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 |
|---|---|---|---|---|
| Optx carpl scphd fx int fixj CPT 25628 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx clavicular fx w/int fix CPT 23515 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx complicated mndblr fx CPT 21470 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Optx cranfcl sep comp mlt CPT 21433 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Optx cranfcl sep w/wiring CPT 21432 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Optx crnfcl sep comp mlt int CPT 21436 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Optx crnfc sep comp int&/xtr CPT 21435 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Optx crpl fx oth/thn scph ea CPT 25645 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Optx gr hmrl tbrs fx int fix CPT 23630 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx lunate dislocation CPT 25695 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx medial ankle fx CPT 27766 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx mndblr cndylr fx CPT 21465 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Optx mndblr fx wo ntrdntl CPT 21461 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Optx mndblr fx xtrnl fixj CPT 21454 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Optx mndblr/max alv ridge fx CPT 21445 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Optx palatal/max fracture CPT 21422 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Optx palatal/max fx comp CPT 21423 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Optx partclr fx&/dslc elbw w CPT 24587 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Optx post ankle fx CPT 27769 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx prox humrl fx w/int fix CPT 23615 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Optx prx hmrl fx fix rpr rpl CPT 23616 | not published | not published | $18,789.56 – $19,729.04 | 3 |
| Optx radial shaft fracture CPT 25515 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx rad/uln dislc aqt/chrnc CPT 25676 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx rdcrpl/ntrcrpl dislc 1+ CPT 25670 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx rdl shft fx&cltx rad/ul CPT 25525 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx rdl shft fx&dstl rad/ul CPT 25526 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx rdl&uln shft fx rds&uln CPT 25575 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx rdl&uln shft fx rds/uln CPT 25574 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx scapular fx w/int fixj CPT 23585 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx sho dislc fx CPT 23670 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx sho dislc neck fx fixj CPT 23680 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Optx strclv dslc aq/chrn grf CPT 23532 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx strnclav dislc aqt/chrn CPT 23530 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx thigh fx CPT 27269 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx tmprmand dislocation CPT 21490 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Optx trns-scphprlnr fx dislc CPT 25685 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx ulnar shft fx int fixj CPT 25545 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Optx ulnar styloid fracture CPT 25652 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Oral hiv-1/hiv-2 screen HCPCS G0435 | not published | not published | $11.98 – $12.58 | 3 |
| Orchiectomy partial CPT 54522 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Orchiopexy (fowler-stephens) CPT 54650 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Orchiopexy ingun/scrot appr CPT 54640 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Organic acids total quant ea spec CPT 83918 | $283.25 | $515.00 | $23.60 – $24.78 | 3 |
| Oropharyngeal biopsy 42800 CPT 42800 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Orthopantogram CPT 70355 | not published | not published | $93.26 – $97.92 | 3 |
| Orthop traing supvj phys/qhp CPT 92066 | not published | not published | $63.22 – $66.38 | 3 |
| Ortho whf rigd without jnt cstm w/fit&adj HCPCS L3808 | $252.06 | $458.30 | not published | 0 |
| Oscillation chest wall mechanical per session CPT 94669 | $128.70 | $234.00 | $234.66 – $246.39 | 3 |
| Osmolality blood CPT 83930 | $142.45 | $259.00 | $6.61 – $6.94 | 3 |
| Osmolality urine CPT 83935 | $145.20 | $264.00 | $6.82 – $7.16 | 3 |
| Ostectomy complete 1st metatarsal head 28111 CPT 28111 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Ostectomy scapula partial CPT 23190 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Osteochondral knee allograft CPT 27415 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Osteochondral knee autograft CPT 27416 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Osteochondral talus autogrft CPT 28446 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Osteoplasty humerus CPT 24420 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Osteot dsc ant 1 vrt sgm crv CPT 22220 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Osteot dsc ant 1vrt sgm lmbr CPT 22224 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Osteot dsc ant 1vrt sgm thrc CPT 22222 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Osteot humerus w/wo int fixj CPT 24400 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Osteot mlt relignmt imed rod CPT 27712 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Osteotomy/graft tarsal/calcaneus/talus 28305 CPT 28305 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Ot evaluation high complexity patient/family CPT 97167 | $342.65 | $623.00 | $102.47 – $107.59 | 3 |
| Ot evaluation low complexity patient/family CPT 97165 | $263.45 | $479.00 | $101.57 – $106.65 | 3 |
| Ot evaluation moderate complexity patient/family CPT 97166 | $265.10 | $482.00 | $96.48 – $101.30 | 3 |
| Other bone graft microvasc CPT 20962 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Other immunoelectrophoresis CPT 86325 | not published | not published | $23.13 – $24.29 | 3 |
| Oth resp proc, group HCPCS G0239 | $55.55 | $101.00 | $40.03 – $42.03 | 3 |
| Oth resp proc, indiv HCPCS G0238 | not published | not published | $30.99 – $32.54 | 3 |
| Ot management orthotic(s)/prosthetic subsequent encounter each 15 minutes CPT 97763 | $112.75 | $205.00 | $50.81 – $53.35 | 3 |
| Ot management/training orthotic(s) upper/lower extremities and/or trunk each 15 minutes CPT 97760 | $102.85 | $187.00 | $47.25 – $49.61 | 3 |
| Ot manual therpy techniques >=1 region each 15 minutes CPT 97140 | $131.45 | $239.00 | $28.43 – $29.85 | 3 |
| Otoplasty 69300 CPT 69300 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Ot re-evaluation patient/family CPT 97168 | $239.25 | $435.00 | $69.31 – $72.78 | 3 |
| Ot therapeutic activities direct patient contact each 15 minutes CPT 97530 | $107.25 | $195.00 | $33.81 – $35.50 | 3 |
| Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes CPT 97130 | $62.70 | $114.00 | $18.55 – $19.48 | 3 |
| Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes CPT 97129 | $97.90 | $178.00 | $19.66 – $20.64 | 3 |
| Ot therapeutic procedure >=1 area therapeutic exercise each 15 minutes CPT 97110 | $112.75 | $205.00 | $29.67 – $31.15 | 3 |
| Ot therapeutic procedure neuromuscular reeducate each 15 minutes CPT 97112 | $100.10 | $182.00 | $31.82 – $33.41 | 3 |
| Ot training self care/home management direct contact each 15 minutes CPT 97535 | $100.65 | $183.00 | $31.10 – $32.66 | 3 |
| Ovarian cystectomy 58925 CPT 58925 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Ovulation tests CPT 84830 | not published | not published | $12.70 – $13.34 | 3 |
| P-32 sod phosphate ther per mci HCPCS A9563 | $719.95 | $1,309.00 | not published | 0 |
| Pabpn1 gene detc abnor allel CPT 81312 | not published | not published | $137.00 – $143.85 | 3 |
| Palb2 gene full gene seq CPT 81307 | $611.05 | $1,111.00 | $676.50 – $710.32 | 3 |
| Palb2 gene known famil vrnt CPT 81308 | not published | not published | $301.35 – $316.42 | 3 |
| Parathormone (pth) intact CPT 83970 | $302.50 | $550.00 | $41.28 – $43.34 | 3 |
| Parathyrd planar w/spect&ct CPT 78072 | not published | not published | $581.86 – $610.95 | 3 |
| Parathyroid planar imaging CPT 78070 | $1,529.00 | $2,780.00 | $428.40 – $449.82 | 3 |
| Parathyroid planar img w/tomo spect CPT 78071 | $1,629.10 | $2,962.00 | $428.40 – $449.82 | 3 |
| Paravaginal defect repair 57284 CPT 57284 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Parial mast w/lymph removal 19302 CPT 19302 | not published | not published | $7,115.73 – $7,471.51 | 3 |
| Paring/cutting benign hyperkeratotic lesion single CPT 11055 | $210.65 | $383.00 | $215.00 – $225.75 | 3 |
| Parotid duct diversion CPT 42507 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Parotid duct diversion CPT 42509 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Parotid duct diversion CPT 42510 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Part exc/post vert comp/sng/thorac 22101 CPT 22101 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Part hymenectomy/revi hymenal ring 56700 CPT 56700 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Partial exc bone humerus CPT 24140 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial excision bone tars/metatars exc talus/calcaneus (both sides) (rest meth ii cah) CPT 28122 | not published | not published | $3,506.34 – $3,681.65 | 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.