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 |
|---|---|---|---|---|
| Ins pq tunnld ip cath w/img CPT 49418 | $3,824.15 | $6,953.00 | $3,836.82 – $4,028.66 | 3 |
| Ins/rpl ldless pm right vent w img & eval CPT 33274 | $18,257.80 | $33,196.00 | not published | 0 |
| Ins/rpl pm gen exist dual lead CPT 33213 | $11,198.55 | $20,361.00 | $11,200.55 – $11,760.58 | 3 |
| Ins/rpl pm gen exist sgl lead CPT 33212 | not published | not published | $8,868.06 – $9,311.46 | 3 |
| Ins/rpl pm w/tv ld atrl CPT 33206 | $15,154.70 | $27,554.00 | $11,200.55 – $11,760.58 | 3 |
| Ins/rpl prph sac/gstr npg/r CPT 64590 | $4,341.70 | $7,894.00 | not published | 0 |
| Inst fibrinolysis agent ini day CPT 32561 | not published | not published | $672.23 – $705.84 | 3 |
| Inst fibrinolysis agent sbsq d CPT 32562 | not published | not published | $672.23 – $705.84 | 3 |
| Instillation anticarcinogenic agent bladder CPT 51720 | $1,246.85 | $2,267.00 | $747.24 – $784.60 | 3 |
| Instll rx agnt into rnal tub CPT 50391 | not published | not published | $267.74 – $281.13 | 3 |
| Ins tun cvad 2 cath w/subq port(s) CPT 36566 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Ins tun cv cath wo subq prt/pm CPT 36557 | $5,434.00 | $9,880.00 | $5,963.01 – $6,261.16 | 3 |
| Ins tun cv cath wo subq prt/pm CPT 36558 | $5,297.60 | $9,632.00 | $3,383.62 – $3,552.80 | 3 |
| Ins tun intraperit dia cath CPT 49421 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Inst via cath agent pleurds CPT 32560 | $839.30 | $1,526.00 | $672.23 – $705.84 | 3 |
| Insulin suppression panel CPT 80432 | not published | not published | $165.61 – $173.89 | 3 |
| Insulin tolerance panel CPT 80434 | not published | not published | $285.03 – $299.28 | 3 |
| Insulin tolerance panel CPT 80435 | not published | not published | $103.00 – $108.15 | 3 |
| Insulin total CPT 83525 | $27.50 | $50.00 | $11.43 – $12.00 | 3 |
| Ins vag brachytx device CPT 57156 | not published | not published | $326.55 – $342.88 | 3 |
| Intens cardiac rehab no exer HCPCS G0423 | not published | not published | $138.14 – $145.05 | 3 |
| Intens cardiac rehab w/exerc HCPCS G0422 | not published | not published | $138.14 – $145.05 | 3 |
| Interdental fixation CPT 21110 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Interdental wirg oth/thn fx CPT 21497 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Interdiscal perq aspir dx CPT 62267 | $1,268.85 | $2,307.00 | $758.85 – $796.79 | 3 |
| Intermediate visual field xm CPT 92082 | not published | not published | $63.22 – $66.38 | 3 |
| Interrogate subq defib CPT 93261 | not published | not published | $39.99 – $41.99 | 3 |
| Interrog dev eval icpms ip CPT 93290 | not published | not published | $39.99 – $41.99 | 3 |
| Interrog dev eval scrms ip CPT 93291 | $26.95 | $49.00 | $30.99 – $32.54 | 3 |
| Interrog device eval heart CPT 93289 | not published | not published | $39.99 – $41.99 | 3 |
| Interrog evl pm/ldls pm ip CPT 93288 | $64.90 | $118.00 | $39.99 – $41.99 | 3 |
| Interthoracoscplr amputation CPT 23900 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Int hrhc lig 1 hroid without img CPT 46945 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Int hrhc lig 2+hroid without img CPT 46946 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Intracranial complete study CPT 93886 | $525.80 | $956.00 | $255.69 – $268.47 | 3 |
| Intracranial limited study CPT 93888 | $350.35 | $637.00 | $112.03 – $117.63 | 3 |
| Intranasal biopsy 30100 CPT 30100 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Intranasal reconstruction CPT 30620 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Intraoral periapical first HCPCS D0220 | not published | not published | $93.26 – $97.92 | 3 |
| Intrapul surf admin endo tube CPT 94610 | not published | not published | $234.66 – $246.39 | 3 |
| Intrauterine transfusion ftl CPT 36460 | not published | not published | $472.77 – $496.41 | 3 |
| Intrinsic factor antibody CPT 86340 | $39.60 | $72.00 | $15.08 – $15.83 | 3 |
| Intrm oph exam est patient CPT 92012 | not published | not published | $142.67 – $149.80 | 3 |
| Intro cath dialysis circuit CPT 36901 | $3,921.50 | $7,130.00 | $1,686.89 – $1,771.24 | 3 |
| Intro cath dialysis circuit w/pta CPT 36902 | $6,179.80 | $11,236.00 | $6,099.19 – $6,404.14 | 3 |
| Intro cath dialysis circuit w/stent plcmnt CPT 36903 | $12,264.45 | $22,299.00 | $12,370.97 – $12,989.52 | 3 |
| Intro catheter aorta CPT 36200 | $2,923.80 | $5,316.00 | not published | 0 |
| Intro cath svc/ivc CPT 36010 | $1,069.75 | $1,945.00 | not published | 0 |
| Intro long gi tube CPT 44500 | $1,298.55 | $2,361.00 | $971.94 – $1,020.54 | 3 |
| Intro long gi tube w/mult fluo CPT 74340 | $707.85 | $1,287.00 | not published | 0 |
| Intro windpipe wire/tube CPT 31730 | not published | not published | $1,907.37 – $2,002.74 | 3 |
| Intrvasc Ultrasound noncoronary 1st vessel CPT 37252 | $4,767.40 | $8,668.00 | not published | 0 |
| Intrvasc Ultrasound noncoronary addl vessel CPT 37253 | $3,929.75 | $7,145.00 | not published | 0 |
| Intubation endotracheal emergency procedure CPT 31500 | $503.25 | $915.00 | not published | 0 |
| Io anal gast n-stim subsq CPT 95981 | not published | not published | $63.22 – $66.38 | 3 |
| Io ga n-stim subsq w/reprog CPT 95982 | not published | not published | $39.99 – $41.99 | 3 |
| Ionm in operatng room 15 min CPT 95940 | $95.70 | $174.00 | not published | 0 |
| Iron CPT 83540 | $101.75 | $185.00 | $6.47 – $6.79 | 3 |
| Iron binding capacity CPT 83550 | $79.75 | $145.00 | $8.74 – $9.18 | 3 |
| Iron stain peripheral blood CPT 85536 | not published | not published | $6.88 – $7.22 | 3 |
| Irradiation of blood product each unit reference CPT 86945 | not published | not published | $40.03 – $42.03 | 3 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $167.20 | $304.00 | $63.22 – $66.38 | 3 |
| Irrigation sphenoid sinus CPT 31002 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Irrigation vagina and/or appl medicament tx disease CPT 57150 | not published | not published | $63.22 – $66.38 | 3 |
| Island pedicle flap graft CPT 15740 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Ivc venogram s&i CPT 75825 | $5,000.05 | $9,091.00 | $3,383.62 – $3,552.80 | 3 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $142.45 | $259.00 | $77.16 – $81.01 | 3 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $173.80 | $316.00 | not published | 0 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $134.75 | $245.00 | $50.18 – $52.69 | 3 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $431.20 | $784.00 | $227.94 – $239.33 | 3 |
| IV inj ra drug dx study CPT 78808 | not published | not published | $428.40 – $449.82 | 3 |
| Ivp w/nephrotomography CPT 74415 | $1,150.05 | $2,091.00 | $187.96 – $197.36 | 3 |
| Ivp w/wo kub w/wo tomography CPT 74400 | $1,317.80 | $2,396.00 | $187.96 – $197.36 | 3 |
| Jak2 targeted sequence analysis CPT 81279 | $423.50 | $770.00 | $185.20 – $194.46 | 3 |
| Jaw arthroscopy/surgery CPT 29800 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Jaw arthroscopy/surgery CPT 29804 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Jejunstmy tube plcmt CPT 44372 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| John cunningham antibody CPT 86711 | $479.05 | $871.00 | $16.89 – $17.73 | 3 |
| Ketamine and metabolite screen - quest CPT 80357 | $149.05 | $271.00 | not published | 0 |
| Ketogenic steroids fract CPT 83582 | not published | not published | $15.47 – $16.24 | 3 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $52.25 | $95.00 | $8.17 – $8.58 | 3 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | not published | not published | $0.29 – $0.30 | 3 |
| Kidney endoscopy CPT 50551 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Kidney endoscopy CPT 50553 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Kidney endoscopy CPT 50570 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Kidney endoscopy CPT 50575 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Kidney endoscopy & biopsy CPT 50574 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Kidney endoscopy & treatment CPT 50561 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Kidney endoscopy & treatment CPT 50580 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Kidney function study CPT 78725 | not published | not published | $428.40 – $449.82 | 3 |
| Kidney imaging morphology CPT 78700 | $1,189.10 | $2,162.00 | $428.40 – $449.82 | 3 |
| Kidney imag w/bld flow multi CPT 78709 | $1,965.70 | $3,574.00 | $581.86 – $610.95 | 3 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $1,566.40 | $2,848.00 | $581.86 – $610.95 | 3 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $933.90 | $1,698.00 | $112.03 – $117.63 | 3 |
| Kit case 4.2mm spinejack HCPCS C1062 | $3,764.73 | $6,844.97 | not published | 0 |
| Kit cath ivl 2.5x40mm 135cm shockwave s4 HCPCS C1761 | $13,867.63 | $25,213.88 | not published | 0 |
| Kit gene analys d816 variant CPT 81273 | not published | not published | $124.87 – $131.11 | 3 |
| Kit lead specify 5-6-5 HCPCS C1778 | $4,935.57 | $8,973.76 | not published | 0 |
| Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set HCPCS C1878 | $695.40 | $1,264.36 | not published | 0 |
| Knee Arthroscopy (Cartilage Repair) CPT 29877 | not published | not published | $3,506.34 – $3,681.65 | 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.