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 |
|---|---|---|---|---|
| Reconstruction of mouth CPT 40845 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of nail bed CPT 11762 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Reconstruction of nose CPT 30410 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of nose CPT 30420 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of orbit CPT 21256 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of throat CPT 42950 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruction of urethra CPT 53410 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Reconstruction of urethra CPT 53430 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Reconstruction of urethra CPT 54308 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Reconstruction of urethra CPT 54312 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Reconstruction of urethra CPT 54318 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Reconstruction of urethra CPT 54322 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Reconstruction of urethra CPT 54324 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Reconstruction of urethra CPT 54326 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Reconstruction tongue fold CPT 41520 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Reconstruct lip with flap CPT 40527 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct lip w/local flap 40525 CPT 40525 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Reconstruct lower jaw bone CPT 21255 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct lower jaw bone CPT 21247 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct orbit/forehead CPT 21172 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct shoulder joint CPT 23470 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Reconstruct shoulder joint CPT 23472 | not published | not published | $18,789.56 – $19,729.04 | 3 |
| Reconstruct ulna/radioulnar CPT 25337 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Reconstruct upper jaw bone CPT 21206 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reconstruct urethra/bladder CPT 53431 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Reconstruct urethra stage 1 CPT 53420 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Reconstruct urethra stage 2 CPT 53425 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Red blood cells each unit HCPCS P9021 | $389.40 | $708.00 | not published | 0 |
| Red blood cells leukocytes reduced each unit HCPCS P9016 | $406.45 | $739.00 | not published | 0 |
| Red blood cells leukocytes reduced irradiated each unit HCPCS P9040 | $653.40 | $1,188.00 | not published | 0 |
| Red cell mass multiple CPT 78121 | not published | not published | $581.86 – $610.95 | 3 |
| Red cell mass single CPT 78120 | not published | not published | $428.40 – $449.82 | 3 |
| Red cell sequestration CPT 78140 | not published | not published | $428.40 – $449.82 | 3 |
| Red cell survival study CPT 78130 | not published | not published | $428.40 – $449.82 | 3 |
| Redo endovas vena cava filtr CPT 37192 | $3,148.75 | $5,725.00 | $3,383.62 – $3,552.80 | 3 |
| Reduce testis torsion CPT 54600 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Reduction of facial bones CPT 21209 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reduction of procidentia 45900 CPT 45900 | not published | not published | $996.56 – $1,046.39 | 3 |
| Re-explore parathyroids CPT 60502 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Refill maint impl spine pump CPT 95991 | not published | not published | $328.94 – $345.38 | 3 |
| Refill/maint pump/resvr syst CPT 96522 | not published | not published | $227.94 – $239.33 | 3 |
| Reinforce clavicle CPT 23490 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Reinforce hip bones CPT 27187 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Reinforce shoulder bones CPT 23491 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Reinforce thigh CPT 27495 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Reinforce tibia CPT 27745 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Reinnervate larynx CPT 31590 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Reinsertion of spinal fixation device 22849 CPT 22849 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Release facial nerve CPT 69720 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Release facial nerve CPT 69725 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Release facial nerve CPT 69955 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Release finger contracture CPT 26525 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Release forearm/hand tendon CPT 26449 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release inner ear canal CPT 69960 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Release knuckle contracture CPT 26520 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release middle ear bone CPT 69650 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Release muscles of hand CPT 26593 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release of foot tendon CPT 28220 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Release of foot tendon 28225 CPT 28225 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release of foot tendons CPT 28222 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release of foot tendons CPT 28226 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release of lower leg tendon CPT 27680 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release of lower leg tendons CPT 27681 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release of midfoot joint CPT 28260 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release of midfoot joint CPT 28264 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Release of shoulder ligament CPT 23415 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Release palm contracture CPT 26040 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Release palm contracture CPT 26121 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release palm contracture CPT 26123 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release palm contracture 26045 CPT 26045 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release palm & finger tendon CPT 26442 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release palm/finger tendon CPT 26440 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Release thumb contracture CPT 26508 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Release wrist/forearm tendon CPT 25295 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Relieve bladder contracture CPT 52640 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Relocation of testis(es) CPT 54680 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Relocation skin pocket aicd CPT 33223 | $2,132.35 | $3,877.00 | $2,211.05 – $2,321.60 | 3 |
| Relocation skin pocket pm CPT 33222 | $2,132.35 | $3,877.00 | $2,211.05 – $2,321.60 | 3 |
| Rem/biv cast full arm/leg CPT 29705 | $276.65 | $503.00 | not published | 0 |
| Rem endovas vena cava filter CPT 37193 | $3,326.95 | $6,049.00 | $3,383.62 – $3,552.80 | 3 |
| Rem interrog dev eval icpms CPT 93297 | not published | not published | $39.99 – $41.99 | 3 |
| Rem interrog dev eval scrms CPT 93298 | not published | not published | $39.99 – $41.99 | 3 |
| Rem interrog evl pm/ids CPT 93296 | not published | not published | $39.99 – $41.99 | 3 |
| Rem mntr physiol 1st dev supply ea 30 days CPT 99454 | not published | not published | $39.99 – $41.99 | 3 |
| Rem mntr physiol 1st set up pt educaj eqp CPT 99453 | not published | not published | $142.67 – $149.80 | 3 |
| Rem mntr wrls p-art prs snr CPT 93264 | not published | not published | $39.99 – $41.99 | 3 |
| Remote 30 day ecg tech supp CPT 93229 | not published | not published | $399.88 – $419.88 | 3 |
| Removal anal seton other marker 46030 CPT 46030 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Removal biliary drg cath CPT 47537 | $1,056.00 | $1,920.00 | $971.94 – $1,020.54 | 3 |
| Removal central venous catheter tunneled without port/pump CPT 36589 | $2,657.60 | $4,832.00 | $672.23 – $705.84 | 3 |
| Removal central venous device tunneled w/port/pump central/peripheral insertion CPT 36590 | $1,425.05 | $2,591.00 | $1,686.89 – $1,771.24 | 3 |
| Removal cerclage w/anes CPT 59871 | $2,644.95 | $4,809.00 | $3,468.96 – $3,642.41 | 3 |
| Removal cerclage without anes CPT 59899 | $338.25 | $615.00 | $216.65 – $227.48 | 3 |
| Removal cerumen impacted (both sides) CPT 69210 | $144.10 | $262.00 | $63.22 – $66.38 | 3 |
| Removal clot in graft oth/thn 35875 CPT 35875 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Removal clot in graft xcp 35876 CPT 35876 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Removal devitalized tissue non-selective debridement without anesthesia per session CPT 97602 | $268.95 | $489.00 | $215.00 – $225.75 | 3 |
| Removal duct glbldr calculi CPT 47544 | $3,314.30 | $6,026.00 | not published | 0 |
| Removal embedded foreign body vestibule mouth smpl CPT 40804 | $428.45 | $779.00 | $971.94 – $1,020.54 | 3 |
| Removal foreign body extrn auditory canal with anes CPT 69205 | not published | not published | $1,769.88 – $1,858.38 | 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.