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 |
|---|---|---|---|---|
| Floor of mouth biopsy 41108 CPT 41108 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Flow cytometry interp 16 or more CPT 88189 | $565.95 | $1,029.00 | not published | 0 |
| Flow cytometry marker each additional CPT 88185 | $235.95 | $429.00 | not published | 0 |
| Flow cytometry one marker technical component CPT 88184 | $523.60 | $952.00 | $384.12 – $403.32 | 3 |
| #flow interp 9 - 15 markers CPT 88188 | $151.25 | $275.00 | not published | 0 |
| Flt3 gene CPT 81245 | $383.35 | $697.00 | $165.51 – $173.79 | 3 |
| Flt3 gene analysis CPT 81246 | $383.35 | $697.00 | $83.00 – $87.15 | 3 |
| Fluidotherapy charges pt CPT 97022 | $115.50 | $210.00 | $16.22 – $17.03 | 3 |
| Fluid pressure muscle 20950 CPT 20950 | not published | not published | $758.85 – $796.79 | 3 |
| Fluorescein angioscopy i&r CPT 92230 | not published | not published | $399.88 – $419.88 | 3 |
| Fluorescein angrph mltiframe CPT 92235 | not published | not published | $231.39 – $242.96 | 3 |
| Fluorescein&icg angiography CPT 92242 | not published | not published | $231.39 – $242.96 | 3 |
| Fluorescent antibody titer dna CPT 86256 | $423.50 | $770.00 | $12.05 – $12.65 | 3 |
| Fluoroguide for spine inject 77003-26 CPT 77003 | $1,128.05 | $2,051.00 | not published | 0 |
| Fluoroguide needle placement CPT 77002 | $1,040.60 | $1,892.00 | not published | 0 |
| Fluoro polarize fetal lung CPT 83663 | not published | not published | $18.91 – $19.86 | 3 |
| Fluoroscopy up to 1 hour CPT 76000 | $776.05 | $1,411.00 | $255.69 – $268.47 | 3 |
| Fmri brain by phys/psych CPT 70555 | not published | not published | $255.69 – $268.47 | 3 |
| Fmri brain by tech CPT 70554 | not published | not published | $255.69 – $268.47 | 3 |
| Fna bx w/ct gdn 1st les CPT 10009 | $1,112.10 | $2,022.00 | $758.85 – $796.79 | 3 |
| Fna bx w/ct gdn ea addl CPT 10010 | $327.25 | $595.00 | not published | 0 |
| Fna bx w/mr gdn 1st les CPT 10011 | not published | not published | $758.85 – $796.79 | 3 |
| Foam stability fetal lung CPT 83662 | not published | not published | $18.91 – $19.86 | 3 |
| Folic acid CPT 82746 | $161.70 | $294.00 | $14.70 – $15.44 | 3 |
| Follow-up angiography CPT 75898 | $1,575.20 | $2,864.00 | $3,383.62 – $3,552.80 | 3 |
| Followup eval of foot pt lop HCPCS G0246 | not published | not published | $142.67 – $149.80 | 3 |
| Foot arch support remov prem HCPCS L3030 | $90.58 | $164.70 | not published | 0 |
| Foot X-ray CPT 73630 | $394.35 | $717.00 | $93.26 – $97.92 | 3 |
| Forehead flap w/vasc pedicle 15731 CPT 15731 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Forensic cytopathology CPT 88125 | not published | not published | $55.84 – $58.64 | 3 |
| Foreskn manip w/lss preputial ads+stretching 54450 CPT 54450 | $261.80 | $476.00 | $267.74 – $281.13 | 3 |
| Fractionation ketosteroids CPT 83593 | not published | not published | $28.50 – $29.92 | 3 |
| Fracture assessment via dxa CPT 77086 | not published | not published | $93.26 – $97.92 | 3 |
| _fragile x methylation-sendout CPT 81244 | $891.55 | $1,621.00 | $44.89 – $47.13 | 3 |
| Fragmenting of kidney stone CPT 50590 | $7,886.45 | $14,339.00 | $3,777.44 – $3,966.31 | 3 |
| Frenectomy 41115 CPT 41115 | $1,267.75 | $2,305.00 | $1,662.71 – $1,745.84 | 3 |
| Frenulotomy of penis CPT 54164 | not published | not published | $2,240.09 – $2,352.10 | 3 |
| Fresh frozen plasma 8-24 hours collection each unit HCPCS P9059 | $202.40 | $368.00 | not published | 0 |
| Fresh frozen plasma frozen within 8 hours of collection each unit HCPCS P9017 | $207.35 | $377.00 | not published | 0 |
| Fresh frozen plasma thawing ea un CPT 86927 | not published | not published | $182.57 – $191.70 | 3 |
| Frozen blood freeze/thaw CPT 86932 | not published | not published | $40.03 – $42.03 | 3 |
| Frozen blood prep CPT 86930 | not published | not published | $182.57 – $191.70 | 3 |
| Frozen blood thaw CPT 86931 | not published | not published | $182.57 – $191.70 | 3 |
| Frozen cell preparation CPT 88241 | not published | not published | $12.09 – $12.69 | 3 |
| Fructosamine glycated protein CPT 82985 | $47.30 | $86.00 | $16.76 – $17.60 | 3 |
| Ft arch suprt premold longit HCPCS L3040 | $55.70 | $101.28 | not published | 0 |
| Ftl cgen abnor 3 proteins CPT 81509 | not published | not published | $1,487.37 – $1,561.74 | 3 |
| Ftl cgen abnor five anal CPT 81512 | $360.80 | $656.00 | $69.52 – $73.00 | 3 |
| Ftl cgen abnor four anal CPT 81511 | $162.80 | $296.00 | $153.50 – $161.18 | 3 |
| Ftl cgen abnor three anal CPT 81510 | $400.40 | $728.00 | $55.54 – $58.32 | 3 |
| Ftl cgen abnor two proteins CPT 81508 | not published | not published | $54.30 – $57.02 | 3 |
| Full field erg w/i&r CPT 92273 | not published | not published | $231.39 – $242.96 | 3 |
| Full mouth x-ray of teeth CPT 70320 | not published | not published | $255.69 – $268.47 | 3 |
| Full thick gft/nose/ear/lid/lip/20sqcm or< 15260 CPT 15260 | $2,167.00 | $3,940.00 | $2,211.05 – $2,321.60 | 3 |
| Full thick gft/scalp/arm/leg/20sqcm or< 15220 CPT 15220 | $2,167.00 | $3,940.00 | $2,211.05 – $2,321.60 | 3 |
| Full thick gft w/close donor fccmnaghf <=20sqcm 15240 CPT 15240 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Fundus photography with i&r 92250 CPT 92250 | not published | not published | $142.58 – $149.71 | 3 |
| Fusion/graft of finger joint CPT 26862 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Fusion/graft of hand joint CPT 26844 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Fusion of ankle joint open CPT 27870 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Fusion of big toe joint CPT 28750 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Fusion of big toe joint CPT 28755 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Fusion of finger joint CPT 26860 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Fusion of finger tendons CPT 26471 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Fusion of finger tendons CPT 26474 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Fusion of foot bones CPT 28730 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Fusion of foot bones CPT 28735 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Fusion of foot bones CPT 28740 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Fusion of hand joint CPT 26843 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Fusion of knee CPT 27580 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Fusion of knuckle CPT 26850 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Fusion of knuckle joint CPT 26516 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Fusion of knuckle joints CPT 26517 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Fusion of knuckle joints CPT 26518 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Fusion of knuckle with graft CPT 26852 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Fusion of spermatic ducts CPT 54900 | not published | not published | $2,240.09 – $2,352.10 | 3 |
| Fusion of spermatic ducts CPT 54901 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Fusion of tendons at wrist CPT 25300 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Fusion of tendons at wrist CPT 25301 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Fusion of thumb CPT 26841 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Fusion of tibiofibular joint CPT 27871 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Fusion of toes CPT 28280 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Fxn gene charac alleles CPT 81285 | not published | not published | $274.83 – $288.57 | 3 |
| Fxn gene detc abnor alleles CPT 81284 | not published | not published | $137.00 – $143.85 | 3 |
| Fxn gene full gene sequence CPT 81286 | not published | not published | $274.83 – $288.57 | 3 |
| Fxn gene known famil variant CPT 81289 | not published | not published | $185.20 – $194.46 | 3 |
| G6pc gene CPT 81250 | not published | not published | $58.49 – $61.41 | 3 |
| G6pd full gene sequence CPT 81249 | $1,584.00 | $2,880.00 | $600.00 – $630.00 | 3 |
| G6pd gene alys cmn variant CPT 81247 | not published | not published | $174.81 – $183.55 | 3 |
| G6pd known familial variant CPT 81248 | not published | not published | $375.25 – $394.01 | 3 |
| Ga-67 gallium 0.1 mci HCPCS A9556 | $227.70 | $414.00 | not published | 0 |
| Gabapentin non-blood CPT 80355 | $95.15 | $173.00 | not published | 0 |
| Galac-1-phosphate uridyltran - sendout CPT 82775 | $335.50 | $610.00 | $21.07 – $22.12 | 3 |
| Galactokinase - sendout CPT 82759 | not published | not published | $21.48 – $22.55 | 3 |
| Galactose transferase test CPT 82776 | not published | not published | $11.74 – $12.33 | 3 |
| Galectin-3 CPT 82777 | $139.15 | $253.00 | $44.25 – $46.46 | 3 |
| Gallbladder Removal (Laparoscopic) CPT 47562 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Gallium illuccix 1 millicure HCPCS A9596 | $4,221.54 | $7,675.52 | not published | 0 |
| Gammaglobulin iga CPT 82784 | $191.95 | $349.00 | $9.30 – $9.76 | 3 |
| Gammaglobulin ige CPT 82785 | $195.25 | $355.00 | $16.46 – $17.28 | 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.