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 |
|---|---|---|---|---|
| Reprogram cochlear implt <7 CPT 92602 | not published | not published | $137.89 – $144.78 | 3 |
| Reprogram cochlear implt 7/> CPT 92604 | not published | not published | $137.89 – $144.78 | 3 |
| Reptilase test CPT 85635 | $113.85 | $207.00 | $9.85 – $10.34 | 3 |
| Reremove wrist tendon lesion CPT 25112 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Rerepair fem hernia blocked CPT 49557 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Rerepair ing hernia blocked CPT 49521 | not published | not published | $6,937.47 – $7,284.34 | 3 |
| Rerepair ing hernia reduce CPT 49520 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Resect back tum < 5 cm CPT 21935 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect back tum 5 cm/> CPT 21936 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect condyle distal phalanx ea toe 28153 CPT 28153 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Resect distal finger tumor CPT 26262 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Resect enlarged toe CPT 28341 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Resect enlarged toe tissue CPT 28340 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Resect face/scalp tum < 2 cm CPT 21015 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect face/scalp tum 2 cm/> CPT 21016 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect femur/knee tumor CPT 27365 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Resect fibula tumor CPT 27646 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Resect foot/toe tumor 3 cm/> CPT 28047 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect forarm/wrist tum 3cm> CPT 25078 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect forearm/wrist tum<3cm CPT 25077 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect hip/pelv tum < 5 cm CPT 27049 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect hip/pelv tum 5 cm/> CPT 27059 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect hip tum incl acetabul CPT 27076 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Resect hip tumor CPT 27075 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Resect hip tum w/innom bone CPT 27077 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Resect inferior turbinate CPT 30140 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Resection of elbow joint CPT 24155 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Resection palate/lesion 42120 CPT 42120 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Resect leg/ankle tum < 5 cm CPT 27615 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect leg/ankle tum 5 cm/> CPT 27616 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect metatarsal tumor CPT 28173 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Resect neck tumor 5 cm/> CPT 21558 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect part/compl phalangeal base ea 28126 CPT 28126 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Resect phalanx of toe tumor CPT 28175 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Resect prox finger tumor CPT 26260 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Resect radius/ulnar tumor CPT 25170 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Resect talus/calcaneus tum CPT 27647 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Resect tarsal tumor CPT 28171 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Resect thigh/knee tum < 5 cm CPT 27329 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect thigh/knee tum 5 cm/> CPT 27364 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Resect tibia tumor CPT 27645 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Respirator motion mgmt simul CPT 77293 | $429.55 | $781.00 | not published | 0 |
| #resp virpnl dfa-adenovirus CPT 87260 | $42.35 | $77.00 | $14.43 – $15.15 | 3 |
| #resp virpnl dfa-parainfluenza CPT 87279 | $42.35 | $77.00 | $16.43 – $17.25 | 3 |
| Resp virus 6-11 targets CPT 87632 | not published | not published | $218.06 – $228.96 | 3 |
| Resuscitation cardiopulmonary CPT 92950 | $691.90 | $1,258.00 | $231.39 – $242.96 | 3 |
| Resuscitation delivery/birthing room CPT 99465 | $868.45 | $1,579.00 | $708.28 – $743.69 | 3 |
| Reticulated platelet assay CPT 85055 | not published | not published | $35.74 – $37.53 | 3 |
| Reticulocyte automated CPT 85045 | $81.95 | $149.00 | $3.99 – $4.19 | 3 |
| Reticulocyte direct measurement automated CPT 85046 | $44.55 | $81.00 | $5.57 – $5.85 | 3 |
| Retrieval of oocyte CPT 58970 | not published | not published | $987.01 – $1,036.37 | 3 |
| Retrograde ejaculation anal CPT 89331 | not published | not published | $19.59 – $20.57 | 3 |
| Revasc evasc fpvt angio cplx 1st CPT 37265 | not published | not published | $6,099.19 – $6,404.14 | 3 |
| Revasc evasc fpvt angio sf 1st CPT 37263 | not published | not published | $6,099.19 – $6,404.14 | 3 |
| Revasc evasc fpvt athrec cplx 1st CPT 37273 | not published | not published | $19,644.52 – $20,626.75 | 3 |
| Revasc evasc fpvt athrec sf 1st CPT 37271 | not published | not published | $19,644.52 – $20,626.75 | 3 |
| Revasc evasc fpvt st athrec sf 1st CPT 37275 | not published | not published | $19,644.52 – $20,626.75 | 3 |
| Revasc evasc fpvt stent cplx 1st CPT 37269 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Revasc evasc fpvt stent sf 1st CPT 37267 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Revasc evasc imvt angio cplx 1st CPT 37298 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Revasc evasc imvt angio sf 1st CPT 37296 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Revasc evasc ivt angio cplx 1st CPT 37256 | not published | not published | $6,099.19 – $6,404.14 | 3 |
| Revasc evasc ivt stent cplx 1st CPT 37260 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Revasc evasc ivt stent sf 1st CPT 37258 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Revasc evasc tpvt angio cplx 1st CPT 37282 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Revasc evasc tpvt angio sf 1st CPT 37280 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Revasc evasc tpvt athrec cplx 1st CPT 37290 | not published | not published | $19,644.52 – $20,626.75 | 3 |
| Revasc evasc tpvt athrec sf 1st CPT 37288 | not published | not published | $19,644.52 – $20,626.75 | 3 |
| Revasc intra lithotrip-ather HCPCS C9766 | $11,050.60 | $20,092.00 | $19,644.52 – $20,626.75 | 3 |
| Revasc intra lithotrip-stent HCPCS C9765 | $11,050.60 | $20,092.00 | $19,644.52 – $20,626.75 | 3 |
| Revasc intravasc lithotripsy HCPCS C9764 | $5,454.35 | $9,917.00 | $12,370.97 – $12,989.52 | 3 |
| Revasc lithotr-ather tib/per HCPCS C9774 | $17,675.35 | $32,137.00 | $19,644.52 – $20,626.75 | 3 |
| Revasc lithotrip-stent-ather HCPCS C9767 | $17,675.35 | $32,137.00 | $19,644.52 – $20,626.75 | 3 |
| Revasc lithotrip tibi/perone HCPCS C9772 | $11,050.60 | $20,092.00 | $12,370.97 – $12,989.52 | 3 |
| Revasc lithotr-stent tib/per HCPCS C9773 | $17,675.35 | $32,137.00 | $19,644.52 – $20,626.75 | 3 |
| Revasc lith-sten-ath tib/per HCPCS C9775 | $17,675.35 | $32,137.00 | $19,644.52 – $20,626.75 | 3 |
| Revise abdomen-venous shunt CPT 49426 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Revise breast reconst 19380 CPT 19380 | not published | not published | $7,115.73 – $7,471.51 | 3 |
| Revise eye sockets CPT 21260 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise eye sockets CPT 21261 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise eye sockets CPT 21263 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise eye sockets CPT 21267 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise eye sockets CPT 21268 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise finger joint each CPT 26135 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revise finger joint each CPT 26140 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Revise gastric port open 43886 CPT 43886 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Revise graft w/vein CPT 35879 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Revise graft w/vein 35881 CPT 35881 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Revise hand/finger tendon CPT 26390 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revise head/neck of femur CPT 27179 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revise hernia & sperm veins CPT 55540 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Revise hip joint replacement CPT 27134 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revise hip joint replacement CPT 27138 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revise hip joint replacement CPT 27137 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revise/implant finger joint CPT 26536 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revise kneecap CPT 27437 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revise kneecap with implant CPT 27438 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revise knuckle joint CPT 26530 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revise knuckle with implant CPT 26531 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revise lower leg tendon CPT 27690 | 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.