SSM HEALTH ST. MARY'S HOSPITAL - JEFFERSON CITY

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
77067	Scr mammo bi incl cad	—	—	$85.16	$385	22
77071	X-Ray Stress View	—	—	$86.69	$211	22
77072	X-Rays for Bone Age	—	—	$23.75	$245	22
77073	X-rays bone length studies	—	—	$40.23	$245	22
77074	X-rays bone survey limited	—	—	$80.36	$245	22
77075	X-rays bone survey complete	—	—	$104	$270	22
77076	X-rays bone survey infant	—	—	$104	$270	22
77077	Joint survey single view	—	—	$40.23	$245	22
77078	Ct bone density axial	—	—	$86.69	$283	22
77080	Dxa bone density axial	—	—	$65.51	$245	22
77081	Dxa bone density/peripheral	—	—	$28.68	$182	22
77084	Magnetic image bone marrow	—	—	$238	$1,290	22
77085	Dxa bone density study	—	—	$66.6	$245	22
77086	Fracture assessment via dxa	—	—	$43.45	$182	22
77089	Tbs dxa cal w/i&r fx risk	—	—	$69.06	$163	14
77090	Tbs techl prep&transmis data	—	—	$3.91	$186	22
77091	Tbs techl calculation only	—	—	$46.43	$186	22
77092	Tbs i&r fx rsk qhp	—	—	$18.72	$44.15	14
77261	Radiation therapy planning	—	—	$130	$306	13
77262	Radiation therapy planning	—	—	$196	$462	13
77263	Radiation therapy planning	—	—	$290	$683	13
77280	Set radiation therapy field	—	—	$134	$559	21
77285	Set radiation therapy field	—	—	$373	$1,023	21
77290	Set radiation therapy field	—	—	$373	$1,732	21
77293	Respirator motion mgmt simul	—	—	$530	$1,250	13
77295	3-d radiotherapy plan	—	—	$354	$2,495	21
77300	Radiation therapy dose plan	—	—	$58.38	$242	21
77301	Radiotherapy dose plan imrt	—	—	$1,379	$6,080	21
77306	Telethx isodose plan simple	—	—	$119	$675	21
77307	Telethx isodose plan cplx	—	—	$218	$675	21
77316	Brachytx isodose plan simple	—	—	$185	$675	21
77317	Brachytx isodose intermed	—	—	$242	$675	21
77318	Brachytx isodose complex	—	—	$328	$773	21
77321	Special teletx port plan	—	—	$71.02	$675	21
77331	Special radiation dosimetry	—	—	$30.89	$242	21
77332	Radiation treatment aid(s)	—	—	$86.42	$242	21
77333	Radiation treatment aid(s)	—	—	$15.51	$242	21
77334	Radiation treatment aid(s)	—	—	$144	$675	21
77336	Radiation physics consult	—	—	$71.02	$242	21
77338	Design mlc device for imrt	—	—	$373	$1,099	21
77370	Radiation physics consult	—	—	$134	$451	21
77371	Srs multisource	—	—	$2,198	$13,279	21
77372	Srs linear based	—	—	$1,269	$13,279	21
77373	SBRT Delivery	—	—	$1,781	$4,836	21
77385	Ntsty modul rad tx dlvr smpl	—	—	$642	$1,515	13
77386	Ntsty modul rad tx dlvr cplx	—	—	$644	$1,520	13
77387	Guidance for radiaj tx dlvr	—	—	$107	$253	13
77401	Radiation treatment delivery	—	—	$33.64	$79.34	13
77402	Radiation treatment delivery	—	—	$102	$591	21
77407	Radiation treatment delivery	—	—	$365	$861	21

Showing top 50 of 13,170 priced procedures, sorted by gross charge.

Data straight from this hospital's federally-mandated machine-readable file (45 CFR § 180). The compliance grade reflects how completely the hospital published the six required data elements, not the quality of care.