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 |
|---|---|---|---|---|
| Air conduction bilat CPT 92552 | $145.75 | $265.00 | $142.58 – $149.71 | 3 |
| Air injection into abdomen 49400 CPT 49400 | $281.05 | $511.00 | not published | 0 |
| Airway resistance by impulse oscillometry 94728 CPT 94728 | not published | not published | $137.89 – $144.78 | 3 |
| Albumin body fluid quantitative each specimen CPT 82042 | $147.40 | $268.00 | $7.78 – $8.17 | 3 |
| Albumin ischemia modified CPT 82045 | not published | not published | $33.94 – $35.64 | 3 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $187.55 | $341.00 | $5.78 – $6.07 | 3 |
| Albumin serum plasma or whole blood CPT 82040 | $195.25 | $355.00 | $4.95 – $5.20 | 3 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | not published | not published | $17.27 – $18.13 | 3 |
| Alcohol/sub misuse assess HCPCS G2011 | not published | not published | $30.99 – $32.54 | 3 |
| Alkaline phosphatase CPT 84075 | $142.45 | $259.00 | $5.18 – $5.44 | 3 |
| Allergen alpha lactalbumin ige CPT 86008 | $85.80 | $156.00 | $17.93 – $18.83 | 3 |
| Allergen egg white ige CPT 86003 | $84.70 | $154.00 | $5.22 – $5.48 | 3 |
| Allergen specific ige qual multi scrn ea CPT 86005 | $22.55 | $41.00 | $7.97 – $8.37 | 3 |
| Allergy injections; 2 or more 95117 CPT 95117 | not published | not published | $50.18 – $52.69 | 3 |
| Allergy injection; single 95115 CPT 95115 | not published | not published | $50.18 – $52.69 | 3 |
| Allergy Skin Testing CPT 95004 | not published | not published | $920.24 – $966.25 | 3 |
| Allg patch or app # of tests 95044 CPT 95044 | not published | not published | $920.24 – $966.25 | 3 |
| Allgrft implnt knee w/scope CPT 29867 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Allograft amniotic activebarrier 200 2x2cm-q4100-cost per sheet HCPCS Q4100 | $226.47 | $411.76 | not published | 0 |
| Allograft epieffect 2x3cm-q4186-cost per sq cm HCPCS Q4186 | $315.64 | $573.90 | not published | 0 |
| Allograft graftjacket 2x12cm-q4107-cost per sq cm HCPCS Q4107 | $2,155.37 | $3,918.86 | not published | 0 |
| Allograft umbilical epicord 15 sq cm-q4187-cost per sq cm HCPCS Q4187 | $1,266.24 | $2,302.26 | not published | 0 |
| All tstg perq&iq drugs/biol CPT 95018 | not published | not published | $40.03 – $42.03 | 3 |
| All tstg perq&iq w/venoms CPT 95017 | not published | not published | $30.99 – $32.54 | 3 |
| Alpha-fetoprotein afp-l3 frac & total CPT 82107 | $343.20 | $624.00 | $64.41 – $67.63 | 3 |
| Alpha-fetoprotein amniotic CPT 82106 | $119.90 | $218.00 | $17.00 – $17.85 | 3 |
| Alpha-fetoprotein tumor marker CPT 82105 | $347.05 | $631.00 | $16.77 – $17.61 | 3 |
| Alt/sgpt CPT 84460 | $92.95 | $169.00 | $5.30 – $5.56 | 3 |
| Aluminum - quest CPT 82108 | $83.05 | $151.00 | $25.48 – $26.75 | 3 |
| Alveoloplasty each quadrant CPT 41874 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Amantadine (symmetrel)-sendout CPT 80375 | $216.70 | $394.00 | not published | 0 |
| Ambl bp mntr w/sw a/r CPT 93788 | not published | not published | $142.58 – $149.71 | 3 |
| Amino acid screen, urine CPT 82128 | $47.30 | $86.00 | $13.87 – $14.56 | 3 |
| Amino acid single qual CPT 82127 | not published | not published | $14.18 – $14.89 | 3 |
| Amino acids quant 2-5 CPT 82136 | not published | not published | $19.61 – $20.59 | 3 |
| Aminolevulinic acid delta CPT 82135 | $191.40 | $348.00 | $16.45 – $17.27 | 3 |
| Amitriptyline (elavil) -sendout CPT 80335 | $293.70 | $534.00 | not published | 0 |
| Ammonia CPT 82140 | $145.20 | $264.00 | $14.57 – $15.30 | 3 |
| Amniocentesisdiagnostic 59000 CPT 59000 | $763.40 | $1,388.00 | $987.01 – $1,036.37 | 3 |
| Amniocentesis therapeutic CPT 59001 | not published | not published | $326.55 – $342.88 | 3 |
| Amniotic fluid scan CPT 82143 | not published | not published | $9.35 – $9.82 | 3 |
| Amp f/th 1/2 jt/phalanx w/neurect local flap CPT 26952 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amphetamine confirm urine -sendout CPT 80324 | $187.00 | $340.00 | not published | 0 |
| Amphetamines 5 or more CPT 80326 | $102.85 | $187.00 | not published | 0 |
| Amplification real-time pcr dna markers infectious disease bacterial vaginosis and vaginitis CPT 81515 | $101.75 | $185.00 | $262.99 – $276.14 | 3 |
| Amp metatarsal w/toe single 28810 CPT 28810 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amp thigh through femur re-amp 27596 CPT 27596 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amputate hand at wrist CPT 25922 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Amputate metacarpal bone 26910 CPT 26910 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amputate thigh through femur 27590 CPT 27590 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amputation follow-up surgery CPT 24925 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amputation follow-up surgery CPT 25907 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amputation follow-up surgery CPT 25909 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Amputation follow-up surgery CPT 25929 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Amputation follow-up surgery CPT 25931 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amputation follow-up surgery CPT 27594 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amputation follow-up surgery CPT 27884 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amputation leg thr tib/fib 27880 CPT 27880 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Amputation leg; tib/fib f/u 27886 CPT 27886 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amputation of foot at ankle CPT 27889 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Amputation of lower leg CPT 27882 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amputation of midtarsal 28800 CPT 28800 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amputation thru metatarsal CPT 28805 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amputation toe interphalangeal joint CPT 28825 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amputation toe metatarsophalangeal joint CPT 28820 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Amylase CPT 82150 | $175.45 | $319.00 | $6.48 – $6.80 | 3 |
| Ana ds-dna CPT 86226 | $378.95 | $689.00 | $12.11 – $12.72 | 3 |
| Analgesics non-opioid definitive assay 1 or 2 acetaminophen CPT 80329 | $171.05 | $311.00 | not published | 0 |
| Anal/urinary muscle study CPT 51784 | not published | not published | $137.89 – $144.78 | 3 |
| Anal/urinary muscle study CPT 51785 | not published | not published | $267.74 – $281.13 | 3 |
| Analysis gene f2 20210g>a variant CPT 81240 | $310.20 | $564.00 | $65.69 – $68.97 | 3 |
| Analysis gene f5 leiden variant CPT 81241 | $327.80 | $596.00 | $73.37 – $77.04 | 3 |
| Analysis nerve CPT 88356 | not published | not published | $55.84 – $58.64 | 3 |
| Analysis; simple cranial nerv pulse gen prgrmg 95976 CPT 95976 | not published | not published | $39.99 – $41.99 | 3 |
| Analysis tumor CPT 88358 | not published | not published | $182.57 – $191.70 | 3 |
| Anaplsma phgcytophlm amp prb CPT 87468 | $43.45 | $79.00 | $35.09 – $36.84 | 3 |
| Anca screen with reflex to titer -quest CPT 86021 | $220.55 | $401.00 | $15.05 – $15.80 | 3 |
| An cholangiogram percutaneous compl CPT 47531 | $3,887.40 | $7,068.00 | $3,836.82 – $4,028.66 | 3 |
| Androstanediol CPT 82154 | not published | not published | $28.83 – $30.27 | 3 |
| An fluoro guide for cvp CPT 77001 | $366.85 | $667.00 | not published | 0 |
| Angio balloon ctrl dialysis seg add-on CPT 36907 | $4,426.40 | $8,048.00 | not published | 0 |
| Angioplasty fem/pop unilat 37224 CPT 37224 | $9,074.45 | $16,499.00 | not published | 0 |
| Angioplasty/iliac/init ves/unilat 37220 CPT 37220 | $10,357.60 | $18,832.00 | not published | 0 |
| Angioplasty tib/pero/unilat/ea add 37232 CPT 37232 | $7,026.25 | $12,775.00 | not published | 0 |
| Angiotensin ii CPT 82163 | not published | not published | $20.52 – $21.55 | 3 |
| Angio tib/peroneal/init ves/unila 37228 CPT 37228 | $13,351.25 | $24,275.00 | not published | 0 |
| Angio trnslmnl balloon same artery ea addl CPT 37247 | $10,653.50 | $19,370.00 | not published | 0 |
| Angio trnslmnl balloon same artery ini CPT 37246 | $11,246.95 | $20,449.00 | $6,099.19 – $6,404.14 | 3 |
| Angio trnslmnl balloon same vein ea addl CPT 37249 | $3,319.80 | $6,036.00 | not published | 0 |
| Angio trnslmnl balloon same vein ini CPT 37248 | $10,062.25 | $18,295.00 | $6,099.19 – $6,404.14 | 3 |
| Ankle arthroscopy/surgery CPT 29891 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Ankle arthroscopy/surgery CPT 29892 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Ankle arthroscopy/surgery CPT 29894 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Ankle arthroscopy/surgery CPT 29895 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Ankle arthroscopy/surgery CPT 29897 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Ankle arthroscopy/surgery CPT 29898 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Ankle arthroscopy/surgery CPT 29899 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Ankle X-ray CPT 73610 | $449.35 | $817.00 | $93.26 – $97.92 | 3 |
| Annual Physical, Established Patient (age 18-39) CPT 99395 | $148.50 | $270.00 | not published | 0 |
| Annual Physical, Established Patient (age 40-64) CPT 99396 | $167.75 | $305.00 | 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.