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 |
|---|---|---|---|---|
| Destruct ben lesion 15/> 17111 CPT 17111 | not published | not published | $215.00 – $225.75 | 3 |
| Destruct cut vasl lesions 10-50cm 17107 CPT 17107 | not published | not published | $792.00 – $831.60 | 3 |
| Destruct cut vasl lesions <10cm 17106 CPT 17106 | not published | not published | $435.63 – $457.41 | 3 |
| Destruct cut vasl lesions >50cm 17108 CPT 17108 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Destruction anal lesion(s) CPT 46910 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Destruction anal lesion(s) CPT 46924 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Destruction anal lesion(s) smpl chem 46900 CPT 46900 | not published | not published | $435.63 – $457.41 | 3 |
| Destruction benign lesions < 14 lesions CPT 17110 | $207.35 | $377.00 | $215.00 – $225.75 | 3 |
| Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 | not published | not published | $215.00 – $225.75 | 3 |
| Destruction laser surgery anal lesions 46917 CPT 46917 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Destruction mal lsn s/n/h/f/g 2.1-3cm CPT 17273 | not published | not published | $435.63 – $457.41 | 3 |
| Destruction mal lsn s/n/h/f/g 3.1-4cm CPT 17274 | not published | not published | $435.63 – $457.41 | 3 |
| Destruction mal lsn t/a/l 3.1-4cm CPT 17264 | not published | not published | $435.63 – $457.41 | 3 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | not published | not published | $435.63 – $457.41 | 3 |
| Destruction penis lesion(s) chem 54050 CPT 54050 | not published | not published | $435.63 – $457.41 | 3 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Destruction premal lesions 15/> 17004 CPT 17004 | not published | not published | $435.63 – $457.41 | 3 |
| Destruction rectal tumor 45190 CPT 45190 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Destruction vag lesions complex 57065 CPT 57065 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Destruction vag lesions simple 57061 CPT 57061 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Detect agent nos dna dir CPT 87797 | not published | not published | $30.03 – $31.53 | 3 |
| Detect agnt mult dna direc CPT 87800 | not published | not published | $43.67 – $45.85 | 3 |
| Devel tst phys/qhp 1st hr CPT 96112 | not published | not published | $137.89 – $144.78 | 3 |
| Device ablt adv novasure HCPCS C1886 | $4,452.25 | $8,095.00 | not published | 0 |
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | $2,475.66 | $4,501.20 | not published | 0 |
| Device sut capio slim opn HCPCS C2631 | $676.05 | $1,229.19 | not published | 0 |
| Device tiss remov myosure reach HCPCS C1782 | $1,076.93 | $1,958.06 | not published | 0 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $243.65 | $443.00 | $93.26 – $97.92 | 3 |
| Dexamethasone panel CPT 80420 | not published | not published | $161.88 – $169.97 | 3 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $352.00 | $640.00 | $22.23 – $23.34 | 3 |
| Diabetes (HbA1c) Test CPT 83036 | $59.95 | $109.00 | $9.71 – $10.20 | 3 |
| Diab manage trn ind/group HCPCS G0109 | $80.30 | $146.00 | $15.78 – $16.57 | 3 |
| Diag bronchoscope/catheter CPT 31643 | not published | not published | $1,907.37 – $2,002.74 | 3 |
| Diag laparo separate proc 49320 CPT 49320 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Diagnostic anoscopy & biopsy CPT 46607 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $152.90 | $278.00 | $142.58 – $149.71 | 3 |
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $80.85 | $147.00 | not published | 0 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $40.15 | $73.00 | not published | 0 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $416.35 | $757.00 | not published | 0 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $580.25 | $1,055.00 | $111.97 – $117.57 | 3 |
| Diagnostic Mammogram (one breast) CPT 77065 | $289.85 | $527.00 | $88.75 – $93.19 | 3 |
| Diagnostic radio unlisted proc CPT 76499 | $646.80 | $1,176.00 | $93.26 – $97.92 | 3 |
| Dialysis one evaluation CPT 90945 | $484.00 | $880.00 | $447.15 – $469.50 | 3 |
| Dialysis repeated eval CPT 90947 | $774.40 | $1,408.00 | not published | 0 |
| Diathermy eg microwave CPT 97024 | not published | not published | $7.82 – $8.21 | 3 |
| Diffusing capacity CPT 94729 | $438.90 | $798.00 | not published | 0 |
| Digoxin total therapeutic drug level CPT 80162 | $169.40 | $308.00 | $13.28 – $13.94 | 3 |
| Dilate esophagus CPT 43453 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Dilate esophagus 1/mult pass CPT 43450 | not published | not published | $971.94 – $1,020.54 | 3 |
| Dilate urethra stricture CPT 53600 | $426.80 | $776.00 | $267.74 – $281.13 | 3 |
| Dilate urethra stricture CPT 53601 | not published | not published | $142.58 – $149.71 | 3 |
| Dilate urethra stricture CPT 53605 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Dilate urethra stricture CPT 53621 | not published | not published | $267.74 – $281.13 | 3 |
| Dilation/female urethra/initial 53660 CPT 53660 | not published | not published | $137.89 – $144.78 | 3 |
| Dilation of anal sphincter CPT 45905 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Dilation of cervical canal 57800 CPT 57800 | $2,390.85 | $4,347.00 | $3,468.96 – $3,642.41 | 3 |
| Dilation of rectal stricture 45910 CPT 45910 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Dilation of urethra CPT 53661 | not published | not published | $142.58 – $149.71 | 3 |
| Dilation of urethra CPT 53665 | not published | not published | $2,240.09 – $2,352.10 | 3 |
| Dilation of vagina CPT 57400 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Dilation salivary duct 42650 CPT 42650 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | $2,080.10 | $3,782.00 | $747.24 – $784.60 | 3 |
| Dilat xst trc ndurlgc px CPT 50436 | $2,411.20 | $4,384.00 | $3,777.44 – $3,966.31 | 3 |
| Dilat xst trc new access rcs CPT 50437 | $4,052.95 | $7,369.00 | $3,777.44 – $3,966.31 | 3 |
| Dir nsl mucous membrane test CPT 95065 | not published | not published | $40.03 – $42.03 | 3 |
| Disability dlco CPT 94727 | $326.70 | $594.00 | $231.39 – $242.96 | 3 |
| Disaccharidases CPT 82657 | $390.50 | $710.00 | $22.17 – $23.28 | 3 |
| Disarticulation sho sec clsr CPT 23921 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Disarticulation shoulder CPT 23920 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Discography cerv/thor spine CPT 72285 | $4,674.45 | $8,499.00 | not published | 0 |
| Dise eval slp do brth flx dx CPT 42975 | not published | not published | $1,907.37 – $2,002.74 | 3 |
| Dissolve clot heart vessel CPT 92975 | $1,098.35 | $1,997.00 | not published | 0 |
| Dist revas ligation hemo CPT 36838 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Diverticulectomy/hypophar/esoph 43130 CPT 43130 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Dmd dup/delet analysis CPT 81161 | $1,010.35 | $1,837.00 | $279.00 – $292.95 | 3 |
| Dmpk gene charac alleles CPT 81239 | not published | not published | $274.83 – $288.57 | 3 |
| Dmpk gene detc abnor allele CPT 81234 | not published | not published | $137.00 – $143.85 | 3 |
| Dna antibody native/double stranded CPT 86225 | $124.30 | $226.00 | $13.74 – $14.43 | 3 |
| Dna gardnerella CPT 87510 | not published | not published | $20.05 – $21.05 | 3 |
| Dna probe chlamydia CPT 87490 | not published | not published | $22.75 – $23.89 | 3 |
| Dna probe gc CPT 87590 | not published | not published | $26.88 – $28.22 | 3 |
| Dna trichomonas CPT 87660 | not published | not published | $20.05 – $21.05 | 3 |
| Doppler echo complete CPT 93320 | $796.95 | $1,449.00 | not published | 0 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $5,369.65 | $9,763.00 | not published | 0 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $831.05 | $1,511.00 | $231.39 – $242.96 | 3 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $495.00 | $900.00 | $142.58 – $149.71 | 3 |
| Double transfer toe-hand CPT 26554 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Dpyd gene common variants CPT 81232 | $527.45 | $959.00 | $174.81 – $183.55 | 3 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $849.75 | $1,545.00 | $758.85 – $796.79 | 3 |
| Drainage ext aud canal abscess 69020 CPT 69020 | $805.20 | $1,464.00 | $758.85 – $796.79 | 3 |
| Drainage external ear complex 69005 CPT 69005 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Drainage external ear simple 69000 CPT 69000 | $975.15 | $1,773.00 | $758.85 – $796.79 | 3 |
| Drainage lymph node lesion 38300 CPT 38300 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Drainage lymph node lesion 38305 CPT 38305 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Drainage mouth roof lesion CPT 42000 | $377.30 | $686.00 | not published | 0 |
| Drainage of arm bursa 23931 CPT 23931 | $2,209.90 | $4,018.00 | $1,769.88 – $1,858.38 | 3 |
| Drainage of bladder abscess CPT 51080 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Drainage of bone lesion CPT 26992 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Drainage of bone lesion CPT 27303 | not published | not published | $3,506.34 – $3,681.65 | 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.