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 |
|---|---|---|---|---|
| Img rta detc/mntr ds poc aly CPT 92229 | not published | not published | $63.22 – $66.38 | 3 |
| Immune complex assay CPT 86332 | $440.00 | $800.00 | $24.37 – $25.59 | 3 |
| Immunoassay tumor antigen quantitative ca 125 CPT 86304 | $68.20 | $124.00 | $20.81 – $21.85 | 3 |
| Immunoassay tumor antigen quantitative ca 19-9 CPT 86301 | $68.20 | $124.00 | $20.81 – $21.85 | 3 |
| Immunoassay tumor qual CPT 86294 | not published | not published | $25.57 – $26.85 | 3 |
| Immunodiff gel qual ea antigen/ab CPT 86331 | $496.10 | $902.00 | $11.98 – $12.58 | 3 |
| Immunodiffusion nes CPT 86329 | $72.60 | $132.00 | $14.05 – $14.75 | 3 |
| Immunofixation electrophoresis serum CPT 86334 | $107.80 | $196.00 | $22.34 – $23.46 | 3 |
| Immunofluorescence per specimen each additional single antibody stain CPT 88350 | $117.70 | $214.00 | not published | 0 |
| Immunofluorescence per specimen initial single antibody stain CPT 88346 | $1,918.95 | $3,489.00 | $182.57 – $191.70 | 3 |
| Immunoglobulin assay CPT 86023 | $178.75 | $325.00 | $12.46 – $13.08 | 3 |
| Immunology procedure CPT 86849 | $118.25 | $215.00 | not published | 0 |
| Impedence cardiogram CPT 93701 | not published | not published | $142.58 – $149.71 | 3 |
| Imp extar knee shck absrb HCPCS C8003 | not published | not published | $18,789.56 – $19,729.04 | 3 |
| Implant neuroelectrodes CPT 64555 | $10,323.50 | $18,770.00 | not published | 0 |
| Implant neuroelectrodes CPT 64561 | $9,286.75 | $16,885.00 | not published | 0 |
| Implant single ventricular device 33975 CPT 33975 | $31,632.70 | $57,514.00 | not published | 0 |
| Implant spinal canal cath CPT 62351 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Impl oi implt sk tc esp<100 CPT 69716 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Impl oi implt sk tc esp>=100 CPT 69729 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Impl oi implt skull perq esp CPT 69714 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Impres&prep auricular prosth CPT 21086 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Impres&prep def obt prosth CPT 21080 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Impres&prep facial prosth CPT 21088 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Impres&prep intrm obt prosth CPT 21079 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Impres&prep mndbl res prosth CPT 21081 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Impres&prep nasal prosth CPT 21087 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Impres&prep orbital prosth CPT 21077 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Impres&prep paltl aug prosth CPT 21082 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Impres&prep paltl lft prosth CPT 21083 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Impres&prep sp aid prosth CPT 21084 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Impres&prep surg obt prosth CPT 21076 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| In-111 autol wbc diag per dose HCPCS A9570 | $2,262.15 | $4,113.00 | not published | 0 |
| In-111 pentetate dtpa / 0.5 mci HCPCS A9548 | $1,087.90 | $1,978.00 | not published | 0 |
| In-111 pentetreotide HCPCS A9572 | $4,241.05 | $7,711.00 | not published | 0 |
| Inc deep opng b1 crtx thorax CPT 21510 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Inc dp bone crtx f/arm&/wrst CPT 25035 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Inc dp opn b1 crtx hum/elbw CPT 23935 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incis 1 vertebral seg cerv CPT 22210 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incis 1 vertebral seg lumbar CPT 22214 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incis 1 vertebral seg thorac CPT 22212 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incise flexor carpi radialis CPT 25001 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incise hand/finger tendon CPT 26460 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Incise inner ear CPT 69801 | $1,847.45 | $3,359.00 | $1,662.71 – $1,745.84 | 3 |
| Incise inner ear nerve CPT 69915 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Incise perq finger tendon 26060 CPT 26060 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Incise sperm duct pouch CPT 55600 | not published | not published | $2,240.09 – $2,352.10 | 3 |
| Incise tendon(s) & muscle(s) CPT 23406 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incise thigh tendon & fascia CPT 27305 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incise wrist/forearm tendon CPT 25290 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision anal septum infant CPT 46070 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Incision & drainage hematoma/seroma/fluid collection CPT 10140 | $1,779.25 | $3,235.00 | $1,769.88 – $1,858.38 | 3 |
| Incision & drainage open of deep abscess (subfascial) pos CPT 22010 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision/fixation of femur CPT 27165 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of achilles tendon CPT 27605 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Incision of achilles tendon CPT 27606 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision of anal sphincter CPT 46080 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Incision of ankle bone CPT 28302 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of breast lesion CPT 19020 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Incision of burn scab initi CPT 16035 | not published | not published | $435.63 – $457.41 | 3 |
| Incision of eardrum CPT 69420 | $300.30 | $546.00 | not published | 0 |
| Incision of eardrum CPT 69421 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Incision of esophagus CPT 43020 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Incision of fibula CPT 27707 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision of finger tendon CPT 26455 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Incision of foot fascia CPT 28008 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision of foot tendon 28234 CPT 28234 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Incision of heel bone CPT 28300 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of hip bone CPT 27146 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of hip bones CPT 27151 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of hip tendon CPT 27000 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Incision of hip tendon CPT 27001 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision of hip tendon CPT 27003 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of hip tendons CPT 27006 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision of jaw joint CPT 21010 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Incision of knee joint CPT 27435 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision of lymph channels CPT 38308 | not published | not published | $4,195.85 – $4,405.64 | 3 |
| Incision of metatarsal CPT 28306 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of metatarsal CPT 28307 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of metatarsal CPT 28308 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision of metatarsals CPT 28309 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of midfoot bones CPT 28304 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of neck of femur CPT 27161 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of palm tendon CPT 26450 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision of prostate CPT 52450 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Incision of rectal abscess CPT 46060 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Incision of sperm duct CPT 55200 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Incision of tendon & muscle CPT 23405 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of tendon sheath CPT 25000 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Incision of thigh CPT 27448 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of thigh CPT 27450 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of thigh tendon CPT 27306 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision of thigh tendon CPT 27390 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision of thigh tendons CPT 27307 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision of thigh tendons CPT 27391 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision of thigh tendons CPT 27392 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Incision of tibia CPT 27705 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Incision of tibia & fibula CPT 27709 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Incision of toe tendons 28011 CPT 28011 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Incision of tongue fold CPT 41010 | $1,384.35 | $2,517.00 | $1,662.71 – $1,745.84 | 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.