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 |
|---|---|---|---|---|
| Mopath procedure level 9 CPT 81408 | $3,612.40 | $6,568.00 | $2,000.00 – $2,100.00 | 3 |
| Morphometric analysis in situ hybridization computer-assisted per specimen each multiplex stain CPT 88374 | $443.85 | $807.00 | $182.57 – $191.70 | 3 |
| Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain computer-assisted CPT 88361 | $334.95 | $609.00 | $384.12 – $403.32 | 3 |
| Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual CPT 88360 | $381.15 | $693.00 | $182.57 – $191.70 | 3 |
| Motion analysis video/3d CPT 96000 | not published | not published | $399.88 – $419.88 | 3 |
| Motion test w/ft press meas CPT 96001 | not published | not published | $920.24 – $966.25 | 3 |
| Mouth vestibule bx/w complex rpr 40814 CPT 40814 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| M/phmtrc alys ishquant/semiq CPT 88377 | $419.65 | $763.00 | $182.57 – $191.70 | 3 |
| M/phmtrc alys skeletal musc CPT 88355 | not published | not published | $182.57 – $191.70 | 3 |
| Mpl gene analysis common variants CPT 81338 | $672.10 | $1,222.00 | $150.33 – $157.85 | 3 |
| M.pneumon dna dir probe CPT 87580 | not published | not published | $20.05 – $21.05 | 3 |
| M.pneumon dna quant CPT 87582 | not published | not published | $302.62 – $317.75 | 3 |
| MRA chest w IV cont HCPCS C8909 | $2,995.85 | $5,447.00 | $373.86 – $392.55 | 3 |
| MRA chest wo IV cont HCPCS C8910 | $2,960.65 | $5,383.00 | $255.69 – $268.47 | 3 |
| MRA chest wwo IV cont HCPCS C8911 | $3,335.20 | $6,064.00 | $373.86 – $392.55 | 3 |
| MRA pelvis w IV cont HCPCS C8918 | $1,850.75 | $3,365.00 | $373.86 – $392.55 | 3 |
| MRA pelvis wo IV cont HCPCS C8919 | $1,828.20 | $3,324.00 | $255.69 – $268.47 | 3 |
| MRA w/cont, abd HCPCS C8900 | $2,846.80 | $5,176.00 | $373.86 – $392.55 | 3 |
| MRA w/cont, lwr ext HCPCS C8912 | $3,054.15 | $5,553.00 | $373.86 – $392.55 | 3 |
| Mra, w/dye, spinal canal HCPCS C8931 | not published | not published | $373.86 – $392.55 | 3 |
| Mra, w/dye, upper extremity HCPCS C8934 | not published | not published | $373.86 – $392.55 | 3 |
| MRA without cont, abd HCPCS C8901 | $2,031.15 | $3,693.00 | $255.69 – $268.47 | 3 |
| MRA without cont, lwr ext HCPCS C8913 | $2,846.80 | $5,176.00 | $255.69 – $268.47 | 3 |
| Mra, without dye, spinal canal HCPCS C8932 | not published | not published | $255.69 – $268.47 | 3 |
| Mra, without dye, upper extr HCPCS C8935 | not published | not published | $255.69 – $268.47 | 3 |
| MRA without fol w/cont, abd HCPCS C8902 | $4,110.15 | $7,473.00 | $373.86 – $392.55 | 3 |
| MRA without fol w/cont, lwr ext HCPCS C8914 | $3,763.65 | $6,843.00 | $373.86 – $392.55 | 3 |
| MRA without fol w/cont, pelvis HCPCS C8920 | $2,114.75 | $3,845.00 | $373.86 – $392.55 | 3 |
| Mra, w/o&w/dye, spinal canal HCPCS C8933 | not published | not published | $373.86 – $392.55 | 3 |
| Mra, w/o&w/dye, upper extr HCPCS C8936 | $2,555.85 | $4,647.00 | $373.86 – $392.55 | 3 |
| Mr elastography CPT 76391 | not published | not published | $255.69 – $268.47 | 3 |
| MRI brain w/dye CPT 70558 | not published | not published | $187.96 – $197.36 | 3 |
| MRI brain without dye CPT 70557 | not published | not published | $585.55 – $614.83 | 3 |
| MRI brain without & w/dye CPT 70559 | not published | not published | $187.96 – $197.36 | 3 |
| MRI breast c- unilateral CPT 77046 | $2,643.30 | $4,806.00 | $255.69 – $268.47 | 3 |
| MRI breast without cont bi CPT 77047 | $2,104.85 | $3,827.00 | $255.69 – $268.47 | 3 |
| MRI cardiac morph & func wo IV cont CPT 75557 | $839.30 | $1,526.00 | $255.69 – $268.47 | 3 |
| MRI cardiac morph & func wwo IV cont CPT 75561 | $1,343.10 | $2,442.00 | $373.86 – $392.55 | 3 |
| MRI cardiac morph & func wwo IV cont w/stress img CPT 75563 | not published | not published | $840.06 – $882.07 | 3 |
| MRI chest without contrast CPT 71550 | $2,960.65 | $5,383.00 | $255.69 – $268.47 | 3 |
| MRI chest without & w/contrast CPT 71552 | $4,110.15 | $7,473.00 | $373.86 – $392.55 | 3 |
| MRI chest w IV cont CPT 71551 | $3,356.65 | $6,103.00 | $840.06 – $882.07 | 3 |
| MRI fetal sngl/1st gestation CPT 74712 | not published | not published | $255.69 – $268.47 | 3 |
| MRI loex nonjt w IV cont CPT 73719 | $3,239.50 | $5,890.00 | $373.86 – $392.55 | 3 |
| MRI lower extremity other than joint without contrast (both sides) CPT 73718 | $3,027.75 | $5,505.00 | $255.69 – $268.47 | 3 |
| MRI lower extremity other than joint without & w/contrast (both sides) CPT 73720 | $3,895.65 | $7,083.00 | $373.86 – $392.55 | 3 |
| MRI orbit/face/neck without contrast CPT 70540 | $2,630.65 | $4,783.00 | $255.69 – $268.47 | 3 |
| MRI orbit/face/neck without & w/contrast CPT 70543 | $4,704.15 | $8,553.00 | $373.86 – $392.55 | 3 |
| MRI orbit fac&nck w IV cont CPT 70542 | $3,143.25 | $5,715.00 | $373.86 – $392.55 | 3 |
| MRI tmj CPT 70336 | $2,938.10 | $5,342.00 | $255.69 – $268.47 | 3 |
| MRI upper extremity other than joint without contrast (both sides) CPT 73218 | $2,960.65 | $5,383.00 | $255.69 – $268.47 | 3 |
| MRI upper extremity other than joint without & w/contrast (both sides) CPT 73220 | $4,110.15 | $7,473.00 | $373.86 – $392.55 | 3 |
| MRI upper extremity w/dye CPT 73219 | $3,239.50 | $5,890.00 | $373.86 – $392.55 | 3 |
| MRI w/cont, breast, bi HCPCS C8906 | $2,526.70 | $4,594.00 | $373.86 – $392.55 | 3 |
| MRI w/cont, breast, uni HCPCS C8903 | $3,054.15 | $5,553.00 | $187.96 – $197.36 | 3 |
| MRI without fol w/cont, breast HCPCS C8908 | $4,455.55 | $8,101.00 | $373.86 – $392.55 | 3 |
| MRI without fol w/cont, brst, un HCPCS C8905 | $3,145.45 | $5,719.00 | $373.86 – $392.55 | 3 |
| Mr safety determination physician/other qhp CPT 76016 | not published | not published | $93.26 – $97.92 | 3 |
| Mr safety implt pos&/immoblj CPT 76019 | not published | not published | $63.22 – $66.38 | 3 |
| Mr sfty implt&/fb asmt stf 1 CPT 76014 | not published | not published | $30.99 – $32.54 | 3 |
| Mr sfty med physics xm cstmz CPT 76017 | not published | not published | $255.69 – $268.47 | 3 |
| Mr spectroscopy CPT 76390 | not published | not published | $93.26 – $97.92 | 3 |
| Msh2 gene dup/delete variant CPT 81297 | $388.30 | $706.00 | $213.30 – $223.96 | 3 |
| Msh2 gene full seq CPT 81295 | $690.25 | $1,255.00 | $381.70 – $400.78 | 3 |
| Msh2 gene known variants CPT 81296 | not published | not published | $337.73 – $354.62 | 3 |
| Msh6 gene dup/delete variant CPT 81300 | $432.85 | $787.00 | $238.00 – $249.90 | 3 |
| Msh6 gene full seq CPT 81298 | $1,160.50 | $2,110.00 | $641.85 – $673.94 | 3 |
| Msh6 gene known variants CPT 81299 | not published | not published | $308.00 – $323.40 | 3 |
| Mt bone graft microvasc CPT 20957 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Mthfr gene analy common variants CPT 81291 | $327.80 | $596.00 | $65.34 – $68.61 | 3 |
| M.tuberculo dna dir probe CPT 87555 | not published | not published | $26.88 – $28.22 | 3 |
| M.tuberculo dna quant CPT 87557 | not published | not published | $42.84 – $44.98 | 3 |
| Mucin synovial fluid CPT 83872 | not published | not published | $5.86 – $6.15 | 3 |
| Mucopolysaccharides CPT 83864 | $144.10 | $262.00 | $28.50 – $29.92 | 3 |
| Mucormycosis antibody CPT 86732 | not published | not published | $15.00 – $15.75 | 3 |
| Multifocal erg w/i&r CPT 92274 | not published | not published | $137.89 – $144.78 | 3 |
| Multiple sleep latency test CPT 95805 | $1,523.50 | $2,770.00 | $920.24 – $966.25 | 3 |
| Mumps antibody igg CPT 86735 | $45.10 | $82.00 | $13.05 – $13.70 | 3 |
| Muscle-skin graft arm CPT 15736 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Muscle-skin graft leg CPT 15738 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Muscle-skin graft trunk CPT 15734 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Muscle test cran nerv unilat CPT 95867 | not published | not published | $231.39 – $242.96 | 3 |
| Muscle test hemidiaphragm CPT 95866 | not published | not published | $137.89 – $144.78 | 3 |
| Muscle test larynx CPT 95865 | not published | not published | $142.58 – $149.71 | 3 |
| Muscle test one fiber CPT 95872 | not published | not published | $231.39 – $242.96 | 3 |
| Muscle transfers CPT 23397 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Muscle transfer shoulder/arm CPT 23395 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Musc myoq/fscq flp h&n pedcl CPT 15733 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Musc/tdn transfer upr a/e 1 CPT 24301 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Mycobacteria dna amp probe CPT 87551 | not published | not published | $48.24 – $50.65 | 3 |
| Mycobacteria dna dir probe CPT 87550 | not published | not published | $20.05 – $21.05 | 3 |
| Mycobacteria dna quant CPT 87552 | not published | not published | $42.84 – $44.98 | 3 |
| Mycoplasma antibody igm CPT 86738 | $162.80 | $296.00 | $13.24 – $13.90 | 3 |
| Myd88 gene p.leu265pro vrnt CPT 81305 | not published | not published | $175.40 – $184.17 | 3 |
| Myelogphy 2/> spine regions CPT 72270 | $4,173.40 | $7,588.00 | $840.06 – $882.07 | 3 |
| Myelography l-s spine CPT 72265 | $1,514.15 | $2,753.00 | $840.06 – $882.07 | 3 |
| Myelography neck spine CPT 72240 | $1,563.10 | $2,842.00 | $840.06 – $882.07 | 3 |
| Myelography thoracic spine CPT 72255 | $3,340.70 | $6,074.00 | $840.06 – $882.07 | 3 |
| Myelography via inj w/s&i 2+ regions CPT 62305 | $4,187.70 | $7,614.00 | $840.06 – $882.07 | 3 |
| Myelography via inj w/s&i cervical CPT 62302 | $2,319.35 | $4,217.00 | $840.06 – $882.07 | 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.