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 |
|---|---|---|---|---|
| Ghs insertion of needle - bone CPT 36680 | $341.55 | $621.00 | not published | 0 |
| Ghs intermed repair 12.6 - 20.0 cm-12035 CPT 12035 | $642.95 | $1,169.00 | $435.63 – $457.41 | 3 |
| Ghs intermed repair 20.1 - 30.0 cm-12036 CPT 12036 | $845.35 | $1,537.00 | $792.00 – $831.60 | 3 |
| Ghs intermed repair over 30 cm - 12037 CPT 12037 | $1,689.60 | $3,072.00 | $2,211.05 – $2,321.60 | 3 |
| Ghs irrigate corpora cavernosa for priapism CPT 54220 | $318.45 | $579.00 | $267.74 – $281.13 | 3 |
| Ghs IV inf sq injection, on-body injector CPT 96377 | $75.90 | $138.00 | $50.18 – $52.69 | 3 |
| Ghs IV infusion bamlanivimab/etesevimab HCPCS M0245 | $450.45 | $819.00 | not published | 0 |
| Ghs IV infusion casirivimab/imdevimab HCPCS M0243 | $479.05 | $871.00 | not published | 0 |
| Ghs IV infusion sotrovimab HCPCS M0247 | $510.95 | $929.00 | not published | 0 |
| Ghs IV thrombolytics - cerebral CPT 37195 | $566.50 | $1,030.00 | $353.96 – $371.66 | 3 |
| Ghs lac repair mouth.ant tong 2.5cm/less CPT 41250 | $319.00 | $580.00 | not published | 0 |
| Ghs layer closure 2.5 cm or less - 12031 CPT 12031 | $560.45 | $1,019.00 | $435.63 – $457.41 | 3 |
| Ghs layer closure 2.5 cm or less - 12041 CPT 12041 | $507.65 | $923.00 | $435.63 – $457.41 | 3 |
| Ghs layer closure 2.5cm or less - 12051 CPT 12051 | $541.75 | $985.00 | $435.63 – $457.41 | 3 |
| Ghs layer closure 2.6 - 5.0 cm - 12052 CPT 12052 | $587.40 | $1,068.00 | $435.63 – $457.41 | 3 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $534.60 | $972.00 | $435.63 – $457.41 | 3 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $613.80 | $1,116.00 | $435.63 – $457.41 | 3 |
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $612.70 | $1,114.00 | $435.63 – $457.41 | 3 |
| Ghs layer closure 7.6 - 12.5 cm - 12044 CPT 12044 | $633.60 | $1,152.00 | $792.00 – $831.60 | 3 |
| Ghs layer closure 7.6 - 12.5 cm - 12054 CPT 12054 | $627.00 | $1,140.00 | $435.63 – $457.41 | 3 |
| Ghs layered repair 12.6 - 20.0 cm -12045 CPT 12045 | not published | not published | $792.00 – $831.60 | 3 |
| Ghs layered repair 12.6 - 20.0 cm -12055 CPT 12055 | $669.90 | $1,218.00 | $435.63 – $457.41 | 3 |
| Ghs layered repair 20.1 - 30.0 cm -12046 CPT 12046 | $711.70 | $1,294.00 | $792.00 – $831.60 | 3 |
| Ghs layered repair 20.1 - 30.0 cm -12056 CPT 12056 | not published | not published | $435.63 – $457.41 | 3 |
| Ghs layered repair over 30.0 cm -12047 CPT 12047 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Ghs layered repair over 3.0 cm -12057 CPT 12057 | not published | not published | $435.63 – $457.41 | 3 |
| Ghs leukocyte alkaline phos (mayo) CPT 85540 | $397.10 | $722.00 | $8.60 – $9.03 | 3 |
| Ghs mbp CPT 83873 | $303.05 | $551.00 | $17.20 – $18.06 | 3 |
| Ghs moderate sedation < 5 yr, 30 min CPT 99151 | $495.55 | $901.00 | not published | 0 |
| Ghs moderate sedation < 5 yr, 30 min, other CPT 99155 | $517.55 | $941.00 | not published | 0 |
| Ghs moderate sedation, > 5 yr, 30 min, other CPT 99156 | $503.80 | $916.00 | not published | 0 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $182.60 | $332.00 | not published | 0 |
| Ghs moderate sedation ea addtl 15 min, other CPT 99157 | $237.05 | $431.00 | not published | 0 |
| Ghs musc test done w/n test comp CPT 95886 | $766.70 | $1,394.00 | not published | 0 |
| Ghs musc tst done w/nerv tst lim CPT 95885 | $293.70 | $534.00 | not published | 0 |
| Ghs myocardial strain img spckl track CPT 93356 | $203.50 | $370.00 | not published | 0 |
| Ghs nailbed repair/nail removal CPT 11760 | $841.50 | $1,530.00 | $792.00 – $831.60 | 3 |
| Ghs nerve blk intercostal, single level CPT 64420 | not published | not published | $756.44 – $794.26 | 3 |
| Ghs nerve block sciatic nerve CPT 64445 | not published | not published | $756.44 – $794.26 | 3 |
| Ghs nerve block suprascapular CPT 64418 | not published | not published | $756.44 – $794.26 | 3 |
| Ghs ng placement w fluoro guidance CPT 43752 | $404.80 | $736.00 | not published | 0 |
| Ghs o2 saturation CPT 82810 | not published | not published | $9.77 – $10.26 | 3 |
| Ghs o2 uptake rest & exercise CPT 94680 | not published | not published | $137.89 – $144.78 | 3 |
| Ghs o2 uptake rest & indirect CPT 94690 | not published | not published | $63.22 – $66.38 | 3 |
| Ghs ob unlisted IV or art inj or infusion CPT 96379 | not published | not published | $50.18 – $52.69 | 3 |
| Ghs opcc repair cvp without subq port CPT 36575 | $839.30 | $1,526.00 | $672.23 – $705.84 | 3 |
| Ghs opcc repair cvp w subq port CPT 36576 | $1,230.35 | $2,237.00 | $1,686.89 – $1,771.24 | 3 |
| Ghs optokenetic CPT 92544 | not published | not published | $137.89 – $144.78 | 3 |
| Ghs oscillating trac CPT 92545 | not published | not published | $231.39 – $242.96 | 3 |
| Ghs ot dds rom CPT 95851 | not published | not published | $7.16 – $7.52 | 3 |
| Ghs ot group caregiver training CPT 97552 | $71.50 | $130.00 | not published | 0 |
| Ghs ot prosthetic training/15 min CPT 97761 | not published | not published | $41.42 – $43.49 | 3 |
| Ghs ot sensory integrative tech/15min CPT 97533 | not published | not published | $62.36 – $65.48 | 3 |
| Ghs ot work hardening-additional hours CPT 97546 | $134.75 | $245.00 | not published | 0 |
| Ghs pacing - transcutaneous CPT 92953 | $684.20 | $1,244.00 | $708.28 – $743.69 | 3 |
| Ghs peritonsillar abscess i andd CPT 42700 | $525.25 | $955.00 | not published | 0 |
| Ghs phenylketonurid CPT 84030 | $96.25 | $175.00 | $5.50 – $5.78 | 3 |
| Ghs picc line insert < 5 CPT 36568 | not published | not published | $1,686.89 – $1,771.24 | 3 |
| Ghs plngl fx pm cl CPT 26725 | $370.15 | $673.00 | $264.33 – $277.55 | 3 |
| Ghs plt ct-manual CPT 85032 | not published | not published | $4.31 – $4.53 | 3 |
| Ghs polysom <6 yrs 4/> parameters CPT 95782 | $5,689.75 | $10,345.00 | $920.24 – $966.25 | 3 |
| Ghs pos nystagmus CPT 92542 | not published | not published | $142.58 – $149.71 | 3 |
| Ghs ppd (tb intradermal) CPT 86580 | $90.20 | $164.00 | $30.99 – $32.54 | 3 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | $96.25 | $175.00 | $9.66 – $10.14 | 3 |
| Ghs protein, misc fluid CPT 84160 | $283.25 | $515.00 | $5.61 – $5.89 | 3 |
| Ghs protoporphyrins fract CPT 84202 | $99.55 | $181.00 | $14.35 – $15.07 | 3 |
| Ghs pr without cont pulse ox CPT 94625 | $84.15 | $153.00 | $63.22 – $66.38 | 3 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | $19.80 | $36.00 | $12.25 – $12.86 | 3 |
| Ghs pt - work hardening/int 2hrs CPT 97545 | $303.60 | $552.00 | not published | 0 |
| Ghs quinidine CPT 80194 | $185.90 | $338.00 | $14.60 – $15.33 | 3 |
| Ghs refill of implantable pump CPT 95990 | not published | not published | $353.96 – $371.66 | 3 |
| Ghs removal intranasal foreign body CPT 30300 | $173.25 | $315.00 | $142.58 – $149.71 | 3 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $2,802.80 | $5,096.00 | $1,723.15 – $1,809.31 | 3 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | $2,788.50 | $5,070.00 | $3,506.34 – $3,681.65 | 3 |
| Ghs respiratory syncytical virus igg/m CPT 86756 | not published | not published | $15.89 – $16.68 | 3 |
| Ghs reticulocyte count CPT 85044 | not published | not published | $4.31 – $4.53 | 3 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $103.95 | $189.00 | $13.91 – $14.61 | 3 |
| Ghs sedimentation rate CPT 85651 | not published | not published | $4.27 – $4.48 | 3 |
| Ghs semen analysis fert CPT 89320 | $420.20 | $764.00 | $12.31 – $12.93 | 3 |
| Ghs semen analysis, post-vas CPT 89300 | not published | not published | $9.84 – $10.33 | 3 |
| Ghs sensitivity (per antimicro) CPT 87184 | $61.60 | $112.00 | $7.48 – $7.85 | 3 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $507.10 | $922.00 | $435.63 – $457.41 | 3 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $733.15 | $1,333.00 | $435.63 – $457.41 | 3 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $563.75 | $1,025.00 | $435.63 – $457.41 | 3 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | not published | not published | $435.63 – $457.41 | 3 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $563.75 | $1,025.00 | $215.00 – $225.75 | 3 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $450.45 | $819.00 | $215.00 – $225.75 | 3 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $675.95 | $1,229.00 | $215.00 – $225.75 | 3 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $619.85 | $1,127.00 | $215.00 – $225.75 | 3 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | not published | not published | $215.00 – $225.75 | 3 |
| Ghs sleep study unattended CPT 95800 | $265.65 | $483.00 | $231.39 – $242.96 | 3 |
| Ghs somatosensory testing lower extremit CPT 95926 | $795.30 | $1,446.00 | $231.39 – $242.96 | 3 |
| Ghs somatosensory testing upper & lower limbs CPT 95938 | $1,113.20 | $2,024.00 | $920.24 – $966.25 | 3 |
| Ghs speech-gen aug dev eval iii, st CPT 92608 | not published | not published | $48.59 – $51.02 | 3 |
| Ghs sphenopalatine ganglion block CPT 64505 | not published | not published | $328.94 – $345.38 | 3 |
| Ghs spont nystagmus CPT 92541 | not published | not published | $142.58 – $149.71 | 3 |
| Ghs sp train/fitting sp device - kx CPT 92609 | $286.55 | $521.00 | $104.56 – $109.79 | 3 |
| Ghs st - eval for alt comm CPT 92567 | $72.60 | $132.00 | $40.03 – $42.03 | 3 |
| Ghs strapping shoulder - 29240 CPT 29240 | not published | not published | $142.58 – $149.71 | 3 |
| Ghs st - re-eval for alt comm CPT 92597 | not published | not published | $72.74 – $76.38 | 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.