Visits & medical services prices at St. Mary Medical Center

Galesburg, IL · every code in this section with a posted price and a Medicare benchmark.

189 codes. Prices are the hospital's own posted facility charges.

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ProcedurePosted cashPosted gross× Medicare
Aep Hearing Status Deter Broadband Stimuli I&R (92651) $368.40 $614 1.6×
Airway Inhalation Treatment (94640) $102 $170 0.4×
Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) $80.40 $134 5.6×
Application on-body injector (96377) $73.80 $123 1.5×
Assessment of aphasia per hr (96105) $300 $500 3.1×
Behavral qualit analys voice (92524) $358.20 $597 3.3×
Bfb traing w/EMG &/manometry 1st 15 min cntct (90912) $61.80 $103 0.8×
Bfb training ea addl 15 min (90913) $42.60 $71 1.3×
Brncdilat rspse spmtry pre&post-brncdilat admn (94060)
range across 2 matching MRF lines
$413.40–$872.40 $689–$1,454 varies
Canalith repositioning proc (95992) $118.20 $197 2.9×
Car seat/bed test 60 min (94780) $178.80 $298 4.5×
Cardiac Stress Tst,Tracing Only (93017) $764.40 $1,274 3.3×
Cardiopulmonary resuscitation (92950) $1,947.60 $3,246 8.4×
Cardioversion (92960)
range across 3 matching MRF lines
$1,465.80–$2,606.40 $2,443–$4,344 varies
Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) $42 $70 1.6×
Cath Place/Coron Angio, Img Super/Interp,R&L Hrt Cath, L Hrt Ventric (93460) $13,213.20 $22,022 3.8×
Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) $11,347.20 $18,912 3.3×
Cbt 1st hour (94644) $139.80 $233 1.0×
Chemo Anti-Neopl Sq/Im (96401) $142.20 $237 1.8×
Chemo Hormon Antineopl Sq/Im (96402) $145.80 $243 1.9×
Chemo IV infusion addl hr (96415) $73.80 $123 1.0×
Chemo IV push addl drug (96411) $370.80 $618 4.8×
Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) $192.60 $321 2.5×
Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) $992.40 $1,654 2.8×
Chemotx admn IV push tq 1/1st sbst/drug (96409) $350.40 $584 1.0×
Chest Wall Manipulation (94668) $102 $170 0.7×
Color/duplex Doppler, complete (93975) $877.20 $1,462 3.4×
Color/duplex Doppler, limited (93976) $463.80 $773 4.1×
Community/Work Reintegration Trainj Ea 15 Min (97537) $108 $180 3.4×
Continuous Pulse Ox (94762) $710.40 $1,184 5.2×
Cpap Ventilation Cpap Initiation&Mgmt (94660) $571.20 $952 2.4×
Cpt initial (94667) $102 $170 0.7×
Critical care first hour (99291) $2,350.20 $3,917 2.7×
Debridement Open Wound 20 Sq Cm< (97597) $187.80 $313 0.9×
Developmental tst admin phys/qhp 1st hour (96112) $331.80 $553 2.4×
Dialysis One Evaluation (90945) $1,207.20 $2,012 2.7×
Dup-scan aorta ivc iliac vascl/bpgs complete (93978) $775.20 $1,292 3.0×
Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) $673.80 $1,123 6.0×
Dup-scan lxtr art/artl bpgs compl bi study (93925) $956.40 $1,594 3.7×
Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) $742.80 $1,238 6.6×
Dup-Scan Xtr Veins Complete Bilateral Study (93970) $1,108.20 $1,847 4.3×
Dup-scan xtr veins unilateral/limited study (93971) $697.80 $1,163 6.2×
Duplex Scan Artl Infl&Ven O/F Hemo Compl Bi Std (93985) $1,565.40 $2,609 6.1×
Duplex Scan Artl Infl&Ven O/F Hemo Compl Uni Std (93986) $1,042.20 $1,737 9.3×
Duplex Scan Hemodialysis Access (93990) $472.80 $788 4.2×
Duplex up extrem art bilat (93930) $1,066.20 $1,777 4.2×
Duplex up extrem art unilat/ltd (93931)
range across 3 matching MRF lines
$756.60–$1,018.20 $1,261–$1,697 varies
ECG/monitoring and analysis (93271) $541.20 $902 5.3×
Echo Congenital Complete (93303) $1,458.60 $2,431 2.5×
Echo Heart Xthoracic,Limited (93308)
range across 3 matching MRF lines
$498.60–$792 $831–$1,320 varies
Echo transesophageal (93312)
range across 2 matching MRF lines
$2,406–$2,535.60 $4,010–$4,226 varies
Echo tthrc r-t 2d w/wo m-mode rest&strs cont ECG (93351)
range across 3 matching MRF lines
$1,810.80–$2,935.20 $3,018–$4,892 varies
EEG awake drowsy (95816) $738.60 $1,231 3.2×
Electrical Stimulation Ea 15 Min (97032) $86.40 $144 5.9×
Electrocardiogram Tracing (93005) $252 $420 4.0×
Emergency Dept Visit Level 2 (99282) $379.80 $633 2.3×
Emergency Dept Visit Level 3 (99283) $648 $1,080 2.2×
Emergency Dept Visit Level 4 (99284) $1,026.60 $1,711 2.3×
Ep & ablate supravent arrhyt (93653) $15,445.80 $25,743 0.6×
Ep & ablate ventric tachy (93654) $15,445.80 $25,743 0.6×
Er level 1 (99281) $183 $305 2.0×
Er level v (99285) $1,706.40 $2,844 2.7×
Eval aud funcj cand/po surg implt dev 1st hr (92626) $280.20 $467 2.0×
Evaluate pt use of inhaler (94664) $102 $170 0.4×
Evaluate Speech Production (92522) $293.40 $489 2.6×
Evaluate Swallowing Function (92610) $309.60 $516 3.6×
Evaluation of speech fluency (92521) $362.40 $604 2.7×
Evoked Auditory Test,Limited (92587) $187.20 $312 0.8×
Exercise test for bronchospasm (94617) $269.40 $449 1.9×
External ECG rec>48hr<7d recording (93242) $190.80 $318 4.8×
External ECG rec>48hr<7d scanning alys w/report (93243) $541.20 $902 3.8×
External ECG rec>7d<15d recording (93246) $318 $530 7.9×
External ECG rec>7d<15d scanning alys w/report (93247) $541.20 $902 3.8×
External Ecg Scanning Analysis Report (93226) $541.20 $902 8.6×
Extracranial Bilat Study (93880) $1,207.20 $2,012 4.7×
Extracranial Uni/Ltd Study (93882) $1,041.60 $1,736 9.3×
F-up/limited tthrc echo congenital car anomaly (93304) $1,135.80 $1,893 1.9×
Group Therapeutic Procedures (97150) $39.60 $66 2.2×
Heart catheterization, both sides, with coronary and bypass graft angiography (93461) $14,436.60 $24,061 4.2×
Hemodialysis Procedure W/ Phys/Qhp Evaluation (90935)
range across 2 matching MRF lines
$2,360.40–$2,990.40 $3,934–$4,984 varies
Holter monitor recording (93225) $541.20 $902 3.8×
Immunization administration (90471)
range across 2 matching MRF lines
$75.60–$91.80 $126–$153 varies
Inital newborn e/m (99460) $123 $205 0.9×
Insert/Place Heart Catheter (93503) $3,792.60 $6,321 2.2×
Iontophoresis 15 min (97033) $86.40 $144 4.5×
Irrig Drug Delivery Device (96523) $158.40 $264 2.5×
IV infusion hydration each additional hour (96361) $201.60 $336 4.0×
IV infusion hydration initial 31 min-1 hour (96360) $424.80 $708 1.9×
IV infusion ther proph addl sequential to 1 hr (96367) $225.60 $376 2.9×
IV infusion therapy prophylaxis/dx ea hour (96366) $207.60 $346 4.1×
IV push initial (96374) $244.20 $407 1.1×
L Hrt Art/Grft Angio (93459) $12,570.60 $20,951 3.6×
Laryngeal Function Studies (92520) $225.60 $376 1.6×
Low frequency non-thermal us (97610) $278.40 $464 1.3×
Lwr Xtr Vasc Stdy Bilat (93924)
range across 2 matching MRF lines
$347.40–$684.60 $579–$1,141 varies
Mechanical chest wall oscillation per session (94669) $115.20 $192 0.5×
Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) $70.20 $117 2.2×
Medical nutrition assmt&ivntj indiv each 15 mi (97802) $71.40 $119 1.9×
Medical nutrition therapy grp2/ indiv ea 30 mi (97804) $106.80 $178 6.3×
Methacholine challenge (94070) $772.80 $1,288 1.9×
Motion Fluoroscopy/Swallow (92611) $410.40 $684 4.5×
Multiple Sleep Latency Test (95805) $2,931 $4,885 3.2×
Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) $246 $410 0.6×
Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) $219.60 $366 1.0×
Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) $376.80 $628 0.9×
Neuromuscular Reeducation (97112) $108 $180 3.3×
Nonphysician Telephone Assessment 11-20 Min (98967) $95.40 $159 3.8×
Nonphysician Telephone Assessment 21-30 Min (98968) $141.60 $236 4.1×
Nonphysician Telephone Assessment 5-10 Min (98966) $49.20 $82 3.6×
Oral Function Therapy (92526)
range across 2 matching MRF lines
$108–$216 $180–$360 varies
Orthc/Prostc Mgmt Sbsq Enc (97763) $108 $180 2.2×
Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) $105 $175 2.3×
Ot eval high complexity (97167) $278.40 $464 2.8×
Ot Eval Low Complex (97165) $231.60 $386 2.3×
Ot Eval Moderate Complexity (97166) $247.20 $412 2.5×
Ot manual therapy 15 min (97140) $105 $175 3.8×
Ot paraffin bath (97018) $52.80 $88 8.8×
Ot Prosthetic Training, Each 15 Min (97761) $123 $205 3.0×
Ot Re-Eval Est Plan Care (97168) $160.80 $268 2.3×
Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) $219 $365 1.6×
Pediatric apnea monitor analyses computer (94776) $319.20 $532 2.3×
Penile Vascular Study,Ltd or F/U (93981) $939.60 $1,566 8.4×
Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) $222.60 $371 0.9×
Percutaneous tests w/allergenic extracts (95004) $46.80 $78 0.1×
Peripheral arterial disease rehab per session (93668) $135.60 $226 2.1×
Phlebotomy therapeutic (99195)
range across 2 matching MRF lines
$190.80–$385.80 $318–$643 varies
Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) $340.80 $568 5.4×
Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) $340.80 $568 5.4×
Physical Performance Test (97750) $106.20 $177 3.1×
Plethysmography (94726) $271.20 $452 0.7×
Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811)
range across 2 matching MRF lines
$4,977–$5,212.20 $8,295–$8,687 varies
Principal care management services, for a single high-risk disease, with the following required elements: one complex… (99426) $159.60 $266 1.5×
Psychiatric diagnostic evaluation (90791) $295.80 $493 1.6×
Psycl/nrpsycl tst tech 2+ tst 1st 30 min (96138) $248.40 $414 0.5×
Pt Asstv Technol Assmt Dir Cntct W/Reprt Ea 15 Min (97755) $90.60 $151 2.4×
Pt Eval High Complex (97163) $278.40 $464 2.8×
Pt eval low complex 20 min (97161) $231.60 $386 2.4×
Pt Eval Mod Complex (97162) $247.20 $412 2.5×
Pt gait training 15 min (97116) $105 $175 3.6×
Pt group caregiver training (97552) $34.80 $58 1.6×
Pt mechanical traction (97012) $80.40 $134 5.6×
Pt Re-Eval Est Plan Care (97164) $160.80 $268 2.4×
Pt ultraviolet (97028) $27.60 $46 3.3×
Pulm function test by gas (94727) $293.40 $489 1.3×
Pulmonary Stress Testing (94618) $367.80 $613 2.6×
R Hrt Art/Grft Angio (93457) $12,403.20 $20,672 3.6×
Refill/Maint Portable Pump (96521) $287.40 $479 1.3×
Refill/Maint Pump/Resvr Syst (96522) $287.40 $479 1.3×
Rem ther mntr dev sply data muscskel sys ea 30 d (98977) $67.80 $113 1.7×
Rem ther mntr dev sply resp (98976) $67.80 $113 1.7×
Remote 30 Day Ecg Rev/Report (93270) $190.80 $318 4.8×
Remote therapeutic mntr 1st set-up&pt educaj eqp (98975) $235.20 $392 1.6×
Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) $290.40 $484 1.4×
Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) $393.60 $656 3.2×
Self Care Mngment Training (97535) $105 $175 3.2×
Sensory Integration Ea 15 Min (97533) $108 $180 1.8×
Sleep study unattended (95806)
range across 2 matching MRF lines
$526.20–$723 $877–$1,205 varies
Slp caregiver training 1st 30 min (97550) $84 $140 1.6×
Slp Stdy Unatnd W/Anal (95801) $81 $135 1.3×
Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) $686.40 $1,144 3.0×
Speech sound lang comprehen (92523) $406.20 $677 1.8×
Spirometry (94010) $470.40 $784 2.0×
Standardized Cognitive Performance Testing (96125) $280.20 $467 2.7×
Stress Tte Only (93350) $1,378.80 $2,298 2.4×
Tensilon Test (95857) $391.80 $653 1.7×
Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) $108 $180 4.8×
Ther Ivntj Ea Addl 15 Min (97130) $108 $180 5.1×
Ther Px 1/> Areas Each 15 Min Aqua Ther W/Xerss (97113) $108 $180 2.9×
Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) $286.80 $478 2.8×
Ther/Proph/Diag Inj Ia (96373) $186 $310 0.8×
Ther/Proph/Diag Inj Sc/Im (96372) $150 $250 1.9×
Ther/Proph/Diag Iv Inf Init (96365) $495.60 $826 2.2×
Therapeutic Activities (97530) $105 $175 3.0×
Tilt table test with heart rhythm and blood pressure monitoring (93660) $1,642.80 $2,738 4.1×
Tte w/doppler, complete (93306)
range across 3 matching MRF lines
$2,502–$3,265.20 $4,170–$5,442 varies
Tte W/O Doppler Complete (93307) $1,294.20 $2,157 5.1×
Tx atrial fib pulm vein isol (93656) $15,445.80 $25,743 0.6×
Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507)
range across 2 matching MRF lines
$83.40–$256.80 $139–$428 varies
Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) $129.60 $216 5.4×
Tx/Pro/Dx Inj New Drug Addon (96375) $217.20 $362 4.3×
Unlisted cardiovascular service/procedure (93799) $1,577.40 $2,629 11.4×
Upr/L Xtremity Art 2 Levels (93922) $533.40 $889 3.7×
Upr/Lxtr Art Stdy 3+ Lvls (93923)
range across 2 matching MRF lines
$778.80–$1,459.20 $1,298–$2,432 varies
Vasopneumatic device (97016) $52.80 $88 4.4×
Vent Mgmt Inpat Init Day (94002) $943.80 $1,573 1.4×
Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) $765 $1,275 1.2×
Vital capacity, total (94150) $98.40 $164 0.7×
Wheelchair Mgmt Ea 15 Min (97542) $108 $180 3.5×
Whirlpool Therapy (97022) $62.40 $104 4.0×

A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.