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 |
|---|---|---|---|---|
| Radical rescj tumor prox hum CPT 23220 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Radical rescj tumor scapula CPT 23210 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Radical resection of elbow CPT 24149 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Radical resection sternum 21630 CPT 21630 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Radic resect abd tumor<5cm 22904 CPT 22904 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Radic resect shoulder tumor 5cm/> 23078 CPT 23078 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Radiology port images(s) CPT 77417 | $268.40 | $488.00 | not published | 0 |
| Radiotherapy dose plan imrt CPT 77301 | $7,157.15 | $13,013.00 | not published | 0 |
| Radium ra223 dichl ther/uci HCPCS A9606 | $371.80 | $676.00 | not published | 0 |
| Radphm lcl tmr plnr bdy sgl day img CPT 78802 | $2,552.55 | $4,641.00 | $581.86 – $610.95 | 3 |
| Radphm lcl tmr plnr bdy two day img CPT 78804 | $3,365.45 | $6,119.00 | $581.86 – $610.95 | 3 |
| Radphm lcl tmr spect/ct 2+ areas/2+ days CPT 78831 | not published | not published | $1,387.37 – $1,456.74 | 3 |
| Radphm lcl tomogr sgl area sgl day CPT 78803 | $2,968.35 | $5,397.00 | $581.86 – $610.95 | 3 |
| Radphm lcl tumor plr sgl day CPT 78800 | $1,763.30 | $3,206.00 | $428.40 – $449.82 | 3 |
| Rad rescj tum dstl/shft hum CPT 24150 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Rad rescj tum shoulder<5 cm CPT 23077 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Rad rescj tum tiss a/e 5 cm+ CPT 24079 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Rad rescj tum tiss a/e <5cm CPT 24077 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Rad resec soft tis tum/ft/toe/<3cm 28046 CPT 28046 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Rad resect abd tumor 5 cm/> CPT 22905 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Rad resect hand tumor < 3 cm CPT 26117 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Rad resect hand tumor 3 cm/> CPT 26118 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Rad resection tum radial h/n CPT 24152 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Rad resect tumor/neck/ant thor/<5cm21557 CPT 21557 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Range of motion measurements CPT 95852 | not published | not published | $5.27 – $5.53 | 3 |
| Rapid Strep Test CPT 87880 | $61.05 | $111.00 | $16.53 – $17.36 | 3 |
| Rbc count only automated CPT 85041 | not published | not published | $3.02 – $3.17 | 3 |
| Rbc depletion of harvest CPT 38212 | not published | not published | $472.77 – $496.41 | 3 |
| Rbc mechanical fragility CPT 85547 | not published | not published | $8.60 – $9.03 | 3 |
| Rbc osmotic fragility CPT 85555 | $150.15 | $273.00 | $7.47 – $7.84 | 3 |
| Rbc serum pretx incubj drugs CPT 86975 | $110.55 | $201.00 | not published | 0 |
| Rcnst bfrnt sp orb rm&lw fhd CPT 21175 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rcnstj forehead w/autograft CPT 21180 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rcnstj forehead with grafts CPT 21179 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rcnstj mdfc lefort i 1 w/grf CPT 21145 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rcnstj mdfc lefort i 2 w/grf CPT 21146 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rcnstj mdfc lefort iii w/i CPT 21155 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rcnstj mdfc lefort iii without i CPT 21154 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rcnstj mdfc lefrtii w/b1 grf CPT 21151 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rcnst mdfc lfrtiii advm w/i CPT 21160 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rcnst mdfc lfrtiii advm wo i CPT 21159 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rdctj forehead cntrg only CPT 21137 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Rdctj forehead cntrg&prostc CPT 21138 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rdctj forehead cntrg&setback CPT 21139 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Realignment of knee CPT 27457 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Realignment of knee CPT 27455 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Realignment of tendons CPT 26437 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Realignment of thigh bone CPT 27454 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Rebuild eardrum structures CPT 69632 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rebuild eardrum structures CPT 69633 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rebuild eardrum structures CPT 69636 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rebuild outer ear canal CPT 69310 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rebuild outer ear canal CPT 69320 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rechanneling w/wo patch graft deep profunda fem art 35372 CPT 35372 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Reconst lwr jaw w/fixation CPT 21196 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconst lwr jaw w/graft CPT 21194 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconst lwr jaw without fixation CPT 21195 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconst lwr jaw without graft CPT 21193 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconst pectus excavatum/carinatum opn 21740 CPT 21740 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Reconstr lwr jaw segment CPT 21198 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstr lwr jaw w/advance CPT 21199 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct cleft foot CPT 28360 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Reconstruct cleft palate CPT 42200 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct cleft palate CPT 42205 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Reconstruct cleft palate CPT 42210 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct cleft palate CPT 42215 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct cleft palate CPT 42220 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct cleft palate CPT 42225 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct cranial bone CPT 21182 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct cranial bone CPT 21183 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct cranial bone CPT 21184 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct elbow joint CPT 24360 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Reconstruct elbow joint CPT 24361 | not published | not published | $18,789.56 – $19,729.04 | 3 |
| Reconstruct elbow joint CPT 24362 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Reconstruct elbow lat ligmnt CPT 24344 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Reconstruct elbow med ligmnt CPT 24346 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Reconstruct extra finger CPT 26587 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Reconstruct finger joint CPT 26545 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Reconstruct finger joint CPT 26548 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Reconstruct head of radius CPT 24365 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Reconstruct head of radius CPT 24366 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Reconstruction ankle joint CPT 27703 | not published | not published | $18,789.56 – $19,729.04 | 3 |
| Reconstruction knee CPT 27427 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Reconstruction knee CPT 27428 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Reconstruction knee CPT 27429 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Reconstruction of anus CPT 46753 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Reconstruction of hip socket CPT 27120 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Reconstruction of hip socket CPT 27122 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Reconstruction of jaw CPT 21245 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of jaw CPT 21246 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of jaw CPT 21248 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of jaw CPT 21249 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of jaw joint CPT 21240 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of jaw joint CPT 21242 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of lower jaw CPT 21244 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of midface CPT 21188 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of mouth CPT 40840 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of mouth CPT 40842 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of mouth CPT 40843 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of mouth CPT 40844 | not published | not published | $6,343.80 – $6,660.99 | 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.