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 |
|---|---|---|---|---|
| Mayo bordetella pertussis antibody igg CPT 86615 | $171.60 | $312.00 | $13.19 – $13.85 | 3 |
| Mayo brcmg brucella antibody igm CPT 86622 | $102.30 | $186.00 | $8.93 – $9.38 | 3 |
| Mayo c1 esterase inhibitor CPT 83883 | $103.40 | $188.00 | $13.60 – $14.28 | 3 |
| Mayo cannabinoids natural definitive assay thc confirmation urine CPT 80349 | $135.85 | $247.00 | not published | 0 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $63.80 | $116.00 | $16.87 – $17.71 | 3 |
| Mayo cd20b mononuclear cell antigen nos quantitative each CPT 86356 | $124.30 | $226.00 | $26.78 – $28.12 | 3 |
| Mayo cdcom hla class ii typing low resolution one locus each CPT 81376 | $411.95 | $749.00 | $122.22 – $128.33 | 3 |
| Mayo ceruloplasmin CPT 82390 | $56.10 | $102.00 | $10.74 – $11.28 | 3 |
| Mayo chemiluminescent parathyroid related peptide CPT 82397 | $419.65 | $763.00 | $14.12 – $14.83 | 3 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $225.50 | $410.00 | $12.88 – $13.52 | 3 |
| Mayo chlap chlamydia pneumoniae antibody igg CPT 86631 | $90.20 | $164.00 | $11.82 – $12.41 | 3 |
| Mayo chlap chlamydia pneumoniae antibody igm CPT 86632 | $118.25 | $215.00 | $12.68 – $13.31 | 3 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $1,376.65 | $2,503.00 | $116.49 – $122.31 | 3 |
| Mayo chromium CPT 82495 | $24.20 | $44.00 | $20.28 – $21.29 | 3 |
| Mayo cocaine definitive assay confirmation urine CPT 80353 | $135.85 | $247.00 | not published | 0 |
| Mayo coccidioides antibody CPT 86635 | $208.45 | $379.00 | $11.47 – $12.04 | 3 |
| Mayo cocou cortisone urine CPT 82542 | $458.70 | $834.00 | $24.09 – $25.29 | 3 |
| Mayo cortisol free CPT 82530 | $235.40 | $428.00 | $16.71 – $17.55 | 3 |
| Mayo covid-19 antibody nucleocapsid total CPT 86769 | $72.60 | $132.00 | $42.13 – $44.24 | 3 |
| Mayo coxiella brunetii (q fever) igg antibody CPT 86638 | $237.60 | $432.00 | $12.12 – $12.73 | 3 |
| Mayo csmpu benzodiazepines definitive assay >=13 urine CPT 80347 | $130.35 | $237.00 | not published | 0 |
| Mayo csmpu opiod/analogs definitive assay >=5 urine CPT 80364 | $95.15 | $173.00 | not published | 0 |
| Mayo cyanide CPT 82600 | $47.30 | $86.00 | $19.40 – $20.37 | 3 |
| Mayo cytopathology in situ hybridization urinary tract 3-5 probes each specimen manual CPT 88120 | not published | not published | $182.57 – $191.70 | 3 |
| Mayo deoxyribonuclease antibody titer CPT 86215 | $107.80 | $196.00 | $13.25 – $13.91 | 3 |
| Mayo dhea (dehydroepiandrosterone) CPT 82626 | $352.00 | $640.00 | $25.27 – $26.53 | 3 |
| Mayo dihydrotestosterone CPT 82642 | $56.10 | $102.00 | $29.28 – $30.74 | 3 |
| Mayo dipstick analyte single step qualitative/semiqualitative synovial fluid CPT 83518 | not published | not published | $9.64 – $10.12 | 3 |
| Mayo efpo chloride stool CPT 82438 | $171.60 | $312.00 | $5.00 – $5.25 | 3 |
| Mayo estriol CPT 82677 | $135.30 | $246.00 | $24.18 – $25.39 | 3 |
| Mayo estrone CPT 82679 | $339.35 | $617.00 | $24.95 – $26.20 | 3 |
| Mayo ethosuximide therapeutic drug level CPT 80168 | $180.95 | $329.00 | $16.34 – $17.16 | 3 |
| Mayo everolimus therapeutic drug level CPT 80169 | $86.90 | $158.00 | $13.73 – $14.42 | 3 |
| Mayo factor ii CPT 85210 | $328.90 | $598.00 | $12.98 – $13.63 | 3 |
| Mayo factor v CPT 85220 | $446.05 | $811.00 | $17.65 – $18.53 | 3 |
| Mayo factor vii CPT 85230 | $457.60 | $832.00 | $17.90 – $18.80 | 3 |
| Mayo factor viii vw factor antigen CPT 85246 | $542.85 | $987.00 | $22.94 – $24.09 | 3 |
| Mayo factor viii vw factor multimetric analysis CPT 85247 | $128.70 | $234.00 | $22.94 – $24.09 | 3 |
| Mayo factor viii vw factor ristocetin cofactor CPT 85245 | $310.75 | $565.00 | $22.94 – $24.09 | 3 |
| Mayo factor x CPT 85260 | $189.20 | $344.00 | $17.90 – $18.80 | 3 |
| Mayo factor xi CPT 85270 | $160.60 | $292.00 | $17.90 – $18.80 | 3 |
| Mayo fat/lipids feces quantitative CPT 82710 | $231.00 | $420.00 | $16.80 – $17.64 | 3 |
| Mayo fbl culture fungi blood CPT 87103 | $91.85 | $167.00 | $20.46 – $21.48 | 3 |
| Mayo fdp/fsp paracoagulation CPT 85366 | not published | not published | $80.46 – $84.48 | 3 |
| Mayo ffspg allergen clam igg CPT 86001 | $56.65 | $103.00 | $7.82 – $8.21 | 3 |
| Mayo fibrinogen antigen CPT 85385 | not published | not published | $14.46 – $15.18 | 3 |
| Mayo gabapentin bld/srm/plasma therapeutic drug level CPT 80171 | $29.70 | $54.00 | $21.67 – $22.75 | 3 |
| Mayo gamma-globin full gene sequencing CPT 81479 | $3,735.60 | $6,792.00 | not published | 0 |
| Mayo hemosiderin qualitative urine CPT 83070 | $88.00 | $160.00 | $4.75 – $4.99 | 3 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-1 rna qualitative CPT 87535 | $112.20 | $204.00 | $35.09 – $36.84 | 3 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-2 CPT 87538 | $62.70 | $114.00 | $35.09 – $36.84 | 3 |
| Mayo hiser histoplasma antibodies immunodiffusion CPT 86698 | $45.10 | $82.00 | $13.79 – $14.48 | 3 |
| Mayo hla typing a/b/c single antigen CPT 86812 | $395.45 | $719.00 | $25.81 – $27.10 | 3 |
| Mayo hvdip HIV 1 antibody CPT 86701 | $178.75 | $325.00 | $8.89 – $9.33 | 3 |
| Mayo hvdip HIV 2 antibody CPT 86702 | $180.95 | $329.00 | $13.52 – $14.20 | 3 |
| Mayo hydroxyprogesterone 17-d CPT 83498 | $116.05 | $211.00 | $27.17 – $28.53 | 3 |
| Mayo immunoassay c1 esterase inhibitor antibody quantitative CPT 83520 | $393.25 | $715.00 | $17.27 – $18.13 | 3 |
| Mayo immunoassay infectious agent antibody quantitative diptheria igg CPT 86317 | $845.35 | $1,537.00 | $14.99 – $15.74 | 3 |
| Mayo immunoassay tumor antigen quantitative ca 27.29 CPT 86300 | $463.10 | $842.00 | $20.81 – $21.85 | 3 |
| Mayo immunoassay tumor antigen quantitative chromogranin a CPT 86316 | $310.20 | $564.00 | $20.81 – $21.85 | 3 |
| Mayo inf agt nucleic acid amp prb helicobacter pylori clarithromycin resistance CPT 87513 | not published | not published | $35.09 – $36.84 | 3 |
| Mayo infectious agent antigen immunoassay direct optical observation cryptococcus CPT 87899 | $84.15 | $153.00 | $16.07 – $16.87 | 3 |
| Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal CPT 87305 | $90.20 | $164.00 | $11.98 – $12.58 | 3 |
| Mayo infectious agent nucleic acid amplified probe enterovirus CPT 87498 | $118.80 | $216.00 | $35.09 – $36.84 | 3 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma genitalium urine CPT 87563 | $92.95 | $169.00 | $35.09 – $36.84 | 3 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma pneumoniae CPT 87581 | $112.20 | $204.00 | $35.09 – $36.84 | 3 |
| Mayo infectious agent nucleic acid amplified probe pneumocystis jirovecii CPT 87594 | $229.90 | $418.00 | $35.09 – $36.84 | 3 |
| Mayo infectious agent nucleic acid quantification cytomegalovirus CPT 87497 | $289.85 | $527.00 | $42.84 – $44.98 | 3 |
| Mayo infectious disease hepatitis c chronic six biochemical assays CPT 81596 | $401.50 | $730.00 | $72.19 – $75.80 | 3 |
| Mayo infliximab therapeutic drug level CPT 80230 | $194.70 | $354.00 | $38.57 – $40.50 | 3 |
| Mayo inhab inhibin a CPT 86336 | $237.60 | $432.00 | $15.59 – $16.37 | 3 |
| Mayo insft insulin free CPT 83527 | $24.20 | $44.00 | $12.95 – $13.60 | 3 |
| Mayo insulin antibodies CPT 86337 | $198.00 | $360.00 | $21.41 – $22.48 | 3 |
| Mayo iodine CPT 83789 | $462.55 | $841.00 | $24.11 – $25.32 | 3 |
| Mayo itraconazole therapeutic drug level CPT 80189 | $46.20 | $84.00 | $27.11 – $28.47 | 3 |
| Mayo lacosamide therapeutic drug level CPT 80235 | $70.40 | $128.00 | $27.11 – $28.47 | 3 |
| Mayo lamotrigine therapeutic drug level CPT 80175 | $29.70 | $54.00 | $13.25 – $13.91 | 3 |
| Mayo ld_i lactate dehydrogenase isoenzymes CPT 83625 | $147.40 | $268.00 | $12.79 – $13.43 | 3 |
| Mayo legionella antibody CPT 86713 | $260.15 | $473.00 | $15.30 – $16.06 | 3 |
| Mayo leptospira antibody igm CPT 86720 | $102.30 | $186.00 | $16.20 – $17.01 | 3 |
| Mayo lipoprotein electrophoresis CPT 83700 | $155.65 | $283.00 | $11.26 – $11.82 | 3 |
| Mayo lywb borrelia burgdorferi (lyme disease) antibody igg confirmatory CPT 86617 | $102.30 | $186.00 | $15.49 – $16.26 | 3 |
| Mayo manganese CPT 83785 | $108.35 | $197.00 | $26.65 – $27.98 | 3 |
| Mayo metanephrines plasma CPT 83835 | $135.30 | $246.00 | $16.94 – $17.79 | 3 |
| Mayo methadone definitive assay confirmation urine CPT 80358 | $194.70 | $354.00 | not published | 0 |
| Mayo mgle voltage-gated calcium channel antibody each CPT 86596 | $243.10 | $442.00 | $12.05 – $12.65 | 3 |
| Mayo mgrm acetylcholine receptor binding antibody CPT 86041 | $31.90 | $58.00 | $18.40 – $19.32 | 3 |
| Mayo microsomal antibody liver-kidney CPT 86376 | $360.80 | $656.00 | $14.55 – $15.28 | 3 |
| Mayo mitotane (lysodren) therapeutic drug level CPT 80299 | $395.45 | $719.00 | $18.64 – $19.57 | 3 |
| Mayo molecular pathology procedure level 2 apoe genotype CPT 81401 | $1,179.20 | $2,144.00 | $137.00 – $143.85 | 3 |
| Mayo mpl sequence analysis exon 10 CPT 81339 | not published | not published | $185.20 – $194.46 | 3 |
| Mayo muramidase CPT 85549 | $168.30 | $306.00 | $18.75 – $19.69 | 3 |
| Mayo muscle-specific kinase (musk) antibody CPT 86366 | $467.50 | $850.00 | $18.40 – $19.32 | 3 |
| Mayo mycophenolic acid therapeutic drug level CPT 80180 | $15.40 | $28.00 | $18.05 – $18.95 | 3 |
| Mayo myoglobin CPT 83874 | $191.40 | $348.00 | $12.92 – $13.57 | 3 |
| Mayo nickel CPT 83885 | not published | not published | $24.51 – $25.74 | 3 |
| Mayo opatu opiates definitive assay >=1 CPT 80361 | $143.55 | $261.00 | not published | 0 |
| Mayo opatu opioid/analogs definitive assay 1 or 2 CPT 80362 | $15.40 | $28.00 | not published | 0 |
| Mayo opatu oxycodone definitive assay CPT 80365 | $130.35 | $237.00 | not published | 0 |
| Mayo organic acid methylmalonic single quantitative CPT 83921 | $355.30 | $646.00 | $21.21 – $22.27 | 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.