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 |
|---|---|---|---|---|
| Colpotomy w/exploration 57000 CPT 57000 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Compatibility test each unit antiglobulin technique CPT 86922 | $204.05 | $371.00 | $182.57 – $191.70 | 3 |
| Compatibility test each unit electronic CPT 86923 | $124.85 | $227.00 | $182.57 – $191.70 | 3 |
| Compatibility test each unit immediate spin technique CPT 86920 | $105.60 | $192.00 | $182.57 – $191.70 | 3 |
| Compatibility test incubate CPT 86921 | $149.60 | $272.00 | $182.57 – $191.70 | 3 |
| Comp cystometrogram/void presssure 51728 CPT 51728 | not published | not published | $747.24 – $784.60 | 3 |
| Comp cystometrogram/void/uret pres 51729 CPT 51729 | not published | not published | $747.24 – $784.60 | 3 |
| Complement antigen each component c3 CPT 86160 | $225.50 | $410.00 | $12.00 – $12.60 | 3 |
| Complement fixation each CPT 86171 | not published | not published | $10.01 – $10.51 | 3 |
| Complete removal of vulva CPT 56625 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Complex cystometrogram 51726 CPT 51726 | not published | not published | $267.74 – $281.13 | 3 |
| Complex repair trunk 1.1-2.5cm 13120 CPT 13120 | $543.95 | $989.00 | $435.63 – $457.41 | 3 |
| Complex repair trunk 2.6-7.5cm 13101 CPT 13101 | not published | not published | $792.00 – $831.60 | 3 |
| Complex uroflowmetry (electronic) 51741 CPT 51741 | not published | not published | $231.39 – $242.96 | 3 |
| Complx repair enel 1.1-2.5 cm 13151 CPT 13151 | $572.00 | $1,040.00 | $792.00 – $831.60 | 3 |
| Complx repair enel 2.6-7.5 cm 13152 CPT 13152 | $841.50 | $1,530.00 | $792.00 – $831.60 | 3 |
| Complx repair enel addl 5cm/< 13153 CPT 13153 | $455.40 | $828.00 | not published | 0 |
| Complx repair fccmnaxghf 13131 CPT 13131 | $450.45 | $819.00 | $435.63 – $457.41 | 3 |
| Complx repair fccmnaxghf 13132 CPT 13132 | $841.50 | $1,530.00 | $435.63 – $457.41 | 3 |
| Complx repair fccmnaxghf 13133 CPT 13133 | $532.40 | $968.00 | not published | 0 |
| Complx repair sal addl 5 cm/> 13122 CPT 13122 | $366.85 | $667.00 | not published | 0 |
| Complx repair trunk 1.1-2.5 cm 13100 CPT 13100 | not published | not published | $792.00 – $831.60 | 3 |
| Composite graft/pri close/don area 15760 CPT 15760 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Comprehensive hearing test CPT 92557 | not published | not published | $137.89 – $144.78 | 3 |
| Compre oph exam est pt 1/> CPT 92014 | not published | not published | $142.67 – $149.80 | 3 |
| Compre oph exam new pt 1/> CPT 92004 | not published | not published | $142.67 – $149.80 | 3 |
| Computed tomographic angiography head and neck with contrast CPT 70471 | not published | not published | $373.86 – $392.55 | 3 |
| Concentration infection agents any type CPT 87015 | $40.70 | $74.00 | $6.68 – $7.01 | 3 |
| Conditioning play audiometry 92582 CPT 92582 | not published | not published | $137.89 – $144.78 | 3 |
| Condylomata destruction 56420 CPT 56420 | $233.75 | $425.00 | $216.65 – $227.48 | 3 |
| Conization/cerv/loop electrode exc 57522 CPT 57522 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Conization of cervix CPT 57520 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Connect omega .5mm HCPCS L8613 | $351.34 | $638.80 | not published | 0 |
| Constj trachesophgl fstl CPT 31611 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Construction of vagina CPT 57291 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Construct thumb replacement CPT 26550 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Construct vagina with graft CPT 57292 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Consultation pathology during surgery CPT 88329 | not published | not published | $63.22 – $66.38 | 3 |
| Consultation pathology during surgery cytological exam initial site CPT 88333 | $603.35 | $1,097.00 | not published | 0 |
| Consultation pathology during surgery frozen section each additional block CPT 88332 | $132.00 | $240.00 | not published | 0 |
| Consultation pathology during surgery frozen section first tissue block CPT 88331 | $282.70 | $514.00 | $182.57 – $191.70 | 3 |
| Consultation/report referred material w/preparation of slides CPT 88323 | $920.15 | $1,673.00 | $55.84 – $58.64 | 3 |
| Consultation/report referred slides prepared elsewhere CPT 88321 | $920.15 | $1,673.00 | $40.03 – $42.03 | 3 |
| Consult comp w/report rfrd material CPT 88325 | $877.25 | $1,595.00 | $182.57 – $191.70 | 3 |
| Contact lens fitg aphakia ou CPT 92312 | not published | not published | $142.58 – $149.71 | 3 |
| Contour cranial bone lesion CPT 21181 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Contour of face bone lesion CPT 21029 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Contrast baths charges CPT 97034 | $56.65 | $103.00 | $14.54 – $15.27 | 3 |
| Contrast exam abdominl aorta 75625-26 CPT 75625 | $4,217.40 | $7,668.00 | $3,383.62 – $3,552.80 | 3 |
| Contrast exam thoracic aorta CPT 75600 | not published | not published | $3,383.62 – $3,552.80 | 3 |
| Contrast exam thoracic aorta 75605-26 CPT 75605 | $7,183.55 | $13,061.00 | $5,963.01 – $6,261.16 | 3 |
| Contrast x-ray gallbladder CPT 74290 | not published | not published | $187.96 – $197.36 | 3 |
| Contrast x-ray of ankle CPT 73615 | $723.25 | $1,315.00 | $373.86 – $392.55 | 3 |
| Contrast x-ray of brain CPT 70010 | not published | not published | $373.86 – $392.55 | 3 |
| Contrast x-ray of brain CPT 70015 | not published | not published | $840.06 – $882.07 | 3 |
| Contrast x-ray of elbow CPT 73085 | $964.70 | $1,754.00 | $373.86 – $392.55 | 3 |
| Contrast x-ray of hip CPT 73525 | $1,327.15 | $2,413.00 | $373.86 – $392.55 | 3 |
| Contrast x-ray of knee joint CPT 73580 | $1,075.25 | $1,955.00 | $373.86 – $392.55 | 3 |
| Contrast x-ray of wrist CPT 73115 | $723.25 | $1,315.00 | $373.86 – $392.55 | 3 |
| Controller infinity pt dbs HCPCS C1787 | $979.46 | $1,780.84 | not published | 0 |
| Control nosebleed pack+caut 30905 CPT 30905 | $191.95 | $349.00 | $142.58 – $149.71 | 3 |
| Control nose/throat bleeding with surg ivntj 42972 CPT 42972 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Control of nosebleed ant comp 30903 CPT 30903 | $201.30 | $366.00 | $142.58 – $149.71 | 3 |
| Control of nosebleedantersmpl 30901 CPT 30901 | $324.50 | $590.00 | $142.58 – $149.71 | 3 |
| Control throat bleeding CPT 42962 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Conversion ext bil drg cath CPT 47535 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Convert nephrostomy catheter CPT 50434 | not published | not published | $2,240.09 – $2,352.10 | 3 |
| Conv gtube to jtube CPT 44373 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Coombs direct CPT 86880 | $97.35 | $177.00 | $63.22 – $66.38 | 3 |
| Coombs indirect qualitative each reagent red cell reference CPT 86885 | not published | not published | $182.57 – $191.70 | 3 |
| Coombs indirect titer reference CPT 86886 | $248.05 | $451.00 | $182.57 – $191.70 | 3 |
| Cor artery disease mrna CPT 81493 | not published | not published | $1,050.00 – $1,102.50 | 3 |
| Core ndl bx lng/med perq CPT 32408 | $1,549.90 | $2,818.00 | $1,769.88 – $1,858.38 | 3 |
| Cor hlx vlgs double osteot CPT 28299 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Cor hlx vlgs dstl mtar osteo CPT 28296 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Cor hlx vlgs prx phlx osteot CPT 28298 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Corneal hysteresis deter CPT 92145 | not published | not published | $63.22 – $66.38 | 3 |
| Coronary angio/cath placement bypass graft/lv gram/lt heart CPT 93459 | $18,909.00 | $34,380.00 | $3,474.11 – $3,647.82 | 3 |
| Coronary angio/lv gram/lt heart CPT 93458 | $17,069.80 | $31,036.00 | $3,474.11 – $3,647.82 | 3 |
| Coronary angio/lv gram/rt< heart CPT 93460 | $18,790.75 | $34,165.00 | $3,474.11 – $3,647.82 | 3 |
| Coronary art/grft angio s&i CPT 93455 | $10,800.90 | $19,638.00 | $3,474.11 – $3,647.82 | 3 |
| Coronary catheterization w/angiography supervision & interpretation CPT 93454 | $7,769.30 | $14,126.00 | $3,474.11 – $3,647.82 | 3 |
| Coronary thrombolysis/iv infusion 92977 CPT 92977 | $620.40 | $1,128.00 | not published | 0 |
| Correct bunion/keller/mcbride/mayo 28292 CPT 28292 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Correct cock-up 5th toe/plast clos 28286 CPT 28286 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Correct finger deformity CPT 26567 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Correct inverted nipple(s) CPT 19355 | not published | not published | $4,195.85 – $4,405.64 | 3 |
| Correction claw finger other CPT 26499 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Correction hallux valgus sesamoidectomy;prox meta osteotomy CPT 28295 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Correction trichiasis epilation forcep 67820 CPT 67820 | not published | not published | $142.58 – $149.71 | 3 |
| Correct metacarpal flaw CPT 26565 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Correct rectal prolapse CPT 45541 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Correct skin color 6.0 cm/< CPT 11920 | not published | not published | $792.00 – $831.60 | 3 |
| Corrj halux rigdus w/implt CPT 28291 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Corrj halux rigdus without implt CPT 28289 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Cortisol acth stimulation test - sendout CPT 80400 | $141.35 | $257.00 | $32.62 – $34.25 | 3 |
| Cortisol total am CPT 82533 | $248.60 | $452.00 | $16.30 – $17.12 | 3 |
| Costotransversectomy CPT 21610 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Co-treatment - group 15 mins, st CPT 92508 | $127.60 | $232.00 | $24.62 – $25.85 | 3 |
| Counseling smoke cess interm >10mins CPT 99407 | $53.35 | $97.00 | not published | 0 |
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.