SSM Health Good Samaritan Hospital - Mt. Vernon
1 Good Samaritan Way, Mount Vernon, IL · SSM Health · · NPI 1609897339
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 |
|---|---|---|---|---|
| Chrom analysis CPT 88273 | not published | not published | $34.81 – $36.55 | 3 |
| Chromatogram assay sugars CPT 84375 | not published | not published | $39.00 – $40.95 | 3 |
| Chromatography CPT 83021 | $271.15 | $493.00 | $18.06 – $18.96 | 3 |
| Chromogenic substrate assay CPT 85130 | $371.80 | $676.00 | $11.89 – $12.48 | 3 |
| Chromo high res and frag x - sendout CPT 81243 | not published | not published | $57.04 – $59.89 | 3 |
| Chromosome analys amniotic CPT 88269 | $418.55 | $761.00 | $173.66 – $182.34 | 3 |
| Chromosome analysis 100 CPT 88249 | not published | not published | $173.17 – $181.83 | 3 |
| Chromosome analysis 15-20 cell count CPT 88262 | $1,512.50 | $2,750.00 | $125.49 – $131.76 | 3 |
| Chromosome analysis 20-25 CPT 88245 | not published | not published | $173.17 – $181.83 | 3 |
| Chromosome analysis 45 CPT 88263 | not published | not published | $150.29 – $157.80 | 3 |
| Chromosome analysis 5 CPT 88261 | $653.95 | $1,189.00 | $264.34 – $277.56 | 3 |
| Chromosome analysis 50-100 CPT 88248 | $942.70 | $1,714.00 | $173.17 – $181.83 | 3 |
| Chromosome analys placenta CPT 88267 | not published | not published | $188.57 – $198.00 | 3 |
| Chromosome banding study CPT 88283 | not published | not published | $68.60 – $72.03 | 3 |
| Chromosome count additional CPT 88285 | not published | not published | $26.91 – $28.26 | 3 |
| Chromosome karyotype study CPT 88280 | $614.35 | $1,117.00 | $33.47 – $35.14 | 3 |
| Chromosome study additional CPT 88289 | $479.05 | $871.00 | $34.43 – $36.15 | 3 |
| Chronic urticaria - sendout CPT 86343 | not published | not published | $12.46 – $13.08 | 3 |
| Chylomicron screen, bf - sendout CPT 82664 | $99.55 | $181.00 | $61.50 – $64.58 | 3 |
| Cine/video x-rays CPT 76120 | not published | not published | $112.03 – $117.63 | 3 |
| Circum 28 days or older CPT 54161 | not published | not published | $2,240.09 – $2,352.10 | 3 |
| Circumcise/surg/28 days or < 54160 CPT 54160 | not published | not published | $747.24 – $784.60 | 3 |
| Circumcision (newborn) CPT 54150 | $2,295.70 | $4,174.00 | $2,240.09 – $2,352.10 | 3 |
| C-kit mutation liquid tumor - sendout CPT 81272 | not published | not published | $329.51 – $345.99 | 3 |
| Claviculectomy partial CPT 23120 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Claviculectomy total CPT 23125 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Clean out mastoid cavity CPT 69222 | $714.45 | $1,299.00 | not published | 0 |
| Clearance of airways CPT 31720 | $146.30 | $266.00 | $234.66 – $246.39 | 3 |
| C-lens fitg corneosclrl lens CPT 92313 | not published | not published | $142.58 – $149.71 | 3 |
| C-lens fitg tech aphakia 1 CPT 92315 | not published | not published | $142.58 – $149.71 | 3 |
| C-lens fitg tech aphakia ou CPT 92316 | not published | not published | $142.58 – $149.71 | 3 |
| C-lens fitg tech corneosclrl CPT 92317 | not published | not published | $40.03 – $42.03 | 3 |
| Clip ligating vesolock lg HCPCS C1760 | $788.84 | $1,434.25 | not published | 0 |
| Clitoroplasty intersex state CPT 56805 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Closed carpo/metacarpal disl thumb w/manip CPT 26641 | $330.00 | $600.00 | $264.33 – $277.55 | 3 |
| Closed carpo/metacarpal fx disl thumb w/manip CPT 26645 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Closed treatment of femoral fracture proximal end neck; wi CPT 27232 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Closed tx/acetabululm without manip 27220 CPT 27220 | not published | not published | $264.33 – $277.55 | 3 |
| Closed tx humerus fx with manip 23605 CPT 23605 | $2,132.35 | $3,877.00 | $1,723.15 – $1,809.31 | 3 |
| Closed tx humerus fx without manip 23600 CPT 23600 | not published | not published | $264.33 – $277.55 | 3 |
| Closed tx humerus fx w/manip 24505 CPT 24505 | $1,397.00 | $2,540.00 | $1,723.15 – $1,809.31 | 3 |
| Closed tx metatarsophalangeal jnt disl without anes CPT 28630 | $329.45 | $599.00 | $264.33 – $277.55 | 3 |
| Closed tx nose/jaw fx CPT 21345 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Closed tx orbit w/manipulj CPT 21401 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Closed tx post hip arthroplasty disloc w/anes 27266 CPT 27266 | $1,531.75 | $2,785.00 | $1,723.15 – $1,809.31 | 3 |
| Closed tx septal&nose fx CPT 21337 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Closed tx sesamoid fx 28530 CPT 28530 | not published | not published | $264.33 – $277.55 | 3 |
| Closed tx/talus fracture without manip 28430 CPT 28430 | not published | not published | $264.33 – $277.55 | 3 |
| Closed tx vert fx w/manj CPT 22315 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Close mastoid fistula CPT 69700 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Close median sternotomy separation 21750 CPT 21750 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Clostridium toxin a w/optic CPT 87803 | not published | not published | $16.00 – $16.80 | 3 |
| Clos txnose fx without stablz 21315 CPT 21315 | $1,947.00 | $3,540.00 | $1,662.71 – $1,745.84 | 3 |
| Closure laceration vestibule mouth > 2.5 cm cmplx CPT 40831 | $820.60 | $1,492.00 | not published | 0 |
| Closure of salivary fistula CPT 42600 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Closure of windpipe lesion 31820 CPT 31820 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Closure paravalvlr leak pq CPT 33999 | $1,709.95 | $3,109.00 | $672.23 – $705.84 | 3 |
| Clot factor fletcher fact CPT 85292 | not published | not published | $18.93 – $19.88 | 3 |
| Clot factor viii reltd antgn CPT 85244 | not published | not published | $20.42 – $21.44 | 3 |
| Clot factor wght kininogen CPT 85293 | not published | not published | $18.93 – $19.88 | 3 |
| Clot factor xii hageman CPT 85280 | $118.25 | $215.00 | $19.35 – $20.32 | 3 |
| Clot factor xiii fibrin scrn CPT 85291 | $39.60 | $72.00 | $9.11 – $9.57 | 3 |
| Clot factor xiii fibrin stab CPT 85290 | $81.95 | $149.00 | $16.34 – $17.16 | 3 |
| Clsd/shoulder dislo/manip/no anest 23650 CPT 23650 | $901.45 | $1,639.00 | $264.33 – $277.55 | 3 |
| Clsd tx bimalleol ank fx without manip 27808 CPT 27808 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx carpo/metacarpl disl thmb manip ea without anes CPT 26670 | $381.15 | $693.00 | $264.33 – $277.55 | 3 |
| Clsd tx clav dislc without manip 23520 CPT 23520 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Clsd tx clavicle dislocation without manip 23540 CPT 23540 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx clavicle fracture w/manip 23505 CPT 23505 | $1,403.05 | $2,551.00 | $1,723.15 – $1,809.31 | 3 |
| Clsd tx/clavicular fx without manip 23500 CPT 23500 | $667.15 | $1,213.00 | $264.33 – $277.55 | 3 |
| Clsd tx coccygeal fracture 27200 CPT 27200 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx/dis phalan fx without manip/ea 26750 CPT 26750 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx dist fib fx w/manip 27788 CPT 27788 | $381.15 | $693.00 | $264.33 – $277.55 | 3 |
| Clsd tx/dis tib/wt bear no manip 27824 CPT 27824 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx elbow dislocation child 24640 CPT 24640 | $381.15 | $693.00 | $264.33 – $277.55 | 3 |
| Clsd tx/fem shaft fx/manipulation 27502 CPT 27502 | $2,037.75 | $3,705.00 | $1,723.15 – $1,809.31 | 3 |
| Clsd tx finger tendon w/wo perq pin 26432 CPT 26432 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Clsd tx fracture of radius 25500 CPT 25500 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx/fx grt toe/phalanx/phalang 28490 CPT 28490 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx/fx/phalanx/phalang/manip 28515 CPT 28515 | $381.15 | $693.00 | $264.33 – $277.55 | 3 |
| Clsd tx fx radius/ulna dist without manip 25600 CPT 25600 | $287.10 | $522.00 | $264.33 – $277.55 | 3 |
| Clsd tx fx radius/ulna dist w/manip 25605 CPT 25605 | $1,531.75 | $2,785.00 | $1,723.15 – $1,809.31 | 3 |
| Clsd tx fx radius/ulna without manip 25560 CPT 25560 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx fx radius/ulna w/manip 25565 CPT 25565 | $1,531.75 | $2,785.00 | $1,723.15 – $1,809.31 | 3 |
| Clsd tx/grt hum tube fx without manip 23620 CPT 23620 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx hip disloc without anes 27265 CPT 27265 | $381.15 | $693.00 | $264.33 – $277.55 | 3 |
| Clsd tx humeral fract without manip 24530 CPT 24530 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx humerus fract without manip 24500 CPT 24500 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx/metacar/interphal artic fx 26740 CPT 26740 | $284.35 | $517.00 | $264.33 – $277.55 | 3 |
| Clsd tx/metacarpal fx/sg without manip 26600 CPT 26600 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx/metacarpal fx/sng/w manip 26605 CPT 26605 | $381.15 | $693.00 | $264.33 – $277.55 | 3 |
| Clsd tx metacarp fx w/manip&ext fix ea bone 26607 CPT 26607 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Clsd tx metatarsal fracture w/manip 28475 CPT 28475 | $1,181.95 | $2,149.00 | $264.33 – $277.55 | 3 |
| Clsd tx/metatarsal fx without manip 28470 CPT 28470 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx/nasal bone fx/stabilize 21320 CPT 21320 | $2,498.10 | $4,542.00 | $3,552.91 – $3,730.55 | 3 |
| Clsd tx of ankle fracture w/manip 28435 CPT 28435 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Clsd tx patella disloc without anes 27560 CPT 27560 | $346.50 | $630.00 | $264.33 – $277.55 | 3 |
| Clsd tx/patellar fx without manip 27520 CPT 27520 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx pelvic ring fx CPT 27197 | not published | not published | $264.33 – $277.55 | 3 |
| Clsd tx pelvic ring fx CPT 27198 | $5,072.65 | $9,223.00 | $264.33 – $277.55 | 3 |
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.