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 |
|---|---|---|---|---|
| Pertussis ag if CPT 87265 | not published | not published | $11.98 – $12.58 | 3 |
| Pet CT skull-mid thgh initial CPT 78815 | $4,385.70 | $7,974.00 | $1,532.36 – $1,608.98 | 3 |
| Pet CT whole body initial CPT 78816 | $4,723.40 | $8,588.00 | $1,532.36 – $1,608.98 | 3 |
| Pet fdg brain metoblic eval sb CPT 78608 | $3,062.95 | $5,569.00 | $1,532.36 – $1,608.98 | 3 |
| Pet image full body CPT 78813 | not published | not published | $1,532.36 – $1,608.98 | 3 |
| Pet image ltd area CPT 78811 | not published | not published | $1,387.37 – $1,456.74 | 3 |
| Pet image skull-thigh CPT 78812 | not published | not published | $1,532.36 – $1,608.98 | 3 |
| Pet image w/ct lmtd CPT 78814 | not published | not published | $1,532.36 – $1,608.98 | 3 |
| Pet not otherwise specified HCPCS G0235 | not published | not published | $428.40 – $449.82 | 3 |
| Pfc sigma fem post aug sz3 8mm HCPCS C1776 | $959.81 | $1,745.11 | not published | 0 |
| Ph1 assmt&mgmt nqhp 11-20 CPT 98967 | $106.15 | $193.00 | not published | 0 |
| Ph1 assmt&mgmt nqhp 21-30 CPT 98968 | $160.60 | $292.00 | not published | 0 |
| Ph1 assmt&mgmt nqhp 5-10 CPT 98966 | $50.60 | $92.00 | not published | 0 |
| Phalangectomy ea toe 28150 CPT 28150 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Ph body fluid CPT 83986 | $75.35 | $137.00 | $3.58 – $3.76 | 3 |
| Phencyclidine (pcp) CPT 83992 | $211.75 | $385.00 | not published | 0 |
| Phenobarbital therapeutic drug level CPT 80184 | $371.80 | $676.00 | $15.30 – $16.06 | 3 |
| Phenytoin total therapeutic drug level CPT 80185 | $243.10 | $442.00 | $13.25 – $13.91 | 3 |
| Phlebotomy therapeutic CPT 99195 | $190.85 | $347.00 | $142.58 – $149.71 | 3 |
| Phleb veins 1 extrm 10-20 stab CPT 37765 | not published | not published | $3,383.62 – $3,552.80 | 3 |
| Phleb veins 1 extrm >20 stab CPT 37766 | not published | not published | $3,383.62 – $3,552.80 | 3 |
| Phosphorus CPT 84100 | $59.95 | $109.00 | $4.74 – $4.98 | 3 |
| Phosphorus 24 hour urine CPT 84105 | $16.50 | $30.00 | $5.78 – $6.07 | 3 |
| Photchmtx tar&uvb/ptrltm&uvb CPT 96910 | not published | not published | $63.22 – $66.38 | 3 |
| Photochemotherapy puva CPT 96912 | not published | not published | $63.22 – $66.38 | 3 |
| Photochemotherapy uv-a or b CPT 96913 | not published | not published | $435.63 – $457.41 | 3 |
| Photo patch test CPT 95052 | not published | not published | $63.22 – $66.38 | 3 |
| Photosensitivity tests CPT 95056 | not published | not published | $142.58 – $149.71 | 3 |
| Phys blood bank serv authrj CPT 86079 | not published | not published | $55.84 – $58.64 | 3 |
| Phys blood bank serv reactj CPT 86078 | $266.20 | $484.00 | $182.57 – $191.70 | 3 |
| Phys blood bank serv xmatch CPT 86077 | not published | not published | $30.99 – $32.54 | 3 |
| Piflu f-18, dia 1 millicurie HCPCS A9595 | $679.35 | $1,235.19 | not published | 0 |
| Pik3ca gene trgt seq alys CPT 81309 | not published | not published | $274.83 – $288.57 | 3 |
| Pild/placebo control clin tr HCPCS G0276 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Pinch graft 1/mlt c> sm ulcer tip/oth area 2cm 15050 CPT 15050 | not published | not published | $792.00 – $831.60 | 3 |
| Pin finger dislocation CPT 26776 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Pin finger fracture each CPT 26756 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Pin hand dislocation CPT 26676 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Pin knuckle dislocation CPT 26706 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Pinworm exam CPT 87172 | $47.30 | $86.00 | $4.27 – $4.48 | 3 |
| Pinworm examinations HCPCS Q0113 | not published | not published | $4.27 – $4.48 | 3 |
| Pituitary evaluation panel CPT 80418 | not published | not published | $579.48 – $608.45 | 3 |
| Place cath xtrnl carotid CPT 36227 | $14,863.20 | $27,024.00 | not published | 0 |
| Place cecostomy tube perc CPT 49442 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Place duod/jej tube perc CPT 49441 | $1,634.05 | $2,971.00 | $2,056.34 – $2,159.15 | 3 |
| Place endorectal app HCPCS C9725 | not published | not published | $996.56 – $1,046.39 | 3 |
| Place gastrostomy tube perc CPT 49440 | $1,715.45 | $3,119.00 | $2,056.34 – $2,159.15 | 3 |
| Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides) CPT 19281 | $2,586.65 | $4,703.00 | $1,769.88 – $1,858.38 | 3 |
| Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left CPT 19282 | $209.00 | $380.00 | not published | 0 |
| Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides) CPT 19285 | $779.90 | $1,418.00 | $758.85 – $796.79 | 3 |
| Placement nephrostomy catheter (both sides) CPT 50432 | $4,617.25 | $8,395.00 | $2,240.09 – $2,352.10 | 3 |
| Placement occlusive device venous/arterial access site post procedure HCPCS G0269 | $650.65 | $1,183.00 | not published | 0 |
| Placement of seton CPT 46020 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Placement stent(s) intravascular transcatheter artery initial CPT 37236 | $23,184.70 | $42,154.00 | $12,370.97 – $12,989.52 | 3 |
| Place ndl musc/tis for right CPT 20555 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Place needles h&n for right CPT 41019 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Place needles pelvic for right CPT 55920 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Place non-slctv cath thoracic arta CPT 36221 | $6,455.90 | $11,738.00 | $3,383.62 – $3,552.80 | 3 |
| Placental lactogen CPT 83632 | not published | not published | $20.22 – $21.23 | 3 |
| Place right device/marker pros CPT 55876 | $1,801.80 | $3,276.00 | not published | 0 |
| Place slctv cath carotd art uni CPT 36224 | $20,918.15 | $38,033.00 | $5,963.01 – $6,261.16 | 3 |
| Place slctv cath carotid/inom art excrn uni CPT 36222 | $15,507.80 | $28,196.00 | $3,383.62 – $3,552.80 | 3 |
| Place slctv cath carotid/inom art intcrn uni CPT 36223 | $19,586.60 | $35,612.00 | $5,963.01 – $6,261.16 | 3 |
| Place slctv cath subclavian art CPT 36225 | $10,986.25 | $19,975.00 | $3,383.62 – $3,552.80 | 3 |
| Place slctv cath vertebral art uni CPT 36226 | $19,155.40 | $34,828.00 | $5,963.01 – $6,261.16 | 3 |
| Plasma volume multiple CPT 78111 | not published | not published | $1,387.37 – $1,456.74 | 3 |
| Plasma volume single CPT 78110 | not published | not published | $1,387.37 – $1,456.74 | 3 |
| Platelet aggregation each agent teg CPT 85576 | $113.85 | $207.00 | $24.91 – $26.16 | 3 |
| Platelet automated CPT 85049 | $56.10 | $102.00 | $4.48 – $4.70 | 3 |
| Platelet deplete of harvest CPT 38213 | not published | not published | $472.77 – $496.41 | 3 |
| Platelet pheresis each unit HCPCS P9034 | $1,074.70 | $1,954.00 | not published | 0 |
| Platelets hla matched leukocytes reduced apheresis/pheresis each unit HCPCS P9052 | $1,676.40 | $3,048.00 | not published | 0 |
| Platelets leukocytes reduced irradiated each unit HCPCS P9033 | $1,555.40 | $2,828.00 | not published | 0 |
| Platelets pheresis leukocytes reduced each unit HCPCS P9035 | $1,146.75 | $2,085.00 | $511.59 – $537.17 | 3 |
| Platelets pheresis leukocytes reduced irradiated each unit HCPCS P9037 | $1,574.65 | $2,863.00 | $680.61 – $714.64 | 3 |
| Platelets pheresis pathogen-reduced each unit HCPCS P9073 | $920.15 | $1,673.00 | not published | 0 |
| Platelet survival CPT 78191 | not published | not published | $428.40 – $449.82 | 3 |
| Plcg2 gene common variants CPT 81320 | not published | not published | $291.36 – $305.93 | 3 |
| Plcmnt biliary drainage cath w/img ext CPT 47533 | $3,501.30 | $6,366.00 | $3,836.82 – $4,028.66 | 3 |
| Plcmnt stent transcath ctrl dialysis seg add-on CPT 36908 | $23,431.10 | $42,602.00 | not published | 0 |
| Plcmnt ureteral stent pq w/img exstng trct CPT 50693 | $4,441.80 | $8,076.00 | $3,777.44 – $3,966.31 | 3 |
| Plcmnt ureteral stent pq w/img new w/cath CPT 50695 | $4,850.45 | $8,819.00 | $3,777.44 – $3,966.31 | 3 |
| Plcmt dlyd xtn pros 1st vsl CPT 34710 | $1,304.05 | $2,371.00 | not published | 0 |
| Plcmt sft tiss loc pq w/img 1st lsn CPT 10035 | $1,345.85 | $2,447.00 | $758.85 – $796.79 | 3 |
| Plcmt sft tiss loc pq w/img ea addl lsn CPT 10036 | $1,074.70 | $1,954.00 | not published | 0 |
| Plcmt xtn pros evasc rpr per vsl CPT 34709 | $4,138.75 | $7,525.00 | not published | 0 |
| Plc pq device breast ea addl lesion stereo guide CPT 19284 | $167.20 | $304.00 | not published | 0 |
| Plc pq device breast ea addl lesion Ultrasound guide CPT 19286 | $182.60 | $332.00 | not published | 0 |
| Plethysmography lung volumes/airway resistance CPT 94726 | $533.50 | $970.00 | $399.88 – $419.88 | 3 |
| Plmt access bil tree sm bwl CPT 47541 | not published | not published | $6,937.47 – $7,284.34 | 3 |
| Plmt biliary drainage cath CPT 47534 | $3,501.30 | $6,366.00 | $3,836.82 – $4,028.66 | 3 |
| Plmt nephroureteral catheter CPT 50433 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Plmt ureteral stent prq CPT 50694 | $4,664.00 | $8,480.00 | $3,777.44 – $3,966.31 | 3 |
| Pm device progr eval dual CPT 93280 | not published | not published | $39.99 – $41.99 | 3 |
| Pm device progr eval multi CPT 93281 | not published | not published | $39.99 – $41.99 | 3 |
| Pml/raralpha 1 breakpoint CPT 81316 | not published | not published | $207.31 – $217.68 | 3 |
| Pmp22 gene dup/delet CPT 81324 | $1,652.75 | $3,005.00 | $758.36 – $796.28 | 3 |
| Pmp22 gene full sequence CPT 81325 | not published | not published | $769.58 – $808.06 | 3 |
| Pmp22 gene known fam variant CPT 81326 | not published | not published | $46.60 – $48.93 | 3 |
| Pm phone r-strip device eval CPT 93293 | not published | not published | $39.99 – $41.99 | 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.