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 subcutaneous infus, for therapy ea. add. hr CPT 96370 | not published | not published | $50.18 – $52.69 | 3 |
| Ghs subcutaneous infus. for therapy init 1 hr CPT 96369 | not published | not published | $227.94 – $239.33 | 3 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $688.05 | $1,251.00 | $792.00 – $831.60 | 3 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | not published | not published | $435.63 – $457.41 | 3 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $1,852.40 | $3,368.00 | $1,662.71 – $1,745.84 | 3 |
| Ghs trypsin (fecal) CPT 84488 | not published | not published | $7.30 – $7.66 | 3 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $381.15 | $693.00 | $264.33 – $277.55 | 3 |
| Ghs tx sp hip disloc abd splnt/trac wo CPT 27256 | not published | not published | $264.33 – $277.55 | 3 |
| Ghs urine, hydroxproline total CPT 83505 | not published | not published | $24.30 – $25.52 | 3 |
| Ghs urine, porphyrins quant CPT 84120 | $215.60 | $392.00 | $14.71 – $15.45 | 3 |
| Ghs vaginal delivery only CPT 59409 | $3,884.65 | $7,063.00 | $3,468.96 – $3,642.41 | 3 |
| Ghs veeg 12-26 hr intmt mont CPT 95715 | not published | not published | $399.88 – $419.88 | 3 |
| Ghs windowing of cast CPT 29730 | not published | not published | $174.14 – $182.85 | 3 |
| Giardia ag if CPT 87269 | $50.05 | $91.00 | $13.61 – $14.29 | 3 |
| Giardia lamblia antibody CPT 86674 | $118.25 | $215.00 | $14.72 – $15.46 | 3 |
| Gi endoscopic ultrasound CPT 76975 | not published | not published | $255.69 – $268.47 | 3 |
| Gi inhouse confirmation CPT 87045 | $165.00 | $300.00 | $9.44 – $9.91 | 3 |
| Gingivoplasty each quadrant CPT 41872 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Gi protein loss CPT 78282 | not published | not published | $428.40 – $449.82 | 3 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | not published | not published | $971.94 – $1,020.54 | 3 |
| Gi trc img intral colon i&r CPT 91113 | not published | not published | $996.56 – $1,046.39 | 3 |
| Gi trc img intral esophagus CPT 91111 | not published | not published | $971.94 – $1,020.54 | 3 |
| Gi wireless capsule measure CPT 91112 | not published | not published | $971.94 – $1,020.54 | 3 |
| Gjb2 gene full sequence CPT 81252 | not published | not published | $101.12 – $106.18 | 3 |
| Gjb2 gene known fam variants CPT 81253 | not published | not published | $61.52 – $64.60 | 3 |
| Gjb6 gene com variants CPT 81254 | not published | not published | $35.00 – $36.75 | 3 |
| Glaucoma scrn hgh risk direc HCPCS G0117 | not published | not published | $30.99 – $32.54 | 3 |
| Glaucoma scrn hgh risk direc HCPCS G0118 | not published | not published | $40.03 – $42.03 | 3 |
| Glucagon plasma - sendout CPT 82943 | $211.75 | $385.00 | $14.29 – $15.00 | 3 |
| Glucagon tolerance panel CPT 80422 | not published | not published | $46.07 – $48.37 | 3 |
| Glucagon tolerance panel CPT 80424 | not published | not published | $50.50 – $53.02 | 3 |
| Glucagon tolerance test CPT 82946 | not published | not published | $17.77 – $18.66 | 3 |
| Glucose 1 hr post dose CPT 82950 | $104.50 | $190.00 | $4.75 – $4.99 | 3 |
| Glucose-6-phosphate dhydrogenase screen CPT 82960 | not published | not published | $6.05 – $6.35 | 3 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $17.60 | $32.00 | $3.28 – $3.44 | 3 |
| Glucose blood quantitative CPT 82947 | $82.50 | $150.00 | $3.93 – $4.13 | 3 |
| Glucose body fluid CPT 82945 | $92.95 | $169.00 | $3.93 – $4.13 | 3 |
| Glucose monitoring continual min 72hr pt CPT 95249 | not published | not published | $63.22 – $66.38 | 3 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $335.50 | $610.00 | $12.87 – $13.51 | 3 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $104.50 | $190.00 | $3.92 – $4.12 | 3 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $44.00 | $80.00 | $18.58 – $19.51 | 3 |
| Gonadotropin hormone panel CPT 80426 | not published | not published | $148.41 – $155.83 | 3 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $167.75 | $305.00 | $18.52 – $19.45 | 3 |
| Gonioscopy CPT 92020 | not published | not published | $142.58 – $149.71 | 3 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $54.02 | $98.21 | not published | 0 |
| Graft hand or finger tendon CPT 26416 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $431.58 | $784.70 | not published | 0 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $958.85 | $1,743.37 | not published | 0 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $886.17 | $1,611.22 | not published | 0 |
| Graft tiss strattice 10x10 frm 10x10cm firm -cost per sq cm HCPCS Q4130 | $6,265.25 | $11,391.36 | not published | 0 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $386.74 | $703.16 | not published | 0 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $109.85 | $199.73 | not published | 0 |
| Great toe-hand transfer CPT 26551 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Great toe with reduction 28495 CPT 28495 | $253.55 | $461.00 | $264.33 – $277.55 | 3 |
| Grfg autol fat lipo 25 cc/< CPT 15773 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Grfg autol fat lipo 50 cc/< CPT 15771 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Grfg autol soft tiss dir exc CPT 15769 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Group mnt 2 or more 30 mins HCPCS G0271 | not published | not published | $12.23 – $12.84 | 3 |
| Group train without patient HCPCS G0543 | $74.25 | $135.00 | $30.99 – $32.54 | 3 |
| Growth hormone antibody CPT 86277 | not published | not published | $15.74 – $16.53 | 3 |
| Growth hormone panel CPT 80428 | not published | not published | $66.70 – $70.04 | 3 |
| Growth hormone panel CPT 80430 | not published | not published | $129.33 – $135.80 | 3 |
| Growth stimulation gene 2 CPT 83006 | not published | not published | $75.60 – $79.38 | 3 |
| Gstrst open wo constj tube CPT 43830 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| G-tube reposition CPT 43761 | $1,049.95 | $1,909.00 | $267.74 – $281.13 | 3 |
| Gu dilat ureter/urethra s&i CPT 74485 | not published | not published | $2,240.09 – $2,352.10 | 3 |
| Guided cath fluid drainage 10030 CPT 10030 | $1,319.45 | $2,399.00 | $758.85 – $796.79 | 3 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $2,571.31 | $4,675.11 | not published | 0 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $118.70 | $215.82 | not published | 0 |
| Guid loc target vol rad tx CPT 77387 | $314.05 | $571.00 | not published | 0 |
| Gum graft CPT 41870 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Gw stiffened micro access kit HCPCS C1894 | $2,469.47 | $4,489.95 | not published | 0 |
| Gynecomastia (males) 19300 CPT 19300 | not published | not published | $4,195.85 – $4,405.64 | 3 |
| Hair removal by electrolysis 17380 CPT 17380 | not published | not published | $792.00 – $831.60 | 3 |
| Hair trnspl 1-15 punch grfts CPT 15775 | not published | not published | $435.63 – $457.41 | 3 |
| Hair trnspl >15 punch grafts CPT 15776 | not published | not published | $435.63 – $457.41 | 3 |
| Handle/convey/speciman/office-lab 99000 CPT 99000 | $39.60 | $72.00 | not published | 0 |
| Hand tendon/muscle transfer CPT 26494 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Hand tendon reconstruction CPT 26500 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Hand tendon reconstruction CPT 26502 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Hand X-ray CPT 73130 | $416.35 | $757.00 | $93.26 – $97.92 | 3 |
| Haptoglobin quantitative CPT 83010 | $148.50 | $270.00 | $12.58 – $13.21 | 3 |
| Harvest cultured skin graft 15040 CPT 15040 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Harvest stem cell concentrte CPT 38215 | not published | not published | $472.77 – $496.41 | 3 |
| Hast w/i&r phys/qhp CPT 94452 | not published | not published | $142.58 – $149.71 | 3 |
| Hast w/oxygen titrate CPT 94453 | not published | not published | $142.58 – $149.71 | 3 |
| Hba1/hba2 full gene sequence CPT 81259 | $1,244.10 | $2,262.00 | $600.00 – $630.00 | 3 |
| Hba1/hba2 gene dup/del vrnts CPT 81269 | $812.35 | $1,477.00 | $202.40 – $212.52 | 3 |
| Hba1/hba2 gene fam vrnt CPT 81258 | not published | not published | $375.25 – $394.01 | 3 |
| Hbb full gene sequence CPT 81364 | $1,400.30 | $2,546.00 | $324.58 – $340.81 | 3 |
| Hbb gene com variants CPT 81361 | not published | not published | $174.81 – $183.55 | 3 |
| Hbb gene dup/del variants CPT 81363 | $794.75 | $1,445.00 | $202.40 – $212.52 | 3 |
| Hbb gene known fam variant CPT 81362 | not published | not published | $375.25 – $394.01 | 3 |
| Hb glycosylated a1c home dev CPT 83037 | not published | not published | $9.71 – $10.20 | 3 |
| Hbot, full body chamber, 30m HCPCS G0277 | $449.90 | $818.00 | not published | 0 |
| Hc fl sm bowel enteroclss tube w kub double contrast CPT 74251 | $2,064.70 | $3,754.00 | $187.96 – $197.36 | 3 |
| Hcg free betachain test CPT 84704 | $27.50 | $50.00 | $15.29 – $16.05 | 3 |
| Hcg qualitative CPT 84703 | $161.70 | $294.00 | $7.52 – $7.90 | 3 |
| Hcg quantitative CPT 84702 | $207.90 | $378.00 | $15.05 – $15.80 | 3 |
| Hc i-131 sodium iodide cap dx per mci HCPCS A9528 | $56.65 | $103.00 | not published | 0 |
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.