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 organic acids qualitative each specimen CPT 83919 | not published | not published | $16.45 – $17.27 | 3 |
| Mayo oxalate 24 hour urine CPT 83945 | $263.45 | $479.00 | $14.45 – $15.17 | 3 |
| Mayo pancreatic elastase fecal qualitative or semi quantitative CPT 82656 | $370.70 | $674.00 | $11.53 – $12.11 | 3 |
| Mayo parvs parvovirus b19 antibody igg CPT 86747 | $192.50 | $350.00 | $15.03 – $15.78 | 3 |
| Mayo paval fluorescent antibody screen agna type 1 CPT 86255 | $749.65 | $1,363.00 | $12.05 – $12.65 | 3 |
| Mayo pborb infectious agent nucleic acid amplified probe borrelia burgdorferi (lyme) CPT 87476 | $346.50 | $630.00 | $35.09 – $36.84 | 3 |
| Mayo phospholipid neutralization hexagonal lupus anticoagulant CPT 85598 | $64.90 | $118.00 | $17.98 – $18.88 | 3 |
| Mayo pntft phenytoin free therapeutic drug level CPT 80186 | $129.80 | $236.00 | $13.76 – $14.45 | 3 |
| Mayo pqnu porphobilinogen urine quantitative 24 hour urine CPT 84110 | $127.60 | $232.00 | $8.44 – $8.86 | 3 |
| Mayo pregnenolone CPT 84140 | $52.25 | $95.00 | $20.67 – $21.70 | 3 |
| Mayo prmb primidone therapeutic drug level CPT 80188 | $185.90 | $338.00 | $16.59 – $17.42 | 3 |
| Mayo proinsulin CPT 84206 | $378.95 | $689.00 | $26.69 – $28.02 | 3 |
| Mayo psaft prostate specific antigen free CPT 84154 | $267.30 | $486.00 | $18.39 – $19.31 | 3 |
| Mayo radioimmunoassay procollagen i intact n-terminal antibody quantitative CPT 83519 | $466.40 | $848.00 | $18.40 – $19.32 | 3 |
| Mayo rbcme osmotic fragility rbc incubated CPT 85557 | not published | not published | $13.36 – $14.03 | 3 |
| Mayo receptor assay transferrin soluble CPT 84238 | $370.70 | $674.00 | $36.57 – $38.40 | 3 |
| Mayo renin CPT 84244 | $101.20 | $184.00 | $21.99 – $23.09 | 3 |
| Mayo repu protein electrophoresis urine CPT 84166 | $187.55 | $341.00 | $17.83 – $18.72 | 3 |
| Mayo selenium CPT 84255 | $59.95 | $109.00 | $25.53 – $26.81 | 3 |
| Mayo semb semen analysis volume/count/motility/differential strict morphologic criteria CPT 89322 | not published | not published | $15.50 – $16.28 | 3 |
| Mayo serotonin CPT 84260 | $770.00 | $1,400.00 | $30.98 – $32.53 | 3 |
| Mayo sfgp rickettsia rickettsii antibody igg CPT 86757 | $339.35 | $617.00 | $19.35 – $20.32 | 3 |
| Mayo sirolimus therapeutic drug level CPT 80195 | $112.20 | $204.00 | $13.73 – $14.42 | 3 |
| Mayo streptococcus pneumoniae antibody igg 23 serotypes multiplex immunoassay quantitative CPT 86581 | $83.05 | $151.00 | $92.03 – $96.63 | 3 |
| Mayo syphilis test non-treponemal antibody qualitative vdrl CPT 86592 | $202.40 | $368.00 | $4.27 – $4.48 | 3 |
| Mayo tau phosphorylated 217 each CPT 84393 | $330.00 | $600.00 | $128.92 – $135.37 | 3 |
| Mayo tcgr analysis gene rearrangement trb@ abnormal clonal population(s) amplification CPT 81340 | $947.65 | $1,723.00 | $208.92 – $219.37 | 3 |
| Mayo tgrp testosterone free CPT 84402 | $108.35 | $197.00 | $25.47 – $26.74 | 3 |
| Mayo tgrp testosterone total CPT 84403 | $251.35 | $457.00 | $25.81 – $27.10 | 3 |
| Mayo thiopurine s-methyltransferase CPT 84433 | $92.95 | $169.00 | $22.17 – $23.28 | 3 |
| Mayo thyroglobulin CPT 84432 | $163.90 | $298.00 | $16.06 – $16.86 | 3 |
| Mayo ticks anaplasma phagocytophilum antibody igg CPT 86666 | $260.15 | $473.00 | $10.18 – $10.69 | 3 |
| Mayo ticks babesia microti antibody igg CPT 86753 | $208.45 | $379.00 | $12.39 – $13.01 | 3 |
| Mayo tramadol definitive assay w metabolite quantitative urine CPT 80373 | $132.55 | $241.00 | not published | 0 |
| Mayo ttfb testosterone bioavailable direct CPT 84410 | not published | not published | $51.28 – $53.84 | 3 |
| Mayo tulab francisella tularensis antibody igg CPT 86668 | $107.80 | $196.00 | $14.16 – $14.87 | 3 |
| Mayo valpg valproic acid free therapeutic drug level CPT 80165 | $84.70 | $154.00 | $13.54 – $14.22 | 3 |
| Mayo vasoactive intestinal peptide CPT 84586 | $407.00 | $740.00 | $35.33 – $37.10 | 3 |
| Mayo vitamin b-2 (riboflavin) CPT 84252 | $147.40 | $268.00 | $20.24 – $21.25 | 3 |
| Mayo vitamin b3 (niacin) CPT 84591 | $127.60 | $232.00 | $17.06 – $17.91 | 3 |
| Mayo vitamin k CPT 84597 | $111.65 | $203.00 | $13.72 – $14.41 | 3 |
| Mayo zonisamide therapeutic drug level CPT 80203 | $46.20 | $84.00 | $13.25 – $13.91 | 3 |
| Mcoln1 gene CPT 81290 | not published | not published | $39.31 – $41.28 | 3 |
| Mcp joint arthroscopy dx CPT 29900 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Mcp joint arthroscopy surg CPT 29901 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Mcp joint arthroscopysurg 29902 CPT 29902 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Mdfc flap w/prsrv vasc pedcl CPT 15730 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Meas lung vol thru 2 yrs CPT 94013 | not published | not published | $399.88 – $419.88 | 3 |
| Measure kidney pressure CPT 50396 | not published | not published | $747.24 – $784.60 | 3 |
| Measurement post void urine by ultrasound CPT 51798 | $172.70 | $314.00 | $63.22 – $66.38 | 3 |
| Measure ureter pressure CPT 50686 | not published | not published | $137.89 – $144.78 | 3 |
| #mec-opiates CPT 80356 | $303.60 | $552.00 | not published | 0 |
| Mecp2 gene dup/delet variant CPT 81304 | not published | not published | $150.00 – $157.50 | 3 |
| Mecp2 gene full seq CPT 81302 | not published | not published | $527.87 – $554.26 | 3 |
| Mecp2 gene known variant CPT 81303 | not published | not published | $120.00 – $126.00 | 3 |
| Medial canthopexy CPT 21280 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Mediastinoscpy w/lmph nod bx CPT 39402 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Mediastinoscpy w/medstnl bx 39401 CPT 39401 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Med physic dos eval rad exps CPT 76145 | not published | not published | $399.88 – $419.88 | 3 |
| Meg evoked single CPT 95966 | not published | not published | $920.24 – $966.25 | 3 |
| Meg spontaneous CPT 95965 | not published | not published | $920.24 – $966.25 | 3 |
| Meniscal trnspl knee w/scpe CPT 29868 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Metabolic Blood Panel (Basic) CPT 80048 | $107.25 | $195.00 | $8.46 – $8.88 | 3 |
| Metabolic Blood Panel (Comprehensive) CPT 80053 | $148.50 | $270.00 | $10.56 – $11.09 | 3 |
| Metabolic panel ionized ca CPT 80047 | $166.10 | $302.00 | $13.73 – $14.42 | 3 |
| Methotrexate therapeutic drug level CPT 80204 | $33.00 | $60.00 | $38.57 – $40.50 | 3 |
| Methylphenidate CPT 80360 | $200.75 | $365.00 | not published | 0 |
| Metyrapone panel CPT 80436 | not published | not published | $91.16 – $95.72 | 3 |
| Mgmt promoter methylation analysis CPT 81287 | not published | not published | $124.64 – $130.87 | 3 |
| Microalbumin urine screen CPT 82044 | not published | not published | $6.23 – $6.54 | 3 |
| Microbe susceptible mlc CPT 87187 | not published | not published | $40.17 – $42.18 | 3 |
| Microdissection laser CPT 88380 | $1,338.15 | $2,433.00 | not published | 0 |
| Microdissection manual CPT 88381 | $575.85 | $1,047.00 | not published | 0 |
| Microfluid analy tears CPT 83861 | not published | not published | $22.48 – $23.60 | 3 |
| Microsatellite instability CPT 81301 | $1,218.80 | $2,216.00 | $348.56 – $365.99 | 3 |
| Microvolt t-wave assess CPT 93025 | not published | not published | $137.89 – $144.78 | 3 |
| Middle cerebral artery echo CPT 76821 | $303.60 | $552.00 | $112.03 – $117.63 | 3 |
| Mitochondrial gene CPT 81440 | not published | not published | $3,324.00 – $3,490.20 | 3 |
| Mlh1 gene CPT 81288 | $562.10 | $1,022.00 | $192.32 – $201.94 | 3 |
| Mlh1 gene dup/delete variant CPT 81294 | $365.75 | $665.00 | $202.40 – $212.52 | 3 |
| Mlh1 gene full seq CPT 81292 | $1,223.75 | $2,225.00 | $675.40 – $709.17 | 3 |
| Mlh1 gene known variants CPT 81293 | not published | not published | $331.00 – $347.55 | 3 |
| Mlt fam grp bhv train 1st 60 CPT 96202 | not published | not published | $17.80 – $18.69 | 3 |
| Mlt fam grp bhv train ea add CPT 96203 | not published | not published | $5.31 – $5.58 | 3 |
| Mlt osteot rlgnm imed rd hum CPT 24410 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Mnl appl strs jt radiography CPT 77071 | $569.80 | $1,036.00 | $93.26 – $97.92 | 3 |
| Mnpj anes sho jt fixj aprats CPT 23700 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Mnpj elbow under anes CPT 24300 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Mnpj of tmj w/anesth CPT 21073 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Mnt subs tx for change dx HCPCS G0270 | $35.20 | $64.00 | $21.65 – $22.73 | 3 |
| Modification of contact lens CPT 92325 | not published | not published | $142.58 – $149.71 | 3 |
| Mog-igg1 antb flo cytmtry ea CPT 86363 | $800.80 | $1,456.00 | $37.73 – $39.62 | 3 |
| Monitor reveal linq ii cardiac HCPCS C1764 | $7,900.73 | $14,364.97 | not published | 0 |
| Monthly tx for dmht 20mins HCPCS G0553 | not published | not published | $142.67 – $149.80 | 3 |
| Mopath procedure level 1 CPT 81400 | $508.20 | $924.00 | $63.96 – $67.16 | 3 |
| Mopath procedure level 3 CPT 81402 | $880.55 | $1,601.00 | $150.33 – $157.85 | 3 |
| Mopath procedure level 5 CPT 81404 | $1,568.60 | $2,852.00 | $274.83 – $288.57 | 3 |
| Mopath procedure level 6 CPT 81405 | $2,065.80 | $3,756.00 | $301.35 – $316.42 | 3 |
| Mopath procedure level 7 CPT 81406 | $256.30 | $466.00 | $282.88 – $297.02 | 3 |
| Mopath procedure level 8 CPT 81407 | not published | not published | $846.27 – $888.58 | 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.