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 |
|---|---|---|---|---|
| Extensive hand surgery CPT 26250 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Extensive jaw surgery CPT 21045 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Extensive mastoid surgery CPT 69511 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Extensive mastoid surgery CPT 69530 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Extensive surgery of throat CPT 42842 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Extensive surgery of throat CPT 42844 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Extensive testis surgery CPT 54535 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| External cannula declotting CPT 36860 | not published | not published | $1,686.89 – $1,771.24 | 3 |
| External chromosome analysis 20-25 cells CPT 88264 | $1,309.55 | $2,381.00 | $144.61 – $151.84 | 3 |
| External ocular photography CPT 92285 | not published | not published | $40.03 – $42.03 | 3 |
| External pretreatment of serum for use in antibody identification by dilution CPT 86976 | $102.30 | $186.00 | $30.99 – $32.54 | 3 |
| External profiling gene expression oncology (breast) mrna 21 genes CPT 81519 | not published | not published | $3,873.00 – $4,066.65 | 3 |
| External recharg sys intern HCPCS L8689 | $1,800.48 | $3,273.60 | not published | 0 |
| External tissue culture neoplastic disorders bone marrow/blood cells CPT 88237 | $1,038.40 | $1,888.00 | $143.75 – $150.94 | 3 |
| Extnd color vision xm CPT 92283 | not published | not published | $63.22 – $66.38 | 3 |
| Extractable nuclear antigen/antibody any method each antibody centromere CPT 86235 | $339.35 | $617.00 | $17.93 – $18.83 | 3 |
| Extrnl counterpulse, per tx HCPCS G0166 | not published | not published | $142.58 – $149.71 | 3 |
| Eye allergy tests CPT 95060 | not published | not published | $142.58 – $149.71 | 3 |
| Ezh2 gene common variants CPT 81237 | not published | not published | $175.40 – $184.17 | 3 |
| Ezh2 gene full gene sequence CPT 81236 | not published | not published | $282.88 – $297.02 | 3 |
| F-18 fdg pet diag HCPCS A9552 | $1,504.25 | $2,735.00 | not published | 0 |
| F-18 sodium fluoride HCPCS A9580 | $1,697.85 | $3,087.00 | not published | 0 |
| F9 full gene sequence CPT 81238 | not published | not published | $600.00 – $630.00 | 3 |
| Face bone graft CPT 21210 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Facial bones <3 CPT 70140 | $422.95 | $769.00 | $93.26 – $97.92 | 3 |
| Facial nerve function test CPT 92516 | not published | not published | $231.39 – $242.96 | 3 |
| Facility svs dental rehab HCPCS G0330 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Factor ix CPT 85250 | $422.40 | $768.00 | $19.04 – $19.99 | 3 |
| Factor viii CPT 85240 | $297.00 | $540.00 | $17.90 – $18.80 | 3 |
| Fallopian tube recnl CPT 58345 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Family therapy without pt 50min 90846 CPT 90846 | $290.40 | $528.00 | not published | 0 |
| Family therapy with patient 50 min 90847 CPT 90847 | $300.85 | $547.00 | not published | 0 |
| Fancc gene CPT 81242 | not published | not published | $36.62 – $38.45 | 3 |
| Fasciotomy hip/thigh any typ CPT 27025 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Fat/lipids feces qualitative CPT 82705 | $79.75 | $145.00 | $5.10 – $5.36 | 3 |
| Fatty acids nonesterified CPT 82725 | $151.80 | $276.00 | $18.77 – $19.71 | 3 |
| Fecal bilirubin test CPT 82252 | not published | not published | $4.56 – $4.79 | 3 |
| Fecal microbiota prep instil HCPCS G0455 | $553.30 | $1,006.00 | $996.56 – $1,046.39 | 3 |
| #fecal-sodium CPT 84302 | $191.40 | $348.00 | $4.86 – $5.10 | 3 |
| Fees w/laryngeal sense test CPT 92616 | not published | not published | $79.72 – $83.71 | 3 |
| Felbamate (felbatol(r)) - sendout CPT 80167 | $14.30 | $26.00 | $18.64 – $19.57 | 3 |
| Femoral endovas graft add-on 34813 CPT 34813 | $3,515.60 | $6,392.00 | not published | 0 |
| Fem/popl revasc w/stent CPT 37226 | $18,103.25 | $32,915.00 | not published | 0 |
| Feno poc CPT 95012 | $53.90 | $98.00 | $40.03 – $42.03 | 3 |
| Fern test HCPCS Q0114 | not published | not published | $9.74 – $10.23 | 3 |
| Ferritin CPT 82728 | $167.75 | $305.00 | $13.63 – $14.31 | 3 |
| Fetal aneuploidy trisom risk CPT 81507 | $479.05 | $871.00 | $795.00 – $834.75 | 3 |
| Fetal biophys profile w/nst 76818 CPT 76818 | not published | not published | $112.03 – $117.63 | 3 |
| Fetal chrmoml microdeltj CPT 81422 | not published | not published | $759.05 – $797.00 | 3 |
| Fetal chrom aneuploidy gsa panel CPT 81420 | $1,715.45 | $3,119.00 | $759.05 – $797.00 | 3 |
| Fetal contract stress test 59020 - 26 CPT 59020 | $180.40 | $328.00 | $216.65 – $227.48 | 3 |
| Fetal cord puncture prenatal CPT 59012 | not published | not published | $326.55 – $342.88 | 3 |
| Fetal fibronectin CPT 82731 | $485.65 | $883.00 | $64.41 – $67.63 | 3 |
| Fetal fluid drainage w/us CPT 59074 | not published | not published | $326.55 – $342.88 | 3 |
| Fetal hemoglobin (kleihauer betke) CPT 85460 | $138.60 | $252.00 | $7.73 – $8.12 | 3 |
| Fetal hemoglobin rosette CPT 85461 | $153.45 | $279.00 | $9.36 – $9.83 | 3 |
| Fetal lung maturity assess lam body dnst CPT 83664 | $211.75 | $385.00 | $19.32 – $20.29 | 3 |
| Fetal non stress test CPT 59025 | $453.75 | $825.00 | $216.65 – $227.48 | 3 |
| Fetal scalp blood sampling 59030 CPT 59030 | not published | not published | $326.55 – $342.88 | 3 |
| Fetal shunt placement w/us CPT 59076 | not published | not published | $326.55 – $342.88 | 3 |
| #_fet/norfentcnfrmur CPT 80354 | $130.35 | $237.00 | not published | 0 |
| Fibrin degradation d dimer quantitative CPT 85379 | $203.50 | $370.00 | $10.18 – $10.69 | 3 |
| Fibrin degradation products CPT 85362 | $107.25 | $195.00 | $6.89 – $7.23 | 3 |
| Fibrin degrade semiquant CPT 85378 | $182.60 | $332.00 | $9.72 – $10.21 | 3 |
| Fibrin degradj d-dimer CPT 85380 | not published | not published | $10.18 – $10.69 | 3 |
| Fibrinogen activity CPT 85384 | $93.50 | $170.00 | $9.72 – $10.21 | 3 |
| Fibrinogen test CPT 85370 | not published | not published | $12.43 – $13.05 | 3 |
| Fibrinolysins/coagulopathy screen interpretation/report CPT 85390 | not published | not published | $15.48 – $16.25 | 3 |
| Fibrinolytic antiplasmin CPT 85410 | not published | not published | $7.71 – $8.10 | 3 |
| Fibrinolytic plasmin CPT 85400 | not published | not published | $7.71 – $8.10 | 3 |
| Fibrinolytic plasminogen CPT 85415 | $214.50 | $390.00 | $17.19 – $18.05 | 3 |
| Fibrinolytic plasminogen CPT 85421 | not published | not published | $10.18 – $10.69 | 3 |
| Fibrinolytic plasminogen xcpt antgnc asa CPT 85420 | $332.20 | $604.00 | $6.53 – $6.86 | 3 |
| Fibula bone graft microvasc CPT 20955 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Filleted finger/toe flap CPT 14350 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Filtered speech hearing test CPT 92571 | not published | not published | $40.03 – $42.03 | 3 |
| Filter spider fx 3mmx320cm HCPCS C1884 | $3,142.40 | $5,713.46 | not published | 0 |
| Filter vena cava fem denali HCPCS C1880 | $3,590.83 | $6,528.79 | not published | 0 |
| Fine needle aspiration biopsy w/fluor gdn;1st lesion 10007 CPT 10007 | $1,054.35 | $1,917.00 | $758.85 – $796.79 | 3 |
| Fine needle aspiration biopsy w/fluor gdn; ea addtl 10008 CPT 10008 | $327.25 | $595.00 | not published | 0 |
| Fine needle aspiration biopsy without img gdn; ea addtl 10004 CPT 10004 | $174.35 | $317.00 | not published | 0 |
| Fine needle aspiration biopsy w/us gdn; ea addtl 10006 CPT 10006 | $443.30 | $806.00 | not published | 0 |
| Fine needle asp without image guide 10021 CPT 10021 | $476.30 | $866.00 | $435.63 – $457.41 | 3 |
| Finger tendon transfer CPT 26497 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Finger tendon transfer CPT 26498 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Fit aphakia spectcl monofocl CPT 92352 | not published | not published | $63.22 – $66.38 | 3 |
| Fit aphakia spectcl multifoc CPT 92353 | not published | not published | $63.22 – $66.38 | 3 |
| Fitg spect low vis 1system CPT 92354 | not published | not published | $40.03 – $42.03 | 3 |
| Fitg spect lw vis cmpnd lens CPT 92355 | not published | not published | $40.03 – $42.03 | 3 |
| Fitting of diaphragm/cap 57170 CPT 57170 | not published | not published | $216.65 – $227.48 | 3 |
| Fixation of ankle joint CPT 27860 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Fixation of knee joint CPT 27570 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Fixation of shoulder blade CPT 23400 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Fix g/colon tube w/device CPT 49460 | $1,062.60 | $1,932.00 | $971.94 – $1,020.54 | 3 |
| Fixtn pq skel dstl rad fx/epiphysl sep CPT 25606 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Flecainide (tambocor)-sendout CPT 80181 | $20.90 | $38.00 | $18.64 – $19.57 | 3 |
| Fl exam g/colon tube w contrast CPT 49465 | $574.20 | $1,044.00 | $255.69 – $268.47 | 3 |
| Flexible Sigmoidoscopy CPT 45330 | not published | not published | $996.56 – $1,046.39 | 3 |
| Flexor-plasty elbow CPT 24330 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Flexor-plasty elbw w/advmnt CPT 24331 | not published | not published | $7,775.89 – $8,164.69 | 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.