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 |
|---|---|---|---|---|
| Revise lower leg tendon CPT 27691 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revise lower leg tendons CPT 27686 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revise middle ear bone CPT 69660 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise middle ear bone CPT 69661 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise middle ear bone CPT 69662 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise middle ear & mastoid CPT 69641 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise middle ear & mastoid CPT 69642 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise middle ear & mastoid CPT 69643 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise middle ear & mastoid CPT 69644 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise middle ear & mastoid CPT 69646 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise middle ear & mastoid 69645 CPT 69645 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revise palsy hand tendon(s) CPT 25315 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revise palsy hand tendon(s) CPT 25316 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revise penis/urethra CPT 54328 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Revise penis/urethra CPT 54332 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Revise penis/urethra CPT 54336 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Revise prosth vag graft lap CPT 57426 | not published | not published | $7,946.52 – $8,343.84 | 3 |
| Revise radius or ulna CPT 25370 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revise radius & ulna CPT 25365 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revise radius & ulna CPT 25375 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revise reconst elbow joint CPT 24370 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revise reconst elbow joint CPT 24371 | not published | not published | $18,789.56 – $19,729.04 | 3 |
| Revise/remove neuroelectrode CPT 61880 | not published | not published | $3,746.49 – $3,933.82 | 3 |
| Revise/remove sling repair CPT 57287 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Revise/replace knee joint CPT 27486 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revise/replace knee joint CPT 27487 | not published | not published | $18,789.56 – $19,729.04 | 3 |
| Revise spermatic cord veins CPT 55530 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Revise spermatic cord veins CPT 55535 | not published | not published | $6,937.47 – $7,284.34 | 3 |
| Revise thigh muscles/tendons CPT 27400 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revise thumb tendon CPT 26490 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revise thumb tendon CPT 26496 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revise ureter CPT 50727 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Revise urethra stage 1 CPT 53400 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Revise urethra stage 2 CPT 53405 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Revise vag graft via vagina CPT 57295 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Revise windpipe scar CPT 31830 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Revise wrist/forearm tendon CPT 25280 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revise wrist joint CPT 25332 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revision of amputation CPT 24935 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of ankle joint CPT 27700 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of big toe CPT 28310 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of bladder neck CPT 52500 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Revision of calf tendon CPT 27687 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revision of cervix CPT 57720 | $2,824.80 | $5,136.00 | $3,468.96 – $3,642.41 | 3 |
| Revision of cervix CPT 59320 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Revision of collar bone CPT 23480 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of collar bone CPT 23485 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revision of colostomy CPT 44340 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Revision of colostomy comp in-depth 44345 CPT 44345 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Revision of colostomy paraclt hernia 44346 CPT 44346 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Revision of femur epiphysis CPT 27185 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revision of foot CPT 28116 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revision of foot and ankle CPT 28262 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of foot bones CPT 28737 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revision of foot fascia 28250 CPT 28250 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revision of foot tendon CPT 28238 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of foot tendon CPT 28261 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Revision of hip bone CPT 27147 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of hip bones CPT 27156 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of hip tendon CPT 27097 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revision of ileostomy complicated 44314 CPT 44314 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Revision of ileostomy; simple 44312 CPT 44312 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Revision of jaw muscle/bone CPT 21295 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Revision of jaw muscle/bone CPT 21296 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Revision of knee joint CPT 27440 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revision of knee joint CPT 27441 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revision of knee joint CPT 27442 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revision of knee joint CPT 27443 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revision of knee joint CPT 27446 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revision of larynx CPT 31400 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revision of leg vein 37780 CPT 37780 | not published | not published | $3,383.62 – $3,552.80 | 3 |
| Revision of neck muscle CPT 21700 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of neck muscle CPT 21720 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revision of neck muscle CPT 21725 | not published | not published | $758.85 – $796.79 | 3 |
| Revision of neck muscle/rib CPT 21705 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of nose CPT 30120 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Revision of nose CPT 30430 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revision of nose CPT 30435 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revision of nose CPT 30450 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revision of nose CPT 30460 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revision of nose CPT 30462 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revision of pelvis CPT 27158 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of penis CPT 54300 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Revision of penis CPT 54304 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Revision of penis CPT 54420 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Revision of penis CPT 54435 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Revision of pharyngeal walls CPT 42892 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revision of radius CPT 25350 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of radius CPT 25355 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revision of scrotum CPT 55175 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Revision of scrotum CPT 55180 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Revision of testis CPT 54660 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Revision of thigh muscles CPT 27430 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of toe CPT 28312 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Revision of ulna CPT 25360 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of unstable kneecap CPT 27420 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of unstable kneecap CPT 27422 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision of upper arm CPT 24940 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revision of urethra CPT 53450 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Revision of urethra CPT 53460 | not published | not published | $3,777.44 – $3,966.31 | 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.