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 |
|---|---|---|---|---|
| Assay of fluoride CPT 82735 | not published | not published | $18.54 – $19.47 | 3 |
| Assay of galactose CPT 82760 | $44.00 | $80.00 | $11.20 – $11.76 | 3 |
| Assay of gdh enzyme CPT 82965 | not published | not published | $13.15 – $13.81 | 3 |
| Assay of glucosidase CPT 82963 | not published | not published | $21.48 – $22.55 | 3 |
| Assay of glutathione CPT 82978 | $83.05 | $151.00 | $15.45 – $16.22 | 3 |
| Assay of haptoglobins CPT 83012 | not published | not published | $26.89 – $28.23 | 3 |
| Assay of idh enzyme CPT 83570 | not published | not published | $8.85 – $9.29 | 3 |
| Assay of interleukin-6 (il-6) CPT 83529 | $116.05 | $211.00 | $17.27 – $18.13 | 3 |
| Assay of intrinsic factor CPT 83528 | not published | not published | $19.82 – $20.81 | 3 |
| Assay of lap enzyme CPT 83670 | not published | not published | $9.81 – $10.30 | 3 |
| Assay of leflunomide CPT 80193 | not published | not published | $38.57 – $40.50 | 3 |
| Assay of lrh hormone CPT 83727 | not published | not published | $17.19 – $18.05 | 3 |
| Assay of methemalbumin CPT 83857 | not published | not published | $10.74 – $11.28 | 3 |
| Assay of neonatal thyroxine CPT 84437 | not published | not published | $6.47 – $6.79 | 3 |
| Assay of osteocalcin CPT 83937 | $79.75 | $145.00 | $29.85 – $31.34 | 3 |
| Assay of phenylketones CPT 84035 | not published | not published | $3.98 – $4.18 | 3 |
| Assay of pregnanediol CPT 84135 | not published | not published | $21.27 – $22.33 | 3 |
| Assay of pregnanetriol CPT 84138 | $151.80 | $276.00 | $21.05 – $22.10 | 3 |
| Assay of procainamide w/metab CPT 80192 | $158.40 | $288.00 | $16.75 – $17.59 | 3 |
| Assay of progesterone CPT 84234 | not published | not published | $64.88 – $68.12 | 3 |
| Assay of prostaglandin CPT 84150 | $335.50 | $610.00 | $41.77 – $43.86 | 3 |
| Assay of PSA complexed CPT 84152 | not published | not published | $18.39 – $19.31 | 3 |
| Assay of quinine CPT 84228 | not published | not published | $11.63 – $12.21 | 3 |
| Assay of rbc pg6d enzyme CPT 84085 | not published | not published | $9.44 – $9.91 | 3 |
| Assay of salicylate CPT 80179 | not published | not published | $18.64 – $19.57 | 3 |
| Assay of semen fructose CPT 82757 | not published | not published | $17.34 – $18.21 | 3 |
| Assay of sialic acid CPT 84275 | $119.90 | $218.00 | $13.44 – $14.11 | 3 |
| Assay of silica CPT 84285 | $199.10 | $362.00 | $25.21 – $26.47 | 3 |
| Assay of somatostatin CPT 84307 | $224.95 | $409.00 | $18.28 – $19.19 | 3 |
| Assay of thiocyanate CPT 84430 | $52.25 | $95.00 | $11.63 – $12.21 | 3 |
| Assay of troponin qual CPT 84512 | not published | not published | $10.09 – $10.59 | 3 |
| Assay of tyrosine CPT 84510 | $91.85 | $167.00 | $10.63 – $11.16 | 3 |
| Assay of urine sulfate CPT 84392 | $75.35 | $137.00 | $5.49 – $5.76 | 3 |
| Assay of urine urobilinogen CPT 84580 | not published | not published | $9.55 – $10.03 | 3 |
| Assay of urine urobilinogen CPT 84583 | not published | not published | $6.05 – $6.35 | 3 |
| Assay phosphatidylglycerol CPT 84081 | $322.85 | $587.00 | $16.52 – $17.35 | 3 |
| Assay phosphohexose enzymes CPT 84087 | not published | not published | $10.73 – $11.27 | 3 |
| Assay rbc glutathione CPT 82979 | not published | not published | $9.44 – $9.91 | 3 |
| Assay toxin or antitoxin CPT 87230 | $95.70 | $174.00 | $19.74 – $20.73 | 3 |
| Assess aphasia/interp/rpt/per hr 96105 CPT 96105 | not published | not published | $94.91 – $99.66 | 3 |
| Assess cyst contrast inject CPT 49424 | $428.45 | $779.00 | not published | 0 |
| Assessment leukocyte fecal qualitative/semiquantitative CPT 89055 | $85.25 | $155.00 | $4.27 – $4.48 | 3 |
| Asses tinnit/pitch/loud/match/mask 92625 CPT 92625 | not published | not published | $137.89 – $144.78 | 3 |
| Assistive tech assessment, ot CPT 97755 | not published | not published | $36.48 – $38.30 | 3 |
| Assist oocyte fertilization CPT 89281 | not published | not published | $182.57 – $191.70 | 3 |
| Ast/sgot CPT 84450 | $108.90 | $198.00 | $5.18 – $5.44 | 3 |
| Athrectomy fem/pop/unilateral 37225 CPT 37225 | $13,558.60 | $24,652.00 | not published | 0 |
| Athrectomy tib/pero/unilat/ini ves 37229 CPT 37229 | $20,324.15 | $36,953.00 | not published | 0 |
| Atomic absorption CPT 82190 | not published | not published | $15.90 – $16.70 | 3 |
| Attach bladder/urethra simple 51840 CPT 51840 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Aud brainstem implt programg CPT 92640 | not published | not published | $137.89 – $144.78 | 3 |
| Audiometry air + bone CPT 92553 | not published | not published | $137.89 – $144.78 | 3 |
| Auditory function 60 min CPT 92620 | not published | not published | $137.89 – $144.78 | 3 |
| Augmentation cheek bone CPT 21270 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Augmentation lower jaw bone CPT 21125 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Augmentation lower jaw bone CPT 21127 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Augmentation of facial bones CPT 21208 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Augment injectable kit 3.0cc HCPCS C1734 | $2,733.96 | $4,970.83 | not published | 0 |
| Augumentation percutaneous vertebral inc cavity creation ea addl thoracic/lumbar vertebral body CPT 22515 | $5,159.00 | $9,380.00 | not published | 0 |
| Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic CPT 22513 | $9,081.60 | $16,512.00 | $7,775.89 – $8,164.69 | 3 |
| Autgrft implnt knee w/scope CPT 29866 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Autochondrocyte implant knee CPT 27412 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Autoimmune rheumatoid arthr anl 12 mrk ia CPT 81490 | not published | not published | $840.65 – $882.68 | 3 |
| Autologous blood process CPT 86890 | $347.05 | $631.00 | $182.57 – $191.70 | 3 |
| Autolog prp not diab ulcer HCPCS G0460 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Automated diff wbc count CPT 85004 | $45.10 | $82.00 | $6.47 – $6.79 | 3 |
| Autonomic nrv adrenrg inervj CPT 95922 | not published | not published | $142.58 – $149.71 | 3 |
| Autonomic nrv parasym inervj CPT 95921 | not published | not published | $137.89 – $144.78 | 3 |
| Autonomic nrv syst funj test CPT 95923 | not published | not published | $142.58 – $149.71 | 3 |
| Av fistula revision CPT 36833 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Av fuse uppr arm basilic CPT 36819 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Av fuse uppr arm cephalic CPT 36818 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Av fusion direct any site CPT 36821 | not published | not published | $3,383.62 – $3,552.80 | 3 |
| Av fusion/forearm vein 36820 CPT 36820 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Avul nail plate addl CPT 11732 | $143.55 | $261.00 | not published | 0 |
| Avulsion nail plate partial/complete simple single nail plate CPT 11730 | $268.40 | $488.00 | $215.00 – $225.75 | 3 |
| Axillary lymphadenect/superficial 38740 CPT 38740 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Baclofen eval charges CPT 97750 | $94.05 | $171.00 | $34.36 – $36.08 | 3 |
| Bacterial meningitis antigen CPT 86403 | $265.10 | $482.00 | $11.54 – $12.12 | 3 |
| Bacterial vaginosis pcr CPT 87801 | $412.50 | $750.00 | $70.20 – $73.71 | 3 |
| Bactericidal level serum CPT 87197 | not published | not published | $15.02 – $15.77 | 3 |
| #bac vag cand-c. albicans naa CPT 87481 | not published | not published | $35.09 – $36.84 | 3 |
| Balloon dilate urtrl strix CPT 50706 | $2,818.75 | $5,125.00 | not published | 0 |
| Bartholin gland cyst/marsupializat 56440 CPT 56440 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Bartonella dna pcr-sendout CPT 87471 | $321.20 | $584.00 | $35.09 – $36.84 | 3 |
| Basic vestibular evaluation CPT 92540 | $765.60 | $1,392.00 | $231.39 – $242.96 | 3 |
| B cells total count CPT 86355 | $214.50 | $390.00 | $37.73 – $39.62 | 3 |
| Bckdhb gene CPT 81205 | not published | not published | $94.99 – $99.74 | 3 |
| Benign lesion paring 2-4 CPT 11056 | $207.35 | $377.00 | $215.00 – $225.75 | 3 |
| Benign lesion paring 4+ CPT 11057 | not published | not published | $215.00 – $225.75 | 3 |
| #_benzodiazconfur CPT 80346 | $249.70 | $454.00 | not published | 0 |
| Beta 2 glycoprotein 1 antibody iga CPT 86146 | $141.35 | $257.00 | $25.45 – $26.72 | 3 |
| Beta-2 microglobulin CPT 82232 | $223.85 | $407.00 | $16.18 – $16.99 | 3 |
| Beta-amyloid 1-40 CPT 82233 | not published | not published | $128.92 – $135.37 | 3 |
| Beta-amyloid 1-42 CPT 82234 | not published | not published | $128.92 – $135.37 | 3 |
| Bfb train 1st 15min cntct 90912 CPT 90912 | not published | not published | $37.86 – $39.75 | 3 |
| Bfb train ea addl 15 min 90913 CPT 90913 | not published | not published | $22.02 – $23.12 | 3 |
| B-hexosaminidase ea assay CPT 83080 | not published | not published | $16.87 – $17.71 | 3 |
| Bilateral n block inj occipital 64405 CPT 64405 | $528.00 | $960.00 | $328.94 – $345.38 | 3 |
| Bilateral n block inj trigeminal 64400 CPT 64400 | $418.55 | $761.00 | $328.94 – $345.38 | 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.