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 |
|---|---|---|---|---|
| Gamma glutamyltransferase CPT 82977 | $129.25 | $235.00 | $7.20 – $7.56 | 3 |
| Gardner vag dna amp probe CPT 87511 | not published | not published | $35.09 – $36.84 | 3 |
| Gardner vag dna quant CPT 87512 | not published | not published | $41.76 – $43.85 | 3 |
| Gastric analy w/ph ea spec CPT 82930 | not published | not published | $6.71 – $7.05 | 3 |
| Gastric emptying imag study CPT 78265 | not published | not published | $428.40 – $449.82 | 3 |
| Gastric emptying imag study CPT 78266 | not published | not published | $581.86 – $610.95 | 3 |
| Gastric motility studies CPT 91020 | not published | not published | $399.88 – $419.88 | 3 |
| Gastric mucosa imaging CPT 78261 | not published | not published | $428.40 – $449.82 | 3 |
| Gastrin test CPT 82938 | not published | not published | $17.69 – $18.57 | 3 |
| Gastroesophageal reflux study CPT 78262 | not published | not published | $428.40 – $449.82 | 3 |
| Gastroesophageal reflux test CPT 91034 | not published | not published | $399.88 – $419.88 | 3 |
| Gastro/jejuno tube, std HCPCS B4087 | $101.28 | $184.14 | not published | 0 |
| Gastrostomy open neonatal CPT 43831 | not published | not published | $971.94 – $1,020.54 | 3 |
| Gated heart multiple CPT 78473 | not published | not published | $428.40 – $449.82 | 3 |
| Gba gene CPT 81251 | not published | not published | $47.25 – $49.61 | 3 |
| Generator barostim neo2 2014 HCPCS C1767 | $10,777.84 | $19,596.08 | not published | 0 |
| Generator emblem MRI sicd subq HCPCS C1722 | $34,429.68 | $62,599.42 | not published | 0 |
| Genetic tstg severe inh cond CPT 81443 | not published | not published | $2,448.56 – $2,570.99 | 3 |
| Genioplasty augmentation CPT 21120 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Geniop sldg augmentation CPT 21123 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Geniop sldg osteot 1 CPT 21121 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Geniop sldg osteot 2/> CPT 21122 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Genome re-evaluation CPT 81427 | not published | not published | $2,337.65 – $2,454.53 | 3 |
| Genome sequence analysis CPT 81425 | not published | not published | $5,031.20 – $5,282.76 | 3 |
| Genome sequence analysis CPT 81426 | not published | not published | $2,709.95 – $2,845.45 | 3 |
| Gentamicin peak therapeutic drug level CPT 80170 | $215.05 | $391.00 | $16.38 – $17.20 | 3 |
| G-esoph reflx tst w/electrod CPT 91035 | $524.15 | $953.00 | $920.24 – $966.25 | 3 |
| Ghs abscess perianal iandd CPT 46050 | $1,273.80 | $2,316.00 | $996.56 – $1,046.39 | 3 |
| Ghs abscess postoperative iandd complex CPT 10180 | $2,759.90 | $5,018.00 | $3,112.75 – $3,268.38 | 3 |
| Ghs acetylcholinesterase, rbc CPT 82482 | $119.90 | $218.00 | $9.81 – $10.30 | 3 |
| Ghs alcohol, methyl (methanol)-medtox CPT 84600 | $191.40 | $348.00 | $17.11 – $17.97 | 3 |
| Ghs alpha thalasemia, 7 deletions CPT 81257 | $1,134.10 | $2,062.00 | $102.26 – $107.37 | 3 |
| Ghs analysis neurostim without reprogramming CPT 95970 | not published | not published | $142.58 – $149.71 | 3 |
| Ghs antibodies (torch) igm CPT 86694 | $243.10 | $442.00 | $14.39 – $15.11 | 3 |
| Ghs aspiration bladder - needle CPT 51100 | not published | not published | $267.74 – $281.13 | 3 |
| Ghs bladder cath - complex-foley CPT 51703 | $539.00 | $980.00 | $137.89 – $144.78 | 3 |
| Ghs bleeding time (ivy) CPT 85002 | $103.40 | $188.00 | $4.82 – $5.06 | 3 |
| Ghs block ilioinguinal/gentitofemoral CPT 64425 | $675.95 | $1,229.00 | $756.44 – $794.26 | 3 |
| Ghs central line insert < age 5, failed CPT 36555 | not published | not published | $3,383.62 – $3,552.80 | 3 |
| Ghs change cysto/gastrost CPT 43762 | $594.55 | $1,081.00 | $267.74 – $281.13 | 3 |
| Ghs chemo >8 hrs CPT 96416 | $568.70 | $1,034.00 | $353.96 – $371.66 | 3 |
| Ghs chemo infusion >8 hrs CPT 96425 | not published | not published | $353.96 – $371.66 | 3 |
| Ghs chemo IV push, ea addtl CPT 96411 | $375.65 | $683.00 | $77.16 – $81.01 | 3 |
| Ghs chlamydia pneumoniae by pcr (arup) (306630) CPT 87486 | $218.90 | $398.00 | $35.09 – $36.84 | 3 |
| Ghs closd tx interphalang jt disloc w/ma CPT 26770 | $358.05 | $651.00 | $264.33 – $277.55 | 3 |
| Ghs closed reduction ankle dislocation CPT 27840 | $346.50 | $630.00 | $264.33 – $277.55 | 3 |
| Ghs closed tx bimalleolar fracture w/manip CPT 27810 | $1,531.75 | $2,785.00 | $1,723.15 – $1,809.31 | 3 |
| Ghs closed tx radiocarpal disloc w manip CPT 25660 | not published | not published | $264.33 – $277.55 | 3 |
| Ghs closed tx tibial fracture w/manip CPT 27752 | $1,914.55 | $3,481.00 | $1,723.15 – $1,809.31 | 3 |
| Ghs closure surg wound/dehiscence-13160 CPT 13160 | $2,568.50 | $4,670.00 | $3,797.52 – $3,987.40 | 3 |
| Ghs clsd red med malleolus fx without manip CPT 27760 | not published | not published | $264.33 – $277.55 | 3 |
| Ghs clsd red med malleolus fx w manip CPT 27762 | $1,747.90 | $3,178.00 | $1,723.15 – $1,809.31 | 3 |
| Ghs clsd tx frac distal tibia w/manipulation CPT 27825 | $1,797.95 | $3,269.00 | $1,723.15 – $1,809.31 | 3 |
| Ghs cl tx knee disl; wo anesth CPT 27550 | $304.70 | $554.00 | $264.33 – $277.55 | 3 |
| Ghs cl tx metacarpophal disloc without anes CPT 26700 | $304.70 | $554.00 | $264.33 – $277.55 | 3 |
| Ghs community re-entry 15 minutes CPT 97537 | not published | not published | $32.69 – $34.32 | 3 |
| Ghs conjunctiva foreign body-superf bil CPT 65205 | $283.80 | $516.00 | $142.58 – $149.71 | 3 |
| Ghs corneal fb without slit lamp bilat CPT 65220 | $238.70 | $434.00 | not published | 0 |
| Ghs corneal fb with slit lamp bilat CPT 65222 | $294.80 | $536.00 | $142.58 – $149.71 | 3 |
| Ghs cricothyroidotomy CPT 31605 | $1,207.80 | $2,196.00 | not published | 0 |
| Ghs cutdown placement under 1 yr CPT 36420 | not published | not published | $142.58 – $149.71 | 3 |
| Ghs diphtheria toxoid ab igg CPT 86648 | not published | not published | $15.21 – $15.97 | 3 |
| Ghs dislocation elbow closed treatment CPT 24600 | $346.50 | $630.00 | $264.33 – $277.55 | 3 |
| Ghs ed peritoneal lavage w guidance if performed CPT 49084 | not published | not published | $971.94 – $1,020.54 | 3 |
| Ghs ed rmvl or bivalving cast CPT 29700 | $264.55 | $481.00 | not published | 0 |
| Ghs ed therapeutic lp, drain csf w fluoro CPT 62329 | not published | not published | $756.44 – $794.26 | 3 |
| Ghs eeg cont rec w/video by tec min 8 chnls CPT 95700 | $372.90 | $678.00 | $231.39 – $242.96 | 3 |
| Ghs electrostagmgraphy CPT 92537 | $910.80 | $1,656.00 | $137.89 – $144.78 | 3 |
| Ghs elect torsion swing CPT 92546 | $317.35 | $577.00 | $137.89 – $144.78 | 3 |
| Ghs epidermal shaving diameter >2.0 cm CPT 11303 | not published | not published | $435.63 – $457.41 | 3 |
| Ghs excision ingrown nail CPT 11765 | $385.00 | $700.00 | $435.63 – $457.41 | 3 |
| Ghs eye exam CPT 92002 | not published | not published | $142.67 – $149.80 | 3 |
| Ghs eyelid foreign body-embedded - bil CPT 67938 | $435.60 | $792.00 | not published | 0 |
| Ghs fat & muscle CPT 89160 | $27.50 | $50.00 | $4.85 – $5.09 | 3 |
| Ghs fb removal foot - deep - left CPT 28192 | $1,563.10 | $2,842.00 | $1,769.88 – $1,858.38 | 3 |
| Ghs fb removal from muscle - complicated CPT 20525 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Ghs fb removal - incisional CPT 10121 | $1,844.15 | $3,353.00 | $1,769.88 – $1,858.38 | 3 |
| Ghs fb removal - non-incisional CPT 20520 | $1,541.10 | $2,802.00 | $1,769.88 – $1,858.38 | 3 |
| Ghs febrile agglutinns(mayo) CPT 86000 | $39.60 | $72.00 | $6.98 – $7.33 | 3 |
| Ghs fish cytogen CPT 88271 | $689.15 | $1,253.00 | $21.42 – $22.49 | 3 |
| Ghs fish hybrid in situ 100-300 CPT 88275 | $620.95 | $1,129.00 | $51.19 – $53.75 | 3 |
| Ghs flow volume loop CPT 94375 | not published | not published | $231.39 – $242.96 | 3 |
| Ghs gastric intub aspiration lavage CPT 43753 | $426.80 | $776.00 | $231.39 – $242.96 | 3 |
| Ghs hcv amplificaiton CPT 87521 | $343.75 | $625.00 | $35.09 – $36.84 | 3 |
| Ghs heavy metals bld (ars,lead,merc) CPT 82715 | not published | not published | $22.97 – $24.12 | 3 |
| Ghs hepatitis c virus (hcv riba) CPT 86804 | not published | not published | $15.49 – $16.26 | 3 |
| Ghs hgb stability-thal CPT 83068 | not published | not published | $9.47 – $9.94 | 3 |
| Ghs histoplasma antigen CPT 87385 | $180.40 | $328.00 | $13.25 – $13.91 | 3 |
| Ghs HIV antibody CPT 86703 | $237.60 | $432.00 | $13.71 – $14.40 | 3 |
| Ghs hla-dr/dq, multiple antigens CPT 86817 | not published | not published | $106.14 – $111.45 | 3 |
| Ghs i and d abscess/hematoma scrotum CPT 54700 | $2,042.70 | $3,714.00 | $2,240.09 – $2,352.10 | 3 |
| Ghs i and d perirectal abscess 46040 CPT 46040 | $2,300.10 | $4,182.00 | $1,282.34 – $1,346.46 | 3 |
| Ghs i and d pilonidal cyst complex CPT 10081 | $975.15 | $1,773.00 | $758.85 – $796.79 | 3 |
| Ghs i and d pilonidal cyst simple CPT 10080 | $856.90 | $1,558.00 | $758.85 – $796.79 | 3 |
| Ghs immun0electrophoresis CPT 86320 | not published | not published | $29.92 – $31.42 | 3 |
| Ghs incision thrombosed ext hemorrhoid CPT 46083 | $363.00 | $660.00 | $267.74 – $281.13 | 3 |
| Ghs inf midline insertion CPT 36140 | $1,830.40 | $3,328.00 | not published | 0 |
| Ghs inhibitor screen CPT 85335 | $321.75 | $585.00 | $12.87 – $13.51 | 3 |
| Ghs init tx 1st degree burn CPT 16000 | $277.20 | $504.00 | $215.00 – $225.75 | 3 |
| Ghs inj tendon origin/insertion CPT 20551 | not published | not published | $328.94 – $345.38 | 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.