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 |
|---|---|---|---|---|
| Partial excision of lip CPT 40500 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Partial hip replacement CPT 27125 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Partial removal finger bone CPT 26235 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Partial removal finger bone CPT 26236 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Partial removal foot fascia CPT 28060 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial removal leg bone(s) CPT 27360 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial removal of fibula CPT 27641 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial removal of foot bone CPT 28288 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial removal of hand bone CPT 26230 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial removal of lip CPT 40530 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Partial removal of nose CPT 30150 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Partial removal of penis CPT 54120 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Partial removal of pharynx 42890 CPT 42890 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Partial removal of radius CPT 25151 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial removal of radius CPT 25230 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial removal of rib CPT 21600 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Partial removal of sternum CPT 21620 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial removal of thyroid CPT 60220 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Partial removal of thyroid CPT 60225 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Partial removal of tibia CPT 27640 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial removal of toe CPT 28160 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial removal of tongue CPT 41120 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Partial removal of ulna CPT 25119 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial removal of ulna CPT 25150 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial removal of ulna CPT 25240 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Partial removal of vaginal wall 57106 CPT 57106 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Partial thyroid excision CPT 60210 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Partial thyroid lobect w/contratlat stot lobec 60212 CPT 60212 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Part removal hip bone deep CPT 27071 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Part removal of metatarsal CPT 28110 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Part removal of metatarsal CPT 28113 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Part removal of metatarsal 28112 CPT 28112 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Part remove hip bone super CPT 27070 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Passy muir valve metal trach HCPCS L8501 | $214.93 | $390.79 | not published | 0 |
| Path clin consltj high 41-60 CPT 80505 | not published | not published | $182.57 – $191.70 | 3 |
| Path clin consltj mod 21-40 CPT 80504 | not published | not published | $182.57 – $191.70 | 3 |
| Path clin consltj sf 5-20 CPT 80503 | not published | not published | $55.84 – $58.64 | 3 |
| Patient recorded spirometry CPT 94015 | not published | not published | $231.39 – $242.96 | 3 |
| Pca3/klk3 antigen CPT 81313 | not published | not published | $255.05 – $267.80 | 3 |
| Pdgfra gene CPT 81314 | $479.05 | $871.00 | $329.51 – $345.99 | 3 |
| Pdt dstr prmlg les phys/qhp CPT 96573 | not published | not published | $215.00 – $225.75 | 3 |
| Pedcle fh/ch/ch/m/n/ax/g/h/f CPT 15574 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Ped home apnea mntr att only CPT 94775 | not published | not published | $137.89 – $144.78 | 3 |
| Ped home apnea mntr dl&alys CPT 94776 | not published | not published | $137.89 – $144.78 | 3 |
| Pedicle enel/ntroral 15576 CPT 15576 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $2,642.20 | $4,804.00 | $187.96 – $197.36 | 3 |
| Pelvic CT scan (with contrast) CPT 72193 | $2,161.50 | $3,930.00 | $187.96 – $197.36 | 3 |
| Pelvic CT scan (without contrast) CPT 72192 | $1,965.70 | $3,574.00 | $112.03 – $117.63 | 3 |
| Pelvic MRI (with and without contrast) CPT 72197 | $4,220.15 | $7,673.00 | $373.86 – $392.55 | 3 |
| Pelvic MRI (with contrast) CPT 72196 | $3,305.50 | $6,010.00 | $373.86 – $392.55 | 3 |
| Pelvic MRI (without contrast) CPT 72195 | $3,012.35 | $5,477.00 | $255.69 – $268.47 | 3 |
| Pelvic ring fracture uni/bil HCPCS G0413 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Pelvic ring fx treat int fix HCPCS G0414 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Pelvic Ultrasound (complete) CPT 76856 | $1,009.25 | $1,835.00 | $112.03 – $117.63 | 3 |
| Pelvic Ultrasound (limited) CPT 76857 | $668.25 | $1,215.00 | $112.03 – $117.63 | 3 |
| Penile injection CPT 54235 | not published | not published | $267.74 – $281.13 | 3 |
| Penile vascular study CPT 93980 | $991.65 | $1,803.00 | $112.03 – $117.63 | 3 |
| Penile vascular study CPT 93981 | not published | not published | $112.03 – $117.63 | 3 |
| Penile venous occlusion CPT 37790 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Penis plastic surgery CPT 54360 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Penis study CPT 54240 | not published | not published | $231.39 – $242.96 | 3 |
| Perc cryo ablate renal tum CPT 50593 | $8,564.60 | $15,572.00 | $11,391.13 – $11,960.68 | 3 |
| Perc d-e cor revasc chro add HCPCS C9608 | $12,367.85 | $22,487.00 | not published | 0 |
| Perc d-e cor revasc chro sin HCPCS C9607 | $21,133.20 | $38,424.00 | $19,644.52 – $20,626.75 | 3 |
| Perc d-e cor revasc t cabg b HCPCS C9605 | $12,287.00 | $22,340.00 | not published | 0 |
| Perc d-e cor revasc t cabg s HCPCS C9604 | $23,588.40 | $42,888.00 | $12,370.97 – $12,989.52 | 3 |
| Perc d-e cor stent ather br HCPCS C9603 | $12,287.00 | $22,340.00 | not published | 0 |
| Perc d-e cor stent ather s HCPCS C9602 | $25,386.90 | $46,158.00 | $19,644.52 – $20,626.75 | 3 |
| Perc drug-el cor stent bran HCPCS C9601 | $14,759.80 | $26,836.00 | not published | 0 |
| Perc drug-el cor stent sing HCPCS C9600 | $20,359.35 | $37,017.00 | $12,370.97 – $12,989.52 | 3 |
| Perc rf ablate renal tumor CPT 50592 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Percut ablate liver rf CPT 47382 | $5,504.95 | $10,009.00 | $6,478.50 – $6,802.42 | 3 |
| Pericardiocentesis wwo imaging CPT 33016 | $1,808.40 | $3,288.00 | $1,686.89 – $1,771.24 | 3 |
| Pericardiotomy/clot/for bod remove 33020 CPT 33020 | $3,651.45 | $6,639.00 | not published | 0 |
| Peri-implt capslc brst compl CPT 19371 | not published | not published | $4,195.85 – $4,405.64 | 3 |
| Perineoplasty rpr per nonob CPT 56810 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Peripheral vascular rehab CPT 93668 | not published | not published | $63.22 – $66.38 | 3 |
| Peritoneal cath sub q resv per CPT 49419 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Peritoneogram rs&i CPT 74190 | $1,337.60 | $2,432.00 | $585.55 – $614.83 | 3 |
| Perit-vens shunt pat tst CPT 78291 | $862.40 | $1,568.00 | $428.40 – $449.82 | 3 |
| Perq dev breast 1st mr guide CPT 19287 | not published | not published | $758.85 – $796.79 | 3 |
| Perq dev breast 1st strtctc CPT 19283 | $1,481.70 | $2,694.00 | $758.85 – $796.79 | 3 |
| Perq p-art revsc 1 abnor bi CPT 33903 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Perq p-art revsc 1 abnor uni CPT 33902 | not published | not published | $19,644.52 – $20,626.75 | 3 |
| Perq p-art revsc 1 nm nt bi CPT 33901 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Perq p-art revsc 1 nm nt uni CPT 33900 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Perq plmt bile duct stent CPT 47538 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Perq plmt bile duct stent CPT 47539 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Perq plmt bile duct stent CPT 47540 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Perq rplcmt g-tube req revsn gstrst trk CPT 43763 | $392.15 | $713.00 | $267.74 – $281.13 | 3 |
| Perq skel fix rad/uln dislc CPT 25671 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Perq skel fix ulnar styld fx CPT 25651 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Perq transcath closure each CPT 93592 | $454.85 | $827.00 | not published | 0 |
| Perq transcath closure pda CPT 93582 | not published | not published | $19,644.52 – $20,626.75 | 3 |
| Perq transcath cls aortic CPT 93591 | not published | not published | $19,644.52 – $20,626.75 | 3 |
| Perq transcath cls mitral CPT 93590 | not published | not published | $19,644.52 – $20,626.75 | 3 |
| Perq tx big toe fracture w/manip 28496 CPT 28496 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Perq tx malar fracture CPT 21355 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Perq tx mndblr fx xtrnl fixj CPT 21452 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Perq tx nasoethmoid fx CPT 21340 | not published | not published | $3,552.91 – $3,730.55 | 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.