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 |
|---|---|---|---|---|
| Lithium therapeutic drug level CPT 80178 | $125.40 | $228.00 | $6.61 – $6.94 | 3 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $4,876.30 | $8,866.00 | not published | 0 |
| Liver ds alys 3 bmrk srm alg CPT 81517 | not published | not published | $176.19 – $185.00 | 3 |
| Liver elastography 91200 CPT 91200 | not published | not published | $137.89 – $144.78 | 3 |
| Liver Function Test CPT 80076 | $159.50 | $290.00 | $8.17 – $8.58 | 3 |
| Liver imaging CPT 78201 | $1,963.50 | $3,570.00 | $581.86 – $610.95 | 3 |
| Liver imag w/vasclr flow CPT 78202 | $1,963.50 | $3,570.00 | $581.86 – $610.95 | 3 |
| Liver/spleen imag static only CPT 78215 | $846.45 | $1,539.00 | $428.40 – $449.82 | 3 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $987.25 | $1,795.00 | $428.40 – $449.82 | 3 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Loudness balance test CPT 92562 | not published | not published | $231.39 – $242.96 | 3 |
| Low back disk surgery CPT 63030 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Low cost skin substitute app HCPCS C5271 | $594.55 | $1,081.00 | not published | 0 |
| Low cost skin substitute app HCPCS C5275 | $552.20 | $1,004.00 | not published | 0 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $2,729.65 | $4,963.00 | $187.96 – $197.36 | 3 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $2,568.50 | $4,670.00 | $373.86 – $392.55 | 3 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $2,407.90 | $4,378.00 | $112.03 – $117.63 | 3 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $4,299.35 | $7,817.00 | $373.86 – $392.55 | 3 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $3,097.05 | $5,631.00 | $373.86 – $392.55 | 3 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $2,898.50 | $5,270.00 | $255.69 – $268.47 | 3 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $584.10 | $1,062.00 | $112.03 – $117.63 | 3 |
| Lower jaw bone graft CPT 21215 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Low frequency non-thermal Ultrasound CPT 97610 | not published | not published | $215.00 – $225.75 | 3 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $11,391.13 – $11,960.68 | 3 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $11,391.13 – $11,960.68 | 3 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $11,391.13 – $11,960.68 | 3 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $11,391.13 – $11,960.68 | 3 |
| L/s ratio fetal lung CPT 83661 | $303.05 | $551.00 | $21.99 – $23.09 | 3 |
| Lumbar diskogram s&i CPT 72295 | $4,674.45 | $8,499.00 | not published | 0 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $18,789.56 – $19,729.04 | 3 |
| Lung function test (mbc/mvv) CPT 94200 | not published | not published | $63.22 – $66.38 | 3 |
| Lung Function Test (Spirometry) CPT 94010 | $317.35 | $577.00 | $231.39 – $242.96 | 3 |
| Lung perfusion imaging CPT 78580 | $994.95 | $1,809.00 | $428.40 – $449.82 | 3 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | $30.99 – $32.54 | 3 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $20.05 – $21.05 | 3 |
| Lymphatics/lymph node imaging CPT 78195 | $2,136.20 | $3,884.00 | $581.86 – $610.95 | 3 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $36.56 – $38.39 | 3 |
| Lymphocyte transformation mitogen CPT 86353 | $158.40 | $288.00 | $49.03 – $51.48 | 3 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $189.51 – $198.99 | 3 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $47.59 – $49.97 | 3 |
| Lymph vessel x-ray arm/leg CPT 75801 | not published | not published | $672.23 – $705.84 | 3 |
| Lymph vessel x-ray arms/legs CPT 75803 | not published | not published | $1,686.89 – $1,771.24 | 3 |
| Lymph vessel x-ray trunk CPT 75805 | not published | not published | $3,383.62 – $3,552.80 | 3 |
| Lymph vessel x-ray trunk CPT 75807 | not published | not published | $3,383.62 – $3,552.80 | 3 |
| Lysis of labial adhesions CPT 56441 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $2,240.09 – $2,352.10 | 3 |
| Macroscopic exam arthropod CPT 87168 | $172.15 | $313.00 | $4.27 – $4.48 | 3 |
| Macroscopic exam parasite CPT 87169 | $28.05 | $51.00 | $4.31 – $4.53 | 3 |
| Magnesium CPT 83735 | $115.50 | $210.00 | $6.70 – $7.04 | 3 |
| Magnetic image bone marrow CPT 77084 | $2,097.70 | $3,814.00 | $255.69 – $268.47 | 3 |
| Malaria antibody CPT 86750 | not published | not published | $13.19 – $13.85 | 3 |
| Manipulate finger w/anesth CPT 26340 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $35.20 | $64.00 | $142.58 – $149.71 | 3 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $57.75 | $105.00 | $142.58 – $149.71 | 3 |
| Manipulation of hip joint CPT 27275 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Manipulation of spine CPT 22505 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Manipulat palm cord post inj CPT 26341 | not published | not published | $264.33 – $277.55 | 3 |
| Manual diff wbc count b-coat CPT 85009 | not published | not published | $5.07 – $5.32 | 3 |
| Marker biop eviva buckle ss HCPCS A4648 | $218.31 | $396.92 | not published | 0 |
| Mastectomy partial CPT 19301 | not published | not published | $4,195.85 – $4,405.64 | 3 |
| Mast mod rad CPT 19307 | not published | not published | $7,115.73 – $7,471.51 | 3 |
| Mastoidectomy CPT 69501 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Mastoidectomy complete 69502 CPT 69502 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Mastoids complete CPT 70130 | $180.95 | $329.00 | $112.03 – $117.63 | 3 |
| Mastoid surgery revision CPT 69603 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Mastopexy CPT 19316 | $6,679.75 | $12,145.00 | $7,115.73 – $7,471.51 | 3 |
| Mast simple complete CPT 19303 | not published | not published | $7,115.73 – $7,471.51 | 3 |
| M.avium-intra dna amp prob CPT 87561 | not published | not published | $35.09 – $36.84 | 3 |
| M.avium-intra dna dir prob CPT 87560 | not published | not published | $27.29 – $28.65 | 3 |
| M.avium-intra dna quant CPT 87562 | not published | not published | $42.84 – $44.98 | 3 |
| Maxillofacial fixation CPT 21100 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $311.30 | $566.00 | $14.46 – $15.18 | 3 |
| Mayo aathr protein s free CPT 85306 | $310.75 | $565.00 | $15.32 – $16.09 | 3 |
| Mayo activated protein c resistance assay CPT 85307 | $268.40 | $488.00 | $15.32 – $16.09 | 3 |
| Mayo adalimumab (humira) therapeutic drug level CPT 80145 | $194.70 | $354.00 | $38.57 – $40.50 | 3 |
| Mayo alcohol biomarkers definitive assay 1 or 2 phosphatidylethanol confirmation CPT 80321 | $79.75 | $145.00 | not published | 0 |
| Mayo alcohol definitive assay volatile screen CPT 80320 | $162.25 | $295.00 | not published | 0 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $129.80 | $236.00 | $14.78 – $15.52 | 3 |
| Mayo alkaloids definitive assay nicotine/cotinine CPT 80323 | $165.00 | $300.00 | not published | 0 |
| Mayo alpha 1 antitrypsin CPT 82103 | $211.75 | $385.00 | $13.44 – $14.11 | 3 |
| Mayo amikacin trough therapeutic drug level CPT 80150 | $170.50 | $310.00 | $15.08 – $15.83 | 3 |
| Mayo amphu amphetamines definitive assay 3 or 4 urine CPT 80325 | $18.70 | $34.00 | not published | 0 |
| Mayo amphu methylenedioxyamphetamines definitive assay urine CPT 80359 | $78.10 | $142.00 | not published | 0 |
| Mayo analysis gene calr common variants exon 9 CPT 81219 | $840.40 | $1,528.00 | $121.63 – $127.71 | 3 |
| Mayo analysis gene jak2 p.val617phe variant CPT 81270 | $1,298.00 | $2,360.00 | $91.66 – $96.24 | 3 |
| Mayo analysis gene smn1 dosage/deletion CPT 81329 | $339.35 | $617.00 | $137.00 – $143.85 | 3 |
| Mayo analysis microarray cytogenomic copy number/snp variants CPT 81229 | $2,618.00 | $4,760.00 | $1,160.00 – $1,218.00 | 3 |
| Mayo androstenedione CPT 82157 | $287.65 | $523.00 | $29.28 – $30.74 | 3 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $215.60 | $392.00 | $14.60 – $15.33 | 3 |
| Mayo antithrombin iii antigen CPT 85301 | $479.05 | $871.00 | $10.81 – $11.35 | 3 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $50.60 | $92.00 | $15.05 – $15.80 | 3 |
| Mayo avwpr vw factor activity CPT 85397 | $174.90 | $318.00 | $30.86 – $32.40 | 3 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | not published | not published | $35.09 – $36.84 | 3 |
| Mayo barbiturates definitive assay confirmation urine CPT 80345 | $149.05 | $271.00 | not published | 0 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $185.90 | $338.00 | $10.18 – $10.69 | 3 |
| Mayo bcrfx analysis translocation bcr/abl1 minor breakpoint qualitative/quantitative CPT 81207 | $790.90 | $1,438.00 | $144.84 – $152.08 | 3 |
| Mayo bcrfx analysis translocation bcr/abl1 other breakpoint qualitative/quantitative CPT 81208 | $372.90 | $678.00 | $214.62 – $225.35 | 3 |
| Mayo blastomyces antibody immunodiffusion CPT 86612 | $45.10 | $82.00 | $12.90 – $13.54 | 3 |
| Mayo bnzu sedative hypnotics definitive urine CPT 80368 | $152.35 | $277.00 | 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.