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 |
|---|---|---|---|---|
| Prostatic microwave thermotx CPT 53850 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Prostatic rf thermotx CPT 53852 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Protein c activity CPT 85303 | $418.00 | $760.00 | $13.84 – $14.53 | 3 |
| Protein electrophoretic fractionation & quantitation serum CPT 84165 | $30.80 | $56.00 | $10.74 – $11.28 | 3 |
| Protein s total CPT 85305 | $479.05 | $871.00 | $11.61 – $12.19 | 3 |
| Protein total 24 hour urine CPT 84156 | $101.20 | $184.00 | $3.67 – $3.85 | 3 |
| Protein total body fluid CPT 84157 | $191.40 | $348.00 | $4.00 – $4.20 | 3 |
| Protein total serum plasma whole blood CPT 84155 | $103.40 | $188.00 | $3.67 – $3.85 | 3 |
| Prothrombin time substitution plasma fractions each CPT 85611 | $39.60 | $72.00 | $3.94 – $4.14 | 3 |
| Protoporphyrin rbc screen CPT 84203 | not published | not published | $9.74 – $10.23 | 3 |
| Provide inr test mater/equip HCPCS G0249 | not published | not published | $142.67 – $149.80 | 3 |
| Prp i/hern init block >5 yr CPT 49507 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Prq av fstl crtj uxtr 1 acs CPT 36836 | not published | not published | $19,644.52 – $20,626.75 | 3 |
| Prq av fstl crt uxtr sep acs CPT 36837 | not published | not published | $19,644.52 – $20,626.75 | 3 |
| Prq card angio/athrect addl CPT 92925 | $12,919.50 | $23,490.00 | not published | 0 |
| Prq cardiac angio addl art CPT 92921 | $7,223.70 | $13,134.00 | not published | 0 |
| Prq card revasc chronic addl CPT 92944 | $8,329.20 | $15,144.00 | not published | 0 |
| Prq card revasc mi 1 vsl CPT 92941 | $12,543.30 | $22,806.00 | not published | 0 |
| Prq card revasc mi 1 vsl drug-eluting HCPCS C9606 | $25,386.90 | $46,158.00 | not published | 0 |
| Prq card stent/ath/angio CPT 92934 | $9,721.80 | $17,676.00 | not published | 0 |
| Prq card stent w/angio addl CPT 92929 | $9,721.80 | $17,676.00 | not published | 0 |
| Prq revasc byp graft 1 art and/or branches CPT 92937 | $11,818.40 | $21,488.00 | $12,370.97 – $12,989.52 | 3 |
| Prq revasc byp graft addl CPT 92938 | $8,329.20 | $15,144.00 | not published | 0 |
| Prq skel fix clcnl fx w/mnpj CPT 28406 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Prq skel fix epcndylr hum fx CPT 24566 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Prq skel fix sprcndlr hum fx CPT 24538 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Prq skel fix talus fx w/mnpj CPT 28436 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Prq skel fix tarsl fx w/mnpj CPT 28456 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Prq tcat plmt ntrac st 1 les CPT 92928 | $15,936.80 | $28,976.00 | $12,370.97 – $12,989.52 | 3 |
| Prq tcat plmt ntrac st 2+les CPT 92930 | not published | not published | $19,644.52 – $20,626.75 | 3 |
| Prq trlml c athrc st angiop1 CPT 92933 | $20,326.90 | $36,958.00 | $19,644.52 – $20,626.75 | 3 |
| Prq trl rvs ch occ ant&rtrgr CPT 92945 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Prq trluml c angiop 1art&/br CPT 92920 | $11,829.95 | $21,509.00 | $6,099.19 – $6,404.14 | 3 |
| Prq trluml c athrc 1 art&/br CPT 92924 | $13,410.10 | $24,382.00 | $12,370.97 – $12,989.52 | 3 |
| Prq trluml revsc ch occ ant CPT 92943 | $11,485.10 | $20,882.00 | $12,370.97 – $12,989.52 | 3 |
| Pr removal foreign body external auditory canal without anesthesia CPT 69200 | $146.85 | $267.00 | $142.58 – $149.71 | 3 |
| Pr removal intrauterine device CPT 58301 | $330.55 | $601.00 | $326.55 – $342.88 | 3 |
| Pr repair intermediate wounds scalp/axillae/trunk/extremities 2.6 - 7.5 cm CPT 12032 | $583.00 | $1,060.00 | $435.63 – $457.41 | 3 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb <= 2.5 cm CPT 12011 | $243.65 | $443.00 | $215.00 – $225.75 | 3 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb 2.6-5.0 cm CPT 12013 | $552.20 | $1,004.00 | $215.00 – $225.75 | 3 |
| Pr repair sprfcl wounds simple scalp/neck/axillae/gent/trunk/ext <= 2.5 cm CPT 12001 | $309.65 | $563.00 | $215.00 – $225.75 | 3 |
| Pr repair superficial wd simple scalp/neck/ax/gent/trunk/ext 2.6-7.5 cm CPT 12002 | $432.85 | $787.00 | $215.00 – $225.75 | 3 |
| Pr split-thickness autograft trunk/arm/leg 1st 100 sq cm/<tbsa infant/child CPT 15100 | $3,087.15 | $5,613.00 | $2,211.05 – $2,321.60 | 3 |
| Prtl exc bone olecrn process CPT 24147 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Prtl exc bone radial h/n CPT 24145 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Prtl exchange transfuse nb CPT 36456 | not published | not published | $472.77 – $496.41 | 3 |
| Prtl excision bone clavicle CPT 23180 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Prtl excision bone scapula CPT 23182 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Pr tube thoracostomy w/connection to drainage open CPT 32551 | $1,302.95 | $2,369.00 | $1,686.89 – $1,771.24 | 3 |
| PSA (Prostate) Test CPT 84153 | $246.40 | $448.00 | $18.39 – $19.31 | 3 |
| Psych/neuropsych test admin automated result 96146 CPT 96146 | not published | not published | $30.99 – $32.54 | 3 |
| Psychotherapy group therapy CPT 90853 | $283.80 | $516.00 | not published | 0 |
| Psychotherapy patient individual therapy 30 minutes CPT 90832 | $265.10 | $482.00 | not published | 0 |
| Psychotherapy patient individual therapy 45 minutes CPT 90834 | $265.10 | $482.00 | not published | 0 |
| Psychotherapy patient individual therapy 60 minutes CPT 90837 | $366.30 | $666.00 | not published | 0 |
| Psych test eval svc phys/qhp 1st hr CPT 96130 | not published | not published | $231.39 – $242.96 | 3 |
| Psy/npsy phys/qhp 2> tst 1st 30 min CPT 96136 | not published | not published | $142.58 – $149.71 | 3 |
| Pt application of modality >=1 area electrical stimulation each 15 minutes CPT 97032 | $133.65 | $243.00 | $15.18 – $15.94 | 3 |
| Pt application of modality >=1 area iontophoresis each 15 minutes CPT 97033 | $122.65 | $223.00 | $18.35 – $19.27 | 3 |
| Pt application of modality >=1 area ultrasound each 15 minutes CPT 97035 | $161.15 | $293.00 | $13.94 – $14.64 | 3 |
| Pt application of modality traction mechanical CPT 97012 | $132.55 | $241.00 | $14.22 – $14.93 | 3 |
| Pten gene dup/delet variant CPT 81323 | $270.60 | $492.00 | $300.00 – $315.00 | 3 |
| Pten gene full sequence CPT 81321 | $541.75 | $985.00 | $600.00 – $630.00 | 3 |
| Pten gene known fam variant CPT 81322 | not published | not published | $46.60 – $48.93 | 3 |
| Pterygomaxillary fossa surg any appr 31040 CPT 31040 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Pt evaluation high complexity patient/family CPT 97163 | $345.40 | $628.00 | $94.04 – $98.74 | 3 |
| Pt evaluation low complexity patient/family CPT 97161 | $228.80 | $416.00 | $98.89 – $103.83 | 3 |
| Pt evaluation moderate complexity patient/family CPT 97162 | $250.25 | $455.00 | $99.73 – $104.72 | 3 |
| Pt re-evaluation patient/family CPT 97164 | $185.35 | $337.00 | $68.90 – $72.34 | 3 |
| Pt repositioning canalith procedure(s) per day CPT 95992 | $71.50 | $130.00 | not published | 0 |
| Pt stimulation electrial unattended >= 1 area other than wound care part of therapy plan HCPCS G0283 | $121.55 | $221.00 | $12.33 – $12.95 | 3 |
| Pt therapeutic procedure >=1 area gait training each 15 minutes CPT 97116 | $92.95 | $169.00 | $28.06 – $29.46 | 3 |
| Pt therapeutic procedure >=1 area massage each 15 minutes CPT 97124 | $94.05 | $171.00 | $30.54 – $32.07 | 3 |
| Pt wheelchair management each 15 minutes CPT 97542 | $97.35 | $177.00 | $31.68 – $33.26 | 3 |
| Pul art balloon repr percut CPT 92997 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Pulm ds ipf mrna 190 gen alg CPT 81554 | not published | not published | $5,409.60 – $5,680.08 | 3 |
| Pulmonary vent imaging CPT 78579 | not published | not published | $428.40 – $449.82 | 3 |
| Pulse ox continuous overnight monitoring CPT 94762 | $448.25 | $815.00 | $137.89 – $144.78 | 3 |
| Pulse ox multiple CPT 94761 | $117.70 | $214.00 | not published | 0 |
| Pulse ox single CPT 94760 | $112.75 | $205.00 | not published | 0 |
| Punc of shunt for asp or inj CPT 61070 | not published | not published | $756.44 – $794.26 | 3 |
| Puncture arterial withdrawal blood for diagnosis CPT 36600 | $69.30 | $126.00 | $142.58 – $149.71 | 3 |
| Puncture aspiration abscess/hematoma/bulla/cyst CPT 10160 | $638.55 | $1,161.00 | $435.63 – $457.41 | 3 |
| Puncture/clear windpipe 31612 CPT 31612 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Puncture spinal lumbar diagnostic CPT 62270 | $1,275.45 | $2,319.00 | $756.44 – $794.26 | 3 |
| Pvb thoracic cont infusion CPT 64463 | not published | not published | $756.44 – $794.26 | 3 |
| Pvb thoracic single inj site CPT 64461 | $675.95 | $1,229.00 | $756.44 – $794.26 | 3 |
| Pyruvate CPT 84210 | $68.20 | $124.00 | $14.48 – $15.20 | 3 |
| Pyruvate kinase CPT 84220 | $111.65 | $203.00 | $9.44 – $9.91 | 3 |
| Quan puplmtry phy/qhp uni/bi CPT 95919 | not published | not published | $142.58 – $149.71 | 3 |
| Quant diff pulm perf and vent w/imaging CPT 78598 | $583.55 | $1,061.00 | $581.86 – $610.95 | 3 |
| Quant diff pulm perf w/imaging CPT 78597 | $1,058.75 | $1,925.00 | $428.40 – $449.82 | 3 |
| Quest t3 uptake CPT 84479 | $16.50 | $30.00 | $6.47 – $6.79 | 3 |
| Radiation physics consult CPT 77336 | $775.50 | $1,410.00 | not published | 0 |
| Radiation therapy dose plan CPT 77300 | $821.15 | $1,493.00 | not published | 0 |
| Radiation treatment aid(s) CPT 77332 | $264.00 | $480.00 | not published | 0 |
| Radiation treatment aid(s) CPT 77334 | $1,213.30 | $2,206.00 | not published | 0 |
| Radiation treatment delivery CPT 77402 | $332.20 | $604.00 | not published | 0 |
| Radiation treatment delivery CPT 77412 | $877.25 | $1,595.00 | not published | 0 |
| Radical rescj tumor clavicle CPT 23200 | 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.