |
| Lutetium lu 177 vipivotide HCPCS A9607 | not published | not published | $255.68 – $481.17 | 8 |
| Lvad shower bag heartmate HCPCS Q0501 | not published | not published | $622.32 – $1,126.37 | 8 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | $28.81 – $2,277.00 | 9 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $18.05 – $36.09 | 8 |
| Lymphadenect/stage/pelv/paraaortic 38562 CPT 38562 | not published | not published | $2,277.00 – $14,735.85 | 9 |
| Lymphatics/lymph node imaging CPT 78195 | $1,088.34 | $1,978.80 | $452.69 – $978.92 | 8 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $32.90 – $65.81 | 8 |
| Lymphocyte transformation mitogen CPT 86353 | not published | not published | $44.13 – $88.25 | 8 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $136.46 – $341.12 | 8 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $42.83 – $85.66 | 8 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $373.13 – $1,130.97 | 8 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $373.13 – $2,838.05 | 8 |
| Lymph vessel x-ray trunk CPT 75805 | not published | not published | $420.80 – $5,692.64 | 8 |
| Lymph vessel x-ray trunk CPT 75807 | not published | not published | $520.64 – $5,692.64 | 8 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $537.23 – $2,277.00 | 10 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $1,325.00 – $5,836.23 | 10 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $1,778.00 – $3,768.77 | 10 |
| Macro exam dissect molec study ea CPT 88387 | not published | not published | $7.23 – $10.00 | 2 |
| Macroscopic exam arthropod CPT 87168 | $85.80 | $156.00 | $3.84 – $7.69 | 8 |
| Macroscopic exam parasite CPT 87169 | $72.05 | $131.00 | $3.88 – $7.76 | 8 |
| Magnesium CPT 83735 | $73.15 | $133.00 | $6.03 – $12.06 | 8 |
| Magnetic image bone marrow CPT 77084 | not published | not published | $237.67 – $430.18 | 8 |
| Makena, 10 mg HCPCS J1726 | not published | not published | $14.65 – $14.65 | 1 |
| Malaria antibody CPT 86750 | $89.10 | $162.00 | $11.87 – $23.74 | 8 |
| Male sling procedure CPT 53440 | not published | not published | $1,778.00 – $23,786.56 | 10 |
| Management of liver hemorrhage 47361 CPT 47361 | not published | not published | $2,277.00 – $3,233.00 | 2 |
| Manipulate finger w/anesth CPT 26340 | $437.25 | $795.00 | $1,325.00 – $2,899.06 | 10 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $1,601.73 – $2,899.06 | 10 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $31.02 | $56.40 | $44.08 – $239.87 | 8 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $87.12 | $158.40 | $42.43 – $239.87 | 8 |
| Manipulation of hip joint CPT 27275 | not published | not published | $1,601.73 – $2,899.06 | 10 |
| Manipulation of spine CPT 22505 | not published | not published | $1,601.73 – $2,899.06 | 10 |
| Manipulat palm cord post inj CPT 26341 | not published | not published | $245.71 – $2,277.00 | 10 |
| Manual diff wbc count b-coat CPT 85009 | not published | not published | $4.56 – $9.13 | 8 |
| Mapping functional cort/subcort ea add'l hr CPT 95962 | not published | not published | $133.69 – $133.69 | 1 |
| Mapping io sentinel lymph node CPT 38900 | not published | not published | $1,351.00 – $2,277.00 | 2 |
| Map tachycard site(s) CPT 93609 | not published | not published | $189.35 – $10,988.00 | 3 |
| Margetuximab-cmkb 25 mg/ml intravenous solution HCPCS J9353 | not published | not published | $52.36 – $101.60 | 8 |
| Marker biop eviva buckle ss HCPCS A4648 | $325.78 | $592.33 | not published | 0 |
| Marker lymphatic sentimag magtrace 10 vial HCPCS A9697 | not published | not published | $1,206.24 – $2,257.20 | 8 |
| Marsupialization liver lesion 47300 CPT 47300 | not published | not published | $2,277.00 – $3,233.00 | 2 |
| Mastectomy partial CPT 19301 | not published | not published | $2,034.00 – $7,059.16 | 10 |
| Mast mod rad CPT 19307 | not published | not published | $2,277.00 – $11,971.60 | 10 |
| Mastoidectomy CPT 69501 | not published | not published | $2,277.00 – $10,672.90 | 10 |
| Mastoidectomy complete 69502 CPT 69502 | not published | not published | $2,277.00 – $10,672.90 | 10 |
| Mastoids complete CPT 70130 | not published | not published | $71.02 – $188.49 | 8 |
| Mastoid surgery revision CPT 69603 | not published | not published | $2,277.00 – $10,672.90 | 10 |
| Mastopexy CPT 19316 | not published | not published | $2,277.00 – $11,971.60 | 10 |
| Mast radical CPT 19305 | not published | not published | $2,277.00 – $3,233.00 | 2 |
| Mast rad urban type CPT 19306 | not published | not published | $2,277.00 – $3,233.00 | 2 |
| Mast simple complete CPT 19303 | not published | not published | $2,277.00 – $11,971.60 | 10 |
| Matrion 1 sq cm HCPCS Q4201 | not published | not published | $123.96 – $224.36 | 8 |
| Matrix tissue 15x10cm gentrix extra-gynecological clgn strl-cost per sq cm HCPCS Q4166 | not published | not published | $30.43 – $224.36 | 8 |
| M.avium-intra dna amp prob CPT 87561 | not published | not published | $31.58 – $63.16 | 8 |
| M.avium-intra dna dir prob CPT 87560 | not published | not published | $24.56 – $49.12 | 8 |
| M.avium-intra dna quant CPT 87562 | not published | not published | $38.56 – $77.11 | 8 |
| Maxillofacial fixation CPT 21100 | not published | not published | $1,778.00 – $10,672.90 | 10 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $138.05 | $251.00 | $13.01 – $26.03 | 8 |
| Mayo aathr protein s free CPT 85306 | $189.20 | $344.00 | $13.79 – $27.58 | 8 |
| Mayo activated protein c resistance assay CPT 85307 | $183.70 | $334.00 | $13.79 – $27.58 | 8 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $162.25 | $295.00 | $34.71 – $69.43 | 8 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | not published | not published | $25.57 – $25.57 | 1 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $177.10 | $322.00 | $21.28 – $21.28 | 1 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $75.35 | $137.00 | $13.30 – $26.60 | 8 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $309.65 | $563.00 | $38.63 – $38.63 | 1 |
| Mayo alpha 1 antitrypsin CPT 82103 | $102.30 | $186.00 | $12.10 – $24.19 | 8 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $191.40 | $348.00 | $13.57 – $27.14 | 8 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | $55.55 | $101.00 | $24.68 – $24.68 | 1 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $106.15 | $193.00 | $19.21 – $19.21 | 1 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $230.45 | $419.00 | $109.47 – $218.93 | 8 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $458.70 | $834.00 | $82.49 – $164.99 | 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.