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 |
|---|---|---|---|---|
| Nsl/sins ndsc med&inf dcmprn CPT 31293 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Nsl/sins ndsc med/inf dcmprn CPT 31292 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Nsl/sins ndsc sphn tiss rmvl CPT 31259 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Nsl/sins ndsc surg frnt sins CPT 31296 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Nsl/sins ndsc surg frnt&sphn CPT 31298 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Nsl/sins ndsc surg max sins CPT 31295 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Nsl/sins ndsc surg on dcmprn CPT 31294 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Nsl/sins ndsc surg sphn sins CPT 31297 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Nsl/sins ndsc total CPT 31253 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Nsl/sins ndsc tot w/sphendt CPT 31257 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Nsl/sinus endoscopy surg dcr CPT 31239 | not published | not published | $3,995.36 – $4,195.13 | 3 |
| Nsl/sinus ndsc cryoabltj pnn CPT 31243 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Nsl/sinus ndsc rf abltj pnn CPT 31242 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Nsl/sns ndsc lig sphnptn art CPT 31241 | not published | not published | $1,907.37 – $2,002.74 | 3 |
| Ntrk1 translocation analysis CPT 81191 | not published | not published | $207.31 – $217.68 | 3 |
| Ntrk2 translocation analysis CPT 81192 | not published | not published | $207.31 – $217.68 | 3 |
| Ntrk3 translocation analysis CPT 81193 | not published | not published | $207.31 – $217.68 | 3 |
| Ntrk translocation analysis CPT 81194 | not published | not published | $518.28 – $544.19 | 3 |
| Ntsty modul rad tx dlvr cplx CPT 77386 | $2,127.95 | $3,869.00 | not published | 0 |
| Ntsty modul rad tx dlvr smpl CPT 77385 | $1,403.05 | $2,551.00 | not published | 0 |
| Nuclear exam of tear flow CPT 78660 | not published | not published | $428.40 – $449.82 | 3 |
| Nuclear matrix protein 22 CPT 86386 | not published | not published | $21.78 – $22.87 | 3 |
| Nuclear rx IV admin CPT 79101 | $1,032.90 | $1,878.00 | not published | 0 |
| Nuclear Stress Test (Heart) CPT 78452 | $4,735.50 | $8,610.00 | $1,387.37 – $1,456.74 | 3 |
| Nuclr rx interstit colloid CPT 79300 | $479.05 | $871.00 | not published | 0 |
| Nudt15 gene common variants CPT 81306 | $660.00 | $1,200.00 | $291.36 – $305.93 | 3 |
| Observation direct referral from physician office for admission HCPCS G0379 | $572.00 | $1,040.00 | $638.18 – $670.09 | 3 |
| Observation per hour HCPCS G0378 | $0.65 | $1.18 | not published | 0 |
| Obstetric panel inc HIV tstg CPT 80081 | not published | not published | $74.86 – $78.60 | 3 |
| Obstetrics panel CPT 80055 | $57.20 | $104.00 | $47.81 – $50.20 | 3 |
| Obtaining screen pap smear HCPCS Q0091 | not published | not published | $30.99 – $32.54 | 3 |
| Ob Ultrasound nuchal meas 1 gest CPT 76813 | not published | not published | $112.03 – $117.63 | 3 |
| Occlude fallopian tube(s) device 58615 CPT 58615 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Onc breast mrna 12 genes CPT 81522 | not published | not published | $3,873.00 – $4,066.65 | 3 |
| Onc breast mrna 58 genes CPT 81520 | not published | not published | $2,510.21 – $2,635.72 | 3 |
| Onc breast mrna 70 genes CPT 81521 | not published | not published | $3,873.00 – $4,066.65 | 3 |
| Onc brst mrna 11 genes CPT 81518 | not published | not published | $3,873.00 – $4,066.65 | 3 |
| Onc brst mrna 70 cnt 31 gene CPT 81523 | not published | not published | $3,873.00 – $4,066.65 | 3 |
| Onc cutan mlnma mrna 31 gene CPT 81529 | not published | not published | $7,193.00 – $7,552.65 | 3 |
| Oncology colon mrna CPT 81525 | not published | not published | $3,116.00 – $3,271.80 | 3 |
| Oncology colorectal scr CPT 81528 | not published | not published | $508.87 – $534.31 | 3 |
| Oncology gynecologic CPT 81535 | not published | not published | $579.46 – $608.43 | 3 |
| Oncology gynecologic CPT 81536 | not published | not published | $177.56 – $186.44 | 3 |
| Oncology lung CPT 81538 | not published | not published | $2,871.00 – $3,014.55 | 3 |
| Oncology prostate prob score CPT 81539 | $831.60 | $1,512.00 | $760.00 – $798.00 | 3 |
| Oncology tissue of origin CPT 81504 | not published | not published | $520.00 – $546.00 | 3 |
| Oncology tum unknown origin CPT 81540 | not published | not published | $3,750.00 – $3,937.50 | 3 |
| Onco (ovar) five proteins CPT 81503 | not published | not published | $897.00 – $941.85 | 3 |
| Onco (ovar) two proteins CPT 81500 | not published | not published | $260.50 – $273.52 | 3 |
| Oncoprotein dcp CPT 83951 | $167.75 | $305.00 | $64.41 – $67.63 | 3 |
| Oncoprotein her-2/neu CPT 83950 | $407.00 | $740.00 | $64.41 – $67.63 | 3 |
| Onc prostate 3 genes CPT 81551 | not published | not published | $2,030.00 – $2,131.50 | 3 |
| Onc prostate mrna 22 cnt gen CPT 81542 | not published | not published | $3,873.00 – $4,066.65 | 3 |
| Onc prostate mrna 46 genes CPT 81541 | not published | not published | $3,873.00 – $4,066.65 | 3 |
| Onc thyr mrna 10,196 gen alg CPT 81546 | not published | not published | $3,600.00 – $3,780.00 | 3 |
| Onc uveal mlnma mrna 15 gene CPT 81552 | not published | not published | $7,776.00 – $8,164.80 | 3 |
| Oocyte identification CPT 89254 | not published | not published | $182.57 – $191.70 | 3 |
| Open bx/exc inguinofem nodes CPT 38531 | not published | not published | $4,195.85 – $4,405.64 | 3 |
| Open nasoethmoid fx with fixj CPT 21339 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Open nasoethmoid fx without fixj CPT 21338 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Open periprosthetic breast capsule 19370 CPT 19370 | not published | not published | $4,195.85 – $4,405.64 | 3 |
| Open tenotomy tendon flexor foot single or multiple 28230 CPT 28230 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Open thrombectomy of av fistula without revision 36831 CPT 36831 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Open tx compl front sinus fx CPT 21344 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Open tx iliac spine uni/bil HCPCS G0412 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Open tx nose fx w/skele fixj CPT 21330 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Open tx nose & septal fx CPT 21335 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Open tx post pelvic fxcture HCPCS G0415 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Open tx rib 1-3 fx w/fix 21811 CPT 21811 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Open tx rib 4-6 fx w/fix 21812 CPT 21812 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Open tx rib 7+ fx w/fix 21813 CPT 21813 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Open tx/sternum fracture 21825 CPT 21825 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Ophthalmic biometry CPT 92136 | not published | not published | $142.58 – $149.71 | 3 |
| Ophthalmodynamometry CPT 92260 | not published | not published | $40.03 – $42.03 | 3 |
| Ophth Ultrasound b & quant a CPT 76510 | not published | not published | $142.58 – $149.71 | 3 |
| Oph Ultrasound dx ant sgm Ultrasound uni/bi CPT 76513 | not published | not published | $112.03 – $117.63 | 3 |
| Oph Ultrasound dx quan a-scan only CPT 76511 | not published | not published | $112.03 – $117.63 | 3 |
| Opioids & opiate analogs 3/4 CPT 80363 | $9.35 | $17.00 | not published | 0 |
| Opn fem art expos cndt crtj 34714 CPT 34714 | $1,826.00 | $3,320.00 | not published | 0 |
| Opn tx complx malar fx CPT 21365 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx complx malar w/grft CPT 21366 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx depress front sinus fx 21343 CPT 21343 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx dprsd zygomatic arch CPT 21356 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx nasomax fx multple CPT 21347 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx nasomax fx w/fixj CPT 21346 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx nasomax fx w/graft CPT 21348 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx orbit fx combined CPT 21387 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx orbit fx periorbital CPT 21386 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx orbit fx transantral CPT 21385 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx orbit fx w/bone grft CPT 21408 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx orbit fx w/implant CPT 21407 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx orbit fx without impl 21406 CPT 21406 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx orbit periorbtl implt CPT 21390 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opn tx orbit periorbt w/grft CPT 21395 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Opps service,sched team conf HCPCS G0175 | not published | not published | $447.15 – $469.50 | 3 |
| Opscpy extnd on/mac draw CPT 92202 | not published | not published | $63.22 – $66.38 | 3 |
| Opscpy extnd rta draw uni/bi CPT 92201 | not published | not published | $63.22 – $66.38 | 3 |
| Optx acrclv dslc aq/chrn grf CPT 23552 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx acromclv dislc aqt/chrn CPT 23550 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx acute shoulder dislc CPT 23660 | not published | not published | $7,775.89 – $8,164.69 | 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.