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 |
|---|---|---|---|---|
| Revision of urethra CPT 57220 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Revision open av fistula without thromb CPT 36832 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Revision orbitofacial bones CPT 21275 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revision/removal of kneecap CPT 27424 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Revision tips CPT 37183 | not published | not published | $6,099.19 – $6,404.14 | 3 |
| Revis reconst shoulder joint CPT 23473 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revis reconst shoulder joint CPT 23474 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Revj fem anast autog vn grf CPT 35884 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Revj fem anast nonautog grf CPT 35883 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Revj mstdc rsltg compl mstdc CPT 69601 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revj mstdc rsltg tympanplsty CPT 69604 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Revj prior hypspad repair CPT 54352 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Revj/rmvl nea pn w/int nstim CPT 64598 | not published | not published | $3,746.49 – $3,933.82 | 3 |
| Rev mastoidectomy rsltg modf rad mstdc 69602 CPT 69602 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rev-rem impl neurostim gen-rec CPT 63688 | not published | not published | $3,746.49 – $3,933.82 | 3 |
| Rev/rmv perph nstim eltrd ra CPT 64585 | not published | not published | $3,746.49 – $3,933.82 | 3 |
| Rev/rmv prph sac/gstr npg/r CPT 64595 | not published | not published | $3,746.49 – $3,933.82 | 3 |
| Rev rplcm arthrp 1ntrspc crv CPT 22861 | not published | not published | $18,789.56 – $19,729.04 | 3 |
| Rev rplcm rthrp 1ntrspc lmbr CPT 22862 | not published | not published | $18,789.56 – $19,729.04 | 3 |
| Rev rplc/rmv thrc vrt tethrg CPT 22838 | not published | not published | $18,789.56 – $19,729.04 | 3 |
| Revsc opn/prq tib/pero stent CPT 37234 | $10,702.45 | $19,459.00 | not published | 0 |
| Rheumatoid factor qualitative CPT 86430 | $147.40 | $268.00 | $6.14 – $6.45 | 3 |
| Rheumatoid factor quantitative CPT 86431 | $56.65 | $103.00 | $5.67 – $5.95 | 3 |
| Rhinp prim lat&alr crtlge&/elvtn nsl tip CPT 30400 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| R hrt cath chd abnl nt cnj CPT 93594 | not published | not published | $3,474.11 – $3,647.82 | 3 |
| R hrt cath chd nml nt cnj CPT 93593 | not published | not published | $3,474.11 – $3,647.82 | 3 |
| Rib cartilage graft CPT 21230 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| R&l hrt cath chd abnl nt cnj CPT 93597 | not published | not published | $3,474.11 – $3,647.82 | 3 |
| R&l hrt cath chd nml nt cnj CPT 93596 | not published | not published | $3,474.11 – $3,647.82 | 3 |
| Rmv anterior spine instrumentation 22855 CPT 22855 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Rmv implant contraceptive capsule 11976 CPT 11976 | not published | not published | $758.85 – $796.79 | 3 |
| Rmvl esophgl sphnctr dev CPT 43285 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Rmvl ext fixj sys under anes CPT 20694 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Rmvl fb upr arm/elbow deep CPT 24201 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Rmvl fecal impaction/fb spx under anes CPT 45915 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Rmvl foreign body upper arm/elbow subcutaneous CPT 24200 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Rmvl icd by tv extr CPT 33244 | $9,291.70 | $16,894.00 | not published | 0 |
| Rmvl icd gen w/rplc icd gen dual lead sys CPT 33263 | $40,989.30 | $74,526.00 | $23,836.63 – $25,028.46 | 3 |
| Rmvl icd gen w/rplc icd gen mlt lead sys CPT 33264 | $34,901.90 | $63,458.00 | $33,636.89 – $35,318.74 | 3 |
| Rmvl icd gen w/rplc icd gen sgl lead sys CPT 33262 | $40,989.30 | $74,526.00 | $23,836.63 – $25,028.46 | 3 |
| Rmvl icd pulse gen only CPT 33241 | $14,539.80 | $26,436.00 | not published | 0 |
| Rmvl ndwellg tun pleural cath CPT 32552 | $913.55 | $1,661.00 | $672.23 – $705.84 | 3 |
| Rmvl perm pm pulse gen CPT 33233 | $9,582.10 | $17,422.00 | $8,868.06 – $9,311.46 | 3 |
| Rmvl phrnc nrv stim pg only CPT 33280 | not published | not published | $3,746.49 – $3,933.82 | 3 |
| Rmvl phrnc nrv stim sys CPT 33278 | not published | not published | $3,746.49 – $3,933.82 | 3 |
| Rmvl phrnc nrv stim transvns CPT 33279 | not published | not published | $3,746.49 – $3,933.82 | 3 |
| Rmvl pm gen w/rplc pm gen mlt lead sys CPT 33229 | $21,780.55 | $39,601.00 | not published | 0 |
| Rmvl pm gen w/rplc pm gen sgl lead sys CPT 33227 | $10,837.20 | $19,704.00 | $8,868.06 – $9,311.46 | 3 |
| Rmvl pq iabp CPT 33968 | $2,963.40 | $5,388.00 | not published | 0 |
| Rmvl pq vad left hrt vein sep session CPT 33992 | $1,405.80 | $2,556.00 | not published | 0 |
| Rmvl prosthhumrl&ulnar cmpnt CPT 24160 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Rmvl subq card rhythm mntr CPT 33286 | $8,570.10 | $15,582.00 | $758.85 – $796.79 | 3 |
| Rmvl tiss expndr without implant insrtn CPT 11971 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Rmvl tot arthrp 1ntrspc crv CPT 22864 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Rmvl tot arthrp 1ntrspc lmbr CPT 22865 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Rmvl tv pm lead dual CPT 33235 | $4,026.55 | $7,321.00 | not published | 0 |
| Rmvl tv pm lead sgl CPT 33234 | $7,898.55 | $14,361.00 | not published | 0 |
| Rmv ntr oi implt skl prq esp CPT 69726 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Rmv ntr oi imp sk tc>=100 CPT 69728 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Rmv ntr oi imp sk tc esp<100 CPT 69727 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Rmv sk-mnt crnl nstm pg/rcvr CPT 61892 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Robot lin-radsurg com, first HCPCS G0339 | $14,691.05 | $26,711.00 | not published | 0 |
| Robt lin-radsurg fractx 2-5 HCPCS G0340 | $14,691.05 | $26,711.00 | not published | 0 |
| Rotavirus antibody CPT 86759 | not published | not published | $18.23 – $19.14 | 3 |
| Routine footcare pt w lops HCPCS G0247 | not published | not published | $215.00 – $225.75 | 3 |
| Rplcm oi implt sk tc esp<100 CPT 69719 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Rplcmt oi implt skl prq esp CPT 69717 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Rplc oi implt sk tc esp>=100 CPT 69730 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Rpl non-tun cvc wo sbq prt/pmp CPT 36580 | $1,488.30 | $2,706.00 | $1,686.89 – $1,771.24 | 3 |
| Rp loclzj tum 2+area 1+d img CPT 78801 | $1,813.90 | $3,298.00 | $428.40 – $449.82 | 3 |
| Rp loclzj tum spect w/ct 1 CPT 78830 | not published | not published | $1,387.37 – $1,456.74 | 3 |
| Rp loclzj tum spect w/ct 2 CPT 78832 | not published | not published | $1,532.36 – $1,608.98 | 3 |
| Rpl picc wo subq port/pump incl image guidnc w/s&i CPT 36584 | $1,298.55 | $2,361.00 | $1,686.89 – $1,771.24 | 3 |
| Rpl tun-cvad w subq port CPT 36582 | $2,971.10 | $5,402.00 | $3,383.62 – $3,552.80 | 3 |
| Rpl tun-cvad w subq pump CPT 36583 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Rpl tun cvc wo subq port CPT 36581 | $3,380.30 | $6,146.00 | $3,383.62 – $3,552.80 | 3 |
| Rpr aa hrn 1st > 10 rdc CPT 49595 | not published | not published | $6,937.47 – $7,284.34 | 3 |
| Rpr aa hrn 1st 3-10 ncr/strn CPT 49594 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Rpr aa hrn 1st 3-10 rdc CPT 49593 | not published | not published | $6,937.47 – $7,284.34 | 3 |
| Rpr aa hrn 1st < 3 cm rdc CPT 49591 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Rpr aa hrn 1st < 3 ncr/strn CPT 49592 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Rpr aa hrn rcr 3-10 rdc CPT 49615 | not published | not published | $6,937.47 – $7,284.34 | 3 |
| Rpr aa hrn rcr < 3 ncr/strn CPT 49614 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Rpr aa hrn rcr < 3 rdc CPT 49613 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Rpr blood ves w/vein graft/up ext 35236 CPT 35236 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Rpr blood vsl grf oth vein lo ex CPT 35286 | not published | not published | $5,963.01 – $6,261.16 | 3 |
| Rpr choanal atresia ntranasl CPT 30540 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rpr choanal atresia trsnpltn CPT 30545 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rpr fem hernia init blocked CPT 49553 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Rpr hern preemie reduc CPT 49491 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Rpr hypspad comp dsj & urtp CPT 54348 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Rpr hypspad comp simple CPT 54340 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Rpr ing hernia baby blocked CPT 49496 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Rpr ing hernia baby reduc CPT 49495 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Rpr ing hernia init blocked CPT 49501 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Rpr ing hernia init reduce CPT 49500 | not published | not published | $6,937.47 – $7,284.34 | 3 |
| Rpr ing hern premie blocked CPT 49492 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Rpr intst excl anrect fist HCPCS C9796 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Rpr nsl vlv collapse w/implt CPT 30468 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Rpr nsl vlv collapse w/rmdlg CPT 30469 | 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.