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 |
|---|---|---|---|---|
| Exc foot/toe tum dep 1.5cm/> CPT 28041 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Exc foot/toe tum subq < 1.5 cm 28043 CPT 28043 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Exc forearm les sc 3 cm/> CPT 25071 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Exc forearm tum deep < 3 cm CPT 25076 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Exc forearm tum deep 3 cm/> CPT 25073 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Exc hand les sc < 1.5 cm CPT 26115 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Exc hand tum deep 1.5 cm/> CPT 26113 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Exc hand tum deep < 1.5 cm 26116 CPT 26116 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Exchange biliary drg cath CPT 47536 | $4,407.70 | $8,014.00 | $3,836.82 – $4,028.66 | 3 |
| Exchange blood transfusion newborn 36450 CPT 36450 | not published | not published | $472.77 – $496.41 | 3 |
| Exchange drainage catheter CPT 49423 | $2,122.45 | $3,859.00 | $2,056.34 – $2,159.15 | 3 |
| Exchange nephrostomy cath CPT 50435 | $1,244.65 | $2,263.00 | $2,240.09 – $2,352.10 | 3 |
| Exc hidradenitis ing simpl 11462 CPT 11462 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Exc hidradenitis peri/umb comp 11471 CPT 11471 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Exc hidradenitis peri/umb int 11470 CPT 11470 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Exc hip/pelv tum deep < 5 cm CPT 27048 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Exc hip/pelv tum deep 5 cm/> CPT 27045 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Excimer lsr psriasis 250-500 CPT 96921 | not published | not published | $215.00 – $225.75 | 3 |
| Excimer lsr psriasis<250sqcm CPT 96920 | not published | not published | $215.00 – $225.75 | 3 |
| Excimer lsr psriasis>500sqcm CPT 96922 | not published | not published | $435.63 – $457.41 | 3 |
| Exc im tumor/back/flank/ < 5 cm 21932 CPT 21932 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Exc im tumor/foot/toe < 1.5 cm 28045 CPT 28045 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Exc im tumor/shoulder area 5cm/> 23073 CPT 23073 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Exc ischial pr ulcer w/ostc musc/myoq flap/skin 15946 CPT 15946 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Exc ischial pr ulc prim sutr CPT 15940 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Exc isch pr ulc prm sut ostc CPT 15941 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Exc isch pr ulc skn flp clsr CPT 15944 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Exc isch pr ulc skn flp ostc CPT 15945 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Excise anal ext tag/papilla CPT 46220 | $1,104.40 | $2,008.00 | $1,282.34 – $1,346.46 | 3 |
| Excise epiphyseal bar CPT 20150 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Excise foot tendon sheath CPT 28086 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Excise foot tendon sheath CPT 28088 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Excise inferior turbinate CPT 30130 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excise intraspinl lesion crv CPT 63265 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Excise intrspinl lesion lmbr CPT 63267 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Excise intrspinl lesion scrl CPT 63268 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Excise lesion testis CPT 54512 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Excise lip or cheek fold CPT 40819 | $2,079.00 | $3,780.00 | $1,662.71 – $1,745.84 | 3 |
| Excise lwr jaw cyst w/repair CPT 21047 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excise mandible lesion CPT 21040 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excise max/zygoma b9 tumor CPT 21030 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excise max/zygoma mal tumor CPT 21034 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excise parotid gland/lesion CPT 42410 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excise parotid gland/lesion CPT 42415 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excise parotid gland/lesion CPT 42420 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excise parotid gland/lesion CPT 42425 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excise pharynx lesion CPT 42808 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excise/repair mouth lesion CPT 40812 | $2,447.50 | $4,450.00 | $1,662.71 – $1,745.84 | 3 |
| Excise sublingual gland CPT 42450 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excise submaxillary gland CPT 42440 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excise subq tumor/abd wall <3 cm 22902 CPT 22902 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Excise tendon forearm/wrist CPT 25109 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Excise wrist tendon sheath CPT 25118 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Excision aural polyp CPT 69540 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Excision benign lesion face/ears/eyelids/nose/lips/muc memb 0.6 - 1.0 cm CPT 11441 | $760.65 | $1,383.00 | $758.85 – $796.79 | 3 |
| Excision benign lesion scalp/neck/hands/feet/genitalia 1.1 - 2.0 cm CPT 11422 | $1,577.40 | $2,868.00 | $1,769.88 – $1,858.38 | 3 |
| Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm CPT 11402 | $1,147.85 | $2,087.00 | $758.85 – $796.79 | 3 |
| Excision benign lesion trunk/arms/legs > 4.0 cm CPT 11406 | $1,984.95 | $3,609.00 | $1,769.88 – $1,858.38 | 3 |
| Excision breast lesion CPT 19125 | not published | not published | $4,195.85 – $4,405.64 | 3 |
| Excision floor mouth lesion 41116 CPT 41116 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision graft extremity CPT 35903 | not published | not published | $3,383.62 – $3,552.80 | 3 |
| Excision gum each quadrant CPT 41820 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision hand/finger tendon CPT 26415 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Excision lesion mouth roof CPT 42106 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision lesion mouth roof CPT 42107 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excision nasal polyp(s) simple 30110 CPT 30110 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Excision of anal lesion(s) CPT 46922 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Excision of gum flap CPT 41821 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Excision of gum lesion CPT 41822 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Excision of gum lesion CPT 41823 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excision of gum lesion CPT 41826 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision of gum lesion CPT 41827 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excision of gum lesion CPT 41828 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Excision of gum lesion 41825 CPT 41825 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision of lingual tonsil CPT 42870 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excision of mouth lesion complex 40816 CPT 40816 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision of neck cyst CPT 42815 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Excision of neck cyst confined 42810 CPT 42810 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision of penis lesion(s) 54060 CPT 54060 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Excision of rectal lesion CPT 45160 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Excision of rectal stricture CPT 45150 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Excision of salivary cyst CPT 42408 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision of tongue lesion CPT 41112 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision of tongue lesion CPT 41114 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision of tongue lesion w/closure 41113 CPT 41113 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision of tonsil tags CPT 42860 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision of umbilicus 49250 CPT 49250 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Excision of uvula CPT 42140 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision of vaginal septum 57130 CPT 57130 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Excision olecranon bursa CPT 24105 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Excision radial head CPT 24130 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Excision tongue lesion without closure 41110 CPT 41110 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Excision tumor soft tissue back/flank subcutaneous >= 3 cm CPT 21931 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Excis partial tal calc CPT 28120 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Excis uppr jaw cyst w/repair CPT 21049 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Exc leg/ankle tum dep 5 cm/ > 27634 CPT 27634 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Exc leg/ankle tum subfasc<5cm 27619 CPT 27619 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Exc les/mucos/sub/ves mouth/no rpr 40810 CPT 40810 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Exc malig feenl <0.5cm 11640 CPT 11640 | not published | not published | $758.85 – $796.79 | 3 |
| Exc malig feenl 1.1-2 11642 CPT 11642 | not published | not published | $758.85 – $796.79 | 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.