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 |
|---|---|---|---|---|
| Drainage of forearm bursa CPT 25031 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Drainage of kidney lesion CPT 50390 | $1,268.85 | $2,307.00 | $758.85 – $796.79 | 3 |
| Drainage of mouth lesion CPT 41006 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Drainage of mouth lesion CPT 41007 | $1,433.30 | $2,606.00 | $1,662.71 – $1,745.84 | 3 |
| Drainage of mouth lesion CPT 41008 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Drainage of mouth lesion CPT 41009 | $548.90 | $998.00 | not published | 0 |
| Drainage of mouth lesion CPT 41016 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Drainage of mouth lesion CPT 41017 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Drainage of mouth lesion CPT 41018 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Drainage of nose lesion int 30000 CPT 30000 | $466.95 | $849.00 | not published | 0 |
| Drainage of pelvis bursa CPT 26991 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Drainage of pelvis lesion 26990 CPT 26990 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Drainage of prostate abscess CPT 52700 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Drainage of prostate abscess CPT 55720 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Drainage of prostate abscess CPT 55725 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Drainage of rectal abscess CPT 45005 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Drainage of rectal abscess 45020 CPT 45020 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Drainage of salivary gland CPT 42305 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Drainage of throat abscess CPT 42725 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Drainage of urethra abscess CPT 53040 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Drainage of urethra abscess 53060 CPT 53060 | not published | not published | $2,240.09 – $2,352.10 | 3 |
| Drainage of urinary leakage CPT 53080 | not published | not published | $747.24 – $784.60 | 3 |
| Drainage of urinary leakage CPT 53085 | not published | not published | $2,240.09 – $2,352.10 | 3 |
| Drain bladder by trocar/cath CPT 51101 | not published | not published | $920.24 – $966.25 | 3 |
| Drain blood from under nail 11740 CPT 11740 | $103.40 | $188.00 | $142.58 – $149.71 | 3 |
| Drain cath image guided peri/retroperitoneal transvag/transrectal CPT 49407 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Drain cath image guided visceral pq CPT 49405 | $2,411.20 | $4,384.00 | $1,769.88 – $1,858.38 | 3 |
| Drain cerebro spinal fluid 62272 CPT 62272 | $865.15 | $1,573.00 | $756.44 – $794.26 | 3 |
| Drain chest lesion CPT 21502 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Drain finger abscess;simple 26010 CPT 26010 | $316.80 | $576.00 | $215.00 – $225.75 | 3 |
| Drain lower leg bursa CPT 27604 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Drain lower leg lesion 27603 CPT 27603 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Drain neck/chest lesion 21501 CPT 21501 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Drain ovarn cyst abd CPT 58805 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Drain ovary abscess open CPT 58820 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Drain penis lesion CPT 54015 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Drain shoulder bone lesion CPT 23035 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Drain shoulder bursa 23031 CPT 23031 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Drain shoulder lesion CPT 23030 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Drain thigh/knee lesion 27301 CPT 27301 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Drain thyroid/tongue cyst CPT 60000 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $313.50 | $570.00 | $215.00 – $225.75 | 3 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $227.70 | $414.00 | $215.00 – $225.75 | 3 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $554.40 | $1,008.00 | $435.63 – $457.41 | 3 |
| Dressing change not for burn w/anes 15852 CPT 15852 | not published | not published | $792.00 – $831.60 | 3 |
| Drng hand tendon sheath 26020 CPT 26020 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Drng of eyelid abscess 67700 CPT 67700 | $318.45 | $579.00 | not published | 0 |
| Drng of finger abscess comp 26011 CPT 26011 | $1,488.30 | $2,706.00 | $1,769.88 – $1,858.38 | 3 |
| Drng of hydrocele 55000 CPT 55000 | $867.90 | $1,578.00 | $758.85 – $796.79 | 3 |
| Drng of ovarian cyst(s) 58800 CPT 58800 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Drng of palm multi bursas 26030 CPT 26030 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Drng of palm single bursa 26025 CPT 26025 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Drng of pelvic abscess transrectal 45000 CPT 45000 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Drng of salivary cyst 42409 CPT 42409 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Drng of scrotum abscess 55100 CPT 55100 | $1,546.60 | $2,812.00 | $1,769.88 – $1,858.38 | 3 |
| Drng salivary gland simple 42300 CPT 42300 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $251.78 | $457.79 | not published | 0 |
| Drug admin & hemodynmic meas CPT 93463 | $202.95 | $369.00 | not published | 0 |
| Drug assay caffeine CPT 80155 | not published | not published | $38.57 – $40.50 | 3 |
| Drug assay posaconazole CPT 80187 | $51.70 | $94.00 | $27.11 – $28.47 | 3 |
| Drug assay rufinamide CPT 80210 | $130.90 | $238.00 | $27.11 – $28.47 | 3 |
| Drug assay vedolizumab CPT 80280 | $113.85 | $207.00 | $38.57 – $40.50 | 3 |
| Drug assay voriconazole CPT 80285 | $48.95 | $89.00 | $27.11 – $28.47 | 3 |
| Drug asy hydroxychloroquine CPT 80220 | not published | not published | $18.64 – $19.57 | 3 |
| Drug of abuse screen urine CPT 80305 | not published | not published | $12.60 – $13.23 | 3 |
| Drug screening tapentadol CPT 80372 | $48.95 | $89.00 | not published | 0 |
| Drug screen quant tiagabine CPT 80199 | $90.75 | $165.00 | $27.11 – $28.47 | 3 |
| Drug test def 15-21 classes HCPCS G0482 | not published | not published | $198.74 – $208.68 | 3 |
| Drug test def 1-7 classes HCPCS G0480 | not published | not published | $114.43 – $120.15 | 3 |
| Drug test def 22+ classes HCPCS G0483 | not published | not published | $246.92 – $259.27 | 3 |
| Drug test def 8-14 classes HCPCS G0481 | not published | not published | $156.59 – $164.42 | 3 |
| Drug test def simple all cl HCPCS G0659 | not published | not published | $62.14 – $65.25 | 3 |
| Drug test prsmv instrmnt CPT 80306 | not published | not published | $17.14 – $18.00 | 3 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $1,183.05 | $2,151.00 | $62.14 – $65.25 | 3 |
| Drvvt confirm - quest CPT 85597 | $125.40 | $228.00 | $17.98 – $18.88 | 3 |
| Dry needling (97799) CPT 97799 | $21.45 | $39.00 | not published | 0 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | not published | not published | $435.63 – $457.41 | 3 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | not published | not published | $435.63 – $457.41 | 3 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | not published | not published | $792.00 – $831.60 | 3 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | not published | not published | $792.00 – $831.60 | 3 |
| Ductogram sgl duct CPT 77053 | $860.20 | $1,564.00 | $255.69 – $268.47 | 3 |
| Duodenal motility study CPT 91022 | not published | not published | $399.88 – $419.88 | 3 |
| Duplex scan bilateral study 93985 CPT 93985 | $376.20 | $684.00 | $255.69 – $268.47 | 3 |
| Duplex scan unilateral study 93986 CPT 93986 | $188.10 | $342.00 | $112.03 – $117.63 | 3 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $415.80 | $756.00 | $112.03 – $117.63 | 3 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | $996.05 | $1,811.00 | $231.39 – $242.96 | 3 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $852.50 | $1,550.00 | $255.69 – $268.47 | 3 |
| Dxa bone density axl vrt fx CPT 77085 | not published | not published | $112.03 – $117.63 | 3 |
| Dx aly aud oi snd prcsr 1st CPT 92622 | not published | not published | $137.89 – $144.78 | 3 |
| Dx bronchoscope/brush 31623 CPT 31623 | not published | not published | $1,907.37 – $2,002.74 | 3 |
| Dx bronchoscope/lavage 31624 CPT 31624 | not published | not published | $1,907.37 – $2,002.74 | 3 |
| Dx bronchoscope/wash 31622 CPT 31622 | not published | not published | $1,907.37 – $2,002.74 | 3 |
| Dx duod intub w/asp spec 43756 CPT 43756 | not published | not published | $971.94 – $1,020.54 | 3 |
| Dx duod intub w/asp specs CPT 43757 | not published | not published | $971.94 – $1,020.54 | 3 |
| Dx gastr intub w/asp spec CPT 43754 | not published | not published | $231.39 – $242.96 | 3 |
| Dx gastr intub w/asp specs CPT 43755 | not published | not published | $137.89 – $144.78 | 3 |
| Dx laryngoscopy w/oper scope CPT 31526 | not published | not published | $1,907.37 – $2,002.74 | 3 |
| Dynamic cavernosometry CPT 54231 | not published | not published | $267.74 – $281.13 | 3 |
| Dynamic surface emg CPT 96002 | not published | not published | $231.39 – $242.96 | 3 |
| Ear canal biopsy 69105 CPT 69105 | not published | not published | $1,662.71 – $1,745.84 | 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.