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 |
|---|---|---|---|---|
| Hla ii typing 1 loc hr CPT 81382 | $282.70 | $514.00 | $123.68 – $129.86 | 3 |
| Hla ii typing ag equiv lr CPT 81375 | not published | not published | $220.74 – $231.78 | 3 |
| Hla i low res one antigen equiv ea CPT 81374 | $169.40 | $308.00 | $74.33 – $78.05 | 3 |
| Hla i typing 1 locus hr CPT 81380 | $1,095.60 | $1,992.00 | $177.25 – $186.11 | 3 |
| Hla i typing complete hr CPT 81379 | not published | not published | $335.38 – $352.15 | 3 |
| Hla i typing complete lr CPT 81372 | not published | not published | $403.59 – $423.77 | 3 |
| Hla i typing high res 1 allele grp ea CPT 81381 | $434.50 | $790.00 | $169.90 – $178.40 | 3 |
| Hla i typing low res one locus ea CPT 81373 | not published | not published | $127.43 – $133.80 | 3 |
| Hla typing a b or c CPT 86813 | not published | not published | $58.00 – $60.90 | 3 |
| Hla typing dr/dq CPT 86816 | not published | not published | $30.17 – $31.68 | 3 |
| Hla x-match noncytotoxc addl CPT 86826 | not published | not published | $36.53 – $38.36 | 3 |
| Hla x-math non-cytotoxic CPT 86825 | not published | not published | $109.49 – $114.96 | 3 |
| Home sleep test/type 2 porta HCPCS G0398 | $517.00 | $940.00 | $231.39 – $242.96 | 3 |
| Home sleep test/type 3 porta HCPCS G0399 | $1,008.70 | $1,834.00 | $231.39 – $242.96 | 3 |
| Home sleep test/type 4 porta HCPCS G0400 | not published | not published | $231.39 – $242.96 | 3 |
| Homocysteine CPT 83090 | $352.00 | $640.00 | $17.92 – $18.82 | 3 |
| Homogenization tissue CPT 87176 | $36.30 | $66.00 | $5.88 – $6.17 | 3 |
| Homovanillic acid (hva) CPT 83150 | $243.65 | $443.00 | $22.41 – $23.53 | 3 |
| Hopd covid-19 spec collect HCPCS C9803 | $35.75 | $65.00 | not published | 0 |
| Hpa-15 genotyping CPT 81112 | not published | not published | $122.22 – $128.33 | 3 |
| Hpa-1 genotyping CPT 81105 | not published | not published | $122.22 – $128.33 | 3 |
| Hpa-2 genotyping CPT 81106 | not published | not published | $122.22 – $128.33 | 3 |
| Hpa-3 genotyping CPT 81107 | not published | not published | $122.22 – $128.33 | 3 |
| Hpa-4 genotyping CPT 81108 | not published | not published | $122.22 – $128.33 | 3 |
| Hpa-5 genotyping CPT 81109 | not published | not published | $122.22 – $128.33 | 3 |
| Hpa-6 genotyping CPT 81110 | not published | not published | $122.22 – $128.33 | 3 |
| Hpa-9 genotyping CPT 81111 | not published | not published | $122.22 – $128.33 | 3 |
| Hpv combo assay ca screen HCPCS G0476 | not published | not published | $35.09 – $36.84 | 3 |
| Hpv low-risk types CPT 87623 | not published | not published | $35.09 – $36.84 | 3 |
| Hpv types 16 & 18 only CPT 87625 | not published | not published | $40.55 – $42.58 | 3 |
| H pylori ag ia CPT 87339 | not published | not published | $16.00 – $16.80 | 3 |
| H pylori (c-13) blood CPT 83009 | not published | not published | $67.36 – $70.73 | 3 |
| H pylori (c-13) breath CPT 83013 | $155.65 | $283.00 | $67.36 – $70.73 | 3 |
| H pylori drug admin CPT 83014 | not published | not published | $7.86 – $8.25 | 3 |
| Hrdtry brst ca-rlatd do 5+ CPT 81432 | $1,535.05 | $2,791.00 | $1,303.95 – $1,369.15 | 3 |
| Hrdtry cardmypy gene panel CPT 81439 | not published | not published | $584.90 – $614.14 | 3 |
| Hrdtry perph neurphy panel CPT 81448 | not published | not published | $584.90 – $614.14 | 3 |
| Hrv skn cll ssp agrft 1st 25 CPT 15011 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Hsv dna dir probe CPT 87528 | not published | not published | $20.05 – $21.05 | 3 |
| Htt gene charac alleles CPT 81274 | not published | not published | $274.83 – $288.57 | 3 |
| Htt gene detc abnor alleles CPT 81271 | $310.20 | $564.00 | $137.00 – $143.85 | 3 |
| Human epididymis protein 4 (he4) CPT 86305 | $214.50 | $390.00 | $20.81 – $21.85 | 3 |
| Hydration IV infusion each additional hour CPT 96361 | $100.10 | $182.00 | $50.18 – $52.69 | 3 |
| Hydration IV infusion initial 31minutes - 1 hour CPT 96360 | $383.35 | $697.00 | $227.94 – $239.33 | 3 |
| Hydrxycorticsterds 17- (17-ohcs) CPT 83491 | $411.40 | $748.00 | $17.90 – $18.80 | 3 |
| Hymenotomy CPT 56442 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Hyoid myotomy & suspension CPT 21685 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| #hypersens-actinomyces ab CPT 86602 | not published | not published | $10.18 – $10.69 | 3 |
| Hysterosalpingography s&i CPT 74740 | $1,144.55 | $2,081.00 | $255.69 – $268.47 | 3 |
| Hysteroscopy ablation CPT 58563 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Hysteroscopy biopsy CPT 58558 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Hysteroscopy dx sep proc CPT 58555 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Hysteroscopy lysis CPT 58559 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Hysteroscopy remove fb CPT 58562 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Hysteroscopy remove myoma CPT 58561 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Hysteroscopy resect septum CPT 58560 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Hysterotomy abdominal 59100 CPT 59100 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| I-123 iobenguane diag HCPCS A9582 | $4,305.40 | $7,828.00 | not published | 0 |
| I-123 ioflupane diag HCPCS A9584 | $3,278.00 | $5,960.00 | not published | 0 |
| I-123 sod iodide diag per 100 uci HCPCS A9516 | $174.90 | $318.00 | not published | 0 |
| I131 iodide cap, rx HCPCS A9517 | $117.70 | $214.00 | not published | 0 |
| Iaadi respiratory synctial virus CPT 87280 | $42.35 | $77.00 | $13.42 – $14.09 | 3 |
| Iadna legionella pneumophila amplified probe tq CPT 87541 | not published | not published | $35.09 – $36.84 | 3 |
| Ia infect ag ab qual/semiquant sgl step CPT 86318 | $169.40 | $308.00 | $18.09 – $18.99 | 3 |
| Ia nfct ab sarscov2 covid19 CPT 86328 | not published | not published | $45.28 – $47.54 | 3 |
| Ibmfs seq alys pnl 30 genes CPT 81441 | not published | not published | $2,448.56 – $2,570.99 | 3 |
| Icd cobalt xt dr MRI is1 df1 HCPCS C1721 | $32,319.18 | $58,762.14 | not published | 0 |
| Icd crtd cobalt hf MRI is1 df1 HCPCS C1882 | $46,687.57 | $84,886.49 | not published | 0 |
| Icd crtp serena MRI HCPCS C2621 | $9,615.70 | $17,483.10 | not published | 0 |
| Icd reliance df4 ib 64cm HCPCS C1895 | $10,772.50 | $19,586.36 | not published | 0 |
| Icg angiography i&r uni/bi CPT 92240 | not published | not published | $231.39 – $242.96 | 3 |
| Icut allergy test-delayed CPT 95028 | not published | not published | $40.03 – $42.03 | 3 |
| Icut allergy test drug/bug CPT 95024 | not published | not published | $63.22 – $66.38 | 3 |
| Icut allergy titrate-airborn CPT 95027 | not published | not published | $30.99 – $32.54 | 3 |
| I&d abscess posterior spine l/s/ls-22015 CPT 22015 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| I&d abscss rtrphryngl/paraphryngl intraorl apprch CPT 42720 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| I&d/bursa/foot 28001 CPT 28001 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Identify sperm tissue CPT 89264 | not published | not published | $55.84 – $58.64 | 3 |
| I&d frarm&/wrst deep absc/hematoma CPT 25028 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Idh1 common variants CPT 81120 | not published | not published | $193.25 – $202.91 | 3 |
| Idh2 common variants CPT 81121 | not published | not published | $295.79 – $310.58 | 3 |
| I&d intramural/intramuscular/submuc abscess transanal anes CPT 46045 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| I&d upper arm/elbow deep abscess/hematoma CPT 23930 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| I & d vag hematoma non-ob 57023 CPT 57023 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| I&d vag hemtma obst/postpart CPT 57022 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Ifnl3 gene CPT 81283 | not published | not published | $73.37 – $77.04 | 3 |
| Igh@/bcl2 translocation alys CPT 81278 | not published | not published | $207.31 – $217.68 | 3 |
| Igh gene rearrang dir probe CPT 81262 | not published | not published | $68.55 – $71.98 | 3 |
| Igh gene rearrange amp meth CPT 81261 | $744.70 | $1,354.00 | $197.99 – $207.89 | 3 |
| Igh@ var region somatic mutation analy CPT 81263 | $1,282.60 | $2,332.00 | $294.52 – $309.25 | 3 |
| Igk rearrangeabn clonal pop CPT 81264 | $558.80 | $1,016.00 | $172.73 – $181.37 | 3 |
| Ihc/icc per specimen each additional single antibody stain CPT 88341 | $362.45 | $659.00 | not published | 0 |
| Ihc/icc per specimen each multiplex antibody stain CPT 88344 | $405.90 | $738.00 | $384.12 – $403.32 | 3 |
| Ihc/icc per specimen initial single antibody stain CPT 88342 | $400.95 | $729.00 | $182.57 – $191.70 | 3 |
| Ikbkap gene CPT 81260 | not published | not published | $39.31 – $41.28 | 3 |
| Iliac bone graft microvasc CPT 20956 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Iliac/fem angio cath insert HCPCS G0278 | $2,931.50 | $5,330.00 | not published | 0 |
| Iliac revasc add-on 37222 CPT 37222 | $7,197.85 | $13,087.00 | not published | 0 |
| Img rta detcj/mntr ds staff CPT 92227 | not published | not published | $63.22 – $66.38 | 3 |
| Img rta detc/mntr ds phy/qhp CPT 92228 | not published | not published | $40.03 – $42.03 | 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.