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 |
|---|---|---|---|---|
| Coveredge 32 lead kit 40cm 48 HCPCS C1897 | $975.85 | $1,774.27 | not published | 0 |
| Covid-19 administration immunization im inj 1st/only component CPT 90480 | $50.05 | $91.00 | not published | 0 |
| Covid-19 IV infusion and post admin monitoring tocilizumab 1st dose HCPCS M0249 | $484.55 | $881.00 | not published | 0 |
| Covid-19 lab test non-cdc HCPCS U0002 | $162.80 | $296.00 | $51.31 – $53.88 | 3 |
| #covid19rsv-rsv CPT 87634 | not published | not published | $70.20 – $73.71 | 3 |
| #coxa-coxsackie a serotype a16 CPT 86658 | $406.45 | $739.00 | $13.03 – $13.68 | 3 |
| C-peptide CPT 84681 | $47.30 | $86.00 | $20.81 – $21.85 | 3 |
| Cptrized corneal topography CPT 92025 | not published | not published | $63.22 – $66.38 | 3 |
| Cptr ophth dx img post segmt CPT 92134 | not published | not published | $63.22 – $66.38 | 3 |
| Cptrz oph img pst sg rta oct CPT 92137 | not published | not published | $231.39 – $242.96 | 3 |
| Crbrospnl fld flw imag cistern CPT 78630 | $1,240.80 | $2,256.00 | $581.86 – $610.95 | 3 |
| C-reactive protein CPT 86140 | $158.40 | $288.00 | $5.18 – $5.44 | 3 |
| C-reactive protein high sensitivity CPT 86141 | $192.50 | $350.00 | $12.95 – $13.60 | 3 |
| C-reactive protein, quantitative CPT 86406 | not published | not published | $10.64 – $11.17 | 3 |
| Creat artery-vein fistula autograft 36825 CPT 36825 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Create eardrum opening CPT 69436 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Create passage to kidney CPT 52334 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Creatine isoforms CPT 82554 | not published | not published | $11.87 – $12.46 | 3 |
| Creatine kinase CPT 82550 | $57.20 | $104.00 | $6.51 – $6.84 | 3 |
| Creatine kinase isoenzymes CPT 82552 | $171.60 | $312.00 | $13.39 – $14.06 | 3 |
| Creatine kinase mb CPT 82553 | $227.70 | $414.00 | $11.55 – $12.13 | 3 |
| Creatine - sendout CPT 82540 | $52.25 | $95.00 | $4.64 – $4.87 | 3 |
| Creatinine CPT 82565 | $81.40 | $148.00 | $5.12 – $5.38 | 3 |
| Creatinine 24 hour urine CPT 82570 | $99.55 | $181.00 | $5.18 – $5.44 | 3 |
| Creatinine clearance urine CPT 82575 | $230.45 | $419.00 | $9.46 – $9.93 | 3 |
| #creutz-prot.,western blot CPT 84182 | $713.90 | $1,298.00 | $29.21 – $30.67 | 3 |
| Cricopharyngeal myotomy 43030 CPT 43030 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Cricotracheal resection CPT 31592 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Crisis psychotherapy additional 30 mins 90840 CPT 90840 | $180.40 | $328.00 | not published | 0 |
| Critical care 30-74 minutes CPT 99291 | $2,988.15 | $5,433.00 | $885.19 – $929.45 | 3 |
| Critical care each additional 30 minutes CPT 99292 | $1,221.00 | $2,220.00 | not published | 0 |
| Cross-over vein graft CPT 34520 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Cryocautery of cervix 57511 CPT 57511 | not published | not published | $326.55 – $342.88 | 3 |
| Cryofibrinogen qualitative - sendout CPT 82585 | $79.75 | $145.00 | $14.14 – $14.85 | 3 |
| Cryoprecipitate each unit HCPCS P9012 | $865.70 | $1,574.00 | not published | 0 |
| Cryopreservation oocyte(s) CPT 89337 | not published | not published | $182.57 – $191.70 | 3 |
| Cryopreservation sperm CPT 89259 | not published | not published | $182.57 – $191.70 | 3 |
| Cryopreserve stem cells CPT 38207 | not published | not published | $472.77 – $496.41 | 3 |
| Cryopreserve testicular tiss CPT 89335 | not published | not published | $55.84 – $58.64 | 3 |
| Cryosurg ablate fa each CPT 19105 | not published | not published | $4,195.85 – $4,405.64 | 3 |
| Cryosurgery penis lesion(s) 54056 CPT 54056 | not published | not published | $215.00 – $225.75 | 3 |
| Cryotherapy of acne 17340 CPT 17340 | not published | not published | $63.22 – $66.38 | 3 |
| Cryptococcus abs qn - sendout CPT 86641 | $202.40 | $368.00 | $14.41 – $15.13 | 3 |
| Cryptosporidium antigen CPT 87272 | $77.55 | $141.00 | $11.98 – $12.58 | 3 |
| Crystal identification light microscopy CPT 89060 | $284.35 | $517.00 | $7.33 – $7.70 | 3 |
| Csf leakage imaging CPT 78650 | $1,963.50 | $3,570.00 | $1,387.37 – $1,456.74 | 3 |
| Csf ventriculography CPT 78635 | not published | not published | $581.86 – $610.95 | 3 |
| CT 3d report other modality w/workstation CPT 76377 | $915.20 | $1,664.00 | not published | 0 |
| Cta abdomen without & /or w/contrast CPT 74175 | $5,082.00 | $9,240.00 | $187.96 – $197.36 | 3 |
| Cta abdominal aorta & (both sides) ileofemoral lower extremity w runoff without & w/contrast CPT 75635 | $3,507.90 | $6,378.00 | $187.96 – $197.36 | 3 |
| Cta lower extremity without & w/contrast (both sides) CPT 73706 | $3,114.65 | $5,663.00 | $187.96 – $197.36 | 3 |
| Cta neck without &/or w/contrast CPT 70498 | $2,917.20 | $5,304.00 | $187.96 – $197.36 | 3 |
| CT Angiogram of Abdomen and Pelvis CPT 74174 | $5,082.00 | $9,240.00 | $373.86 – $392.55 | 3 |
| CT Angiogram of the Chest (for blood clot) CPT 71275 | $3,864.85 | $7,027.00 | $187.96 – $197.36 | 3 |
| CT Angiogram of the Head CPT 70496 | $3,260.40 | $5,928.00 | $187.96 – $197.36 | 3 |
| CT angio hrt w/3d image CPT 75574 | $1,824.35 | $3,317.00 | $373.86 – $392.55 | 3 |
| CT angio pelvis CPT 72191 | $2,191.75 | $3,985.00 | $187.96 – $197.36 | 3 |
| Cta upper extremity w &/or without contrast left CPT 73206 | $3,144.90 | $5,718.00 | $187.96 – $197.36 | 3 |
| CT bone density axial CPT 77078 | not published | not published | $93.26 – $97.92 | 3 |
| CT cerebral perf w cont & prcssng CPT 70473 | not published | not published | $187.96 – $197.36 | 3 |
| CT colonography dx CPT 74261 | not published | not published | $112.03 – $117.63 | 3 |
| CT colonography dx w/dye CPT 74262 | not published | not published | $187.96 – $197.36 | 3 |
| CT colonography screening CPT 74263 | not published | not published | $255.69 – $268.47 | 3 |
| CT guidance for needle placement CPT 77012 | $2,123.00 | $3,860.00 | not published | 0 |
| CT guidance for percutaneous drain w/catheter placement supervision & interpretation CPT 75989 | $1,895.85 | $3,447.00 | not published | 0 |
| CT guid cryo ablat intramuscular CPT 20999 | not published | not published | $264.33 – $277.55 | 3 |
| CT guid parench tis ablat CPT 77013 | $1,193.50 | $2,170.00 | not published | 0 |
| CT heart w/evaluation of calcium without contrast CPT 75571 | $95.70 | $174.00 | $93.26 – $97.92 | 3 |
| CT hrt c+ strux cgen hrt ds CPT 75573 | not published | not published | $373.86 – $392.55 | 3 |
| CT hrt w/3d image CPT 75572 | not published | not published | $373.86 – $392.55 | 3 |
| CT limited or localized follow-up study CPT 76380 | $990.00 | $1,800.00 | $93.26 – $97.92 | 3 |
| CT lower extremity w/contrast (both sides) CPT 73701 | $2,477.20 | $4,504.00 | $187.96 – $197.36 | 3 |
| CT lower extremity without contrast (both sides) CPT 73700 | $1,941.50 | $3,530.00 | $112.03 – $117.63 | 3 |
| CT lwr extremity w/o&w/dye CPT 73702 | $2,781.35 | $5,057.00 | $187.96 – $197.36 | 3 |
| CT neck soft tissue w/contrast CPT 70491 | $2,059.20 | $3,744.00 | $187.96 – $197.36 | 3 |
| CT neck soft tissue without contrast CPT 70490 | $1,887.60 | $3,432.00 | $112.03 – $117.63 | 3 |
| CT neck soft tissue without & w/contrast CPT 70492 | $2,230.80 | $4,056.00 | $187.96 – $197.36 | 3 |
| CT orbit/sella/fossa w/wo contrast CPT 70482 | $2,973.30 | $5,406.00 | $187.96 – $197.36 | 3 |
| CT orbit/sella/ or posterior outer inner or middle ear w/contrast CPT 70481 | $2,334.20 | $4,244.00 | $187.96 – $197.36 | 3 |
| CT orbit/sella/ or posterior outer inner or middle ear without contrast CPT 70480 | $1,972.85 | $3,587.00 | $112.03 – $117.63 | 3 |
| Ctrl nosebld postir subsq 30906 CPT 30906 | $265.65 | $483.00 | not published | 0 |
| CT scan for therapy guide CPT 77014 | $1,343.65 | $2,443.00 | not published | 0 |
| CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 | $5,618.25 | $10,215.00 | $373.86 – $392.55 | 3 |
| CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 | $4,334.00 | $7,880.00 | $373.86 – $392.55 | 3 |
| CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 | $4,173.95 | $7,589.00 | $255.69 – $268.47 | 3 |
| CT thoracic spine w/contrast CPT 72129 | $2,568.50 | $4,670.00 | $187.96 – $197.36 | 3 |
| CT thoracic spine without contrast CPT 72128 | $2,407.90 | $4,378.00 | $112.03 – $117.63 | 3 |
| CT thorax low dose for lung screening without contrast CPT 71271 | $295.35 | $537.00 | $112.03 – $117.63 | 3 |
| CT t-spine w /wo contrast CPT 72130 | $2,654.85 | $4,827.00 | $187.96 – $197.36 | 3 |
| CT upper extremity w/contrast (both sides) CPT 73201 | $2,668.05 | $4,851.00 | $373.86 – $392.55 | 3 |
| CT upper extremity without contrast (both sides) CPT 73200 | $1,994.85 | $3,627.00 | $112.03 – $117.63 | 3 |
| CT uppr extremity w/o&w/dye CPT 73202 | $3,144.90 | $5,718.00 | $187.96 – $197.36 | 3 |
| Cultr oocyte/embryo <4 days CPT 89250 | not published | not published | $182.57 – $191.70 | 3 |
| Cultr oocyte/embryo <4 days CPT 89251 | not published | not published | $182.57 – $191.70 | 3 |
| Cult skin graft fnhfg 15155 CPT 15155 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Cult skin grft t/arm/leg CPT 15150 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Culture aerobic additional method definitive id each CPT 87077 | $49.50 | $90.00 | $8.08 – $8.48 | 3 |
| Culture afb any source CPT 87116 | $194.15 | $353.00 | $10.80 – $11.34 | 3 |
| Culture anaerobic additional method definitive id each CPT 87076 | $61.05 | $111.00 | $8.08 – $8.48 | 3 |
| Culture anaerobic except blood CPT 87075 | $155.65 | $283.00 | $9.47 – $9.94 | 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.