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 |
|---|---|---|---|---|
| Rpr&refit spct prsth aphakia CPT 92371 | not published | not published | $63.22 – $66.38 | 3 |
| Rpr rem hernia init reduce CPT 49550 | not published | not published | $3,836.82 – $4,028.66 | 3 |
| Rpr xtnsr tndn leg prim without grft ea tndn CPT 27664 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Rsect hip tum incl femur CPT 27078 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Rsv assay w/optic CPT 87807 | $121.00 | $220.00 | $13.10 – $13.76 | 3 |
| Rtm 1st set-up&pt educaj eqp CPT 98975 | not published | not published | $142.67 – $149.80 | 3 |
| Rtm dev sply cbt 16-30 d CPT 98978 | not published | not published | $39.99 – $41.99 | 3 |
| Rtm dev sply mscskl 16-30 d CPT 98977 | not published | not published | $39.99 – $41.99 | 3 |
| Rtm dev sply resp sys 16-30d CPT 98976 | not published | not published | $39.99 – $41.99 | 3 |
| Rubella antibody igg CPT 86762 | $118.25 | $215.00 | $14.39 – $15.11 | 3 |
| Rubeola ag if CPT 87283 | not published | not published | $60.80 – $63.84 | 3 |
| Rubeola antibody igg CPT 86765 | $45.10 | $82.00 | $12.88 – $13.52 | 3 |
| Runx1 gene targeted seq alys CPT 81334 | not published | not published | $329.51 – $345.99 | 3 |
| Russell viper venom diluted CPT 85613 | $254.10 | $462.00 | $9.58 – $10.06 | 3 |
| Rx metab gen seq alys pnl 6 CPT 81418 | not published | not published | $917.08 – $962.93 | 3 |
| Salivary gland function exam CPT 78232 | not published | not published | $428.40 – $449.82 | 3 |
| Salivary gland imaging CPT 78230 | $950.40 | $1,728.00 | $428.40 – $449.82 | 3 |
| Salivary glnd img serial img CPT 78231 | not published | not published | $428.40 – $449.82 | 3 |
| Salmonella antibody CPT 86768 | $162.80 | $296.00 | $13.19 – $13.85 | 3 |
| Salpingostomy 58770 CPT 58770 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Same day nb discharge 99463 CPT 99463 | not published | not published | $142.67 – $149.80 | 3 |
| Sars-cov-2 antb quantitative CPT 86413 | not published | not published | $51.43 – $54.00 | 3 |
| Sarscov coronavirus ag ia CPT 87426 | not published | not published | $35.33 – $37.10 | 3 |
| Sarscov & inf vir a&b ag ia CPT 87428 | not published | not published | $70.29 – $73.80 | 3 |
| S bowel endoscope w/stent CPT 44379 | not published | not published | $6,505.69 – $6,830.97 | 3 |
| Scan duplex abd/pelvis/retroperitoneal complete CPT 93975 | $1,188.00 | $2,160.00 | $255.69 – $268.47 | 3 |
| Scan duplex abd/pelvis/retroperitoneal limited CPT 93976 | $1,060.40 | $1,928.00 | $112.03 – $117.63 | 3 |
| Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 | $1,397.55 | $2,541.00 | $255.69 – $268.47 | 3 |
| Scan duplex aorta/ivc/iliac unilateral/limited CPT 93979 | $869.00 | $1,580.00 | $112.03 – $117.63 | 3 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $443.30 | $806.00 | $112.03 – $117.63 | 3 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $721.60 | $1,312.00 | $112.03 – $117.63 | 3 |
| Scan duplex lower extremity arteries complete bilateral CPT 93925 | $1,636.80 | $2,976.00 | $255.69 – $268.47 | 3 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $782.10 | $1,422.00 | $112.03 – $117.63 | 3 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $659.45 | $1,199.00 | $112.03 – $117.63 | 3 |
| Sclerotherapy fluid collection pq w/img CPT 49185 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Scope plantar fasciotomy CPT 29893 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Scope uretscp lithovue dig disp HCPCS C1747 | $1,687.95 | $3,069.00 | not published | 0 |
| Scr c/v cyto, automated sys HCPCS G0147 | not published | not published | $18.54 – $19.47 | 3 |
| Scr c/v cyto, autosys, rescr HCPCS G0148 | not published | not published | $31.94 – $33.54 | 3 |
| Scr c/v cyto,thinlayer,rescr HCPCS G0144 | not published | not published | $43.97 – $46.17 | 3 |
| Scr c/v cyto,thinlayer,rescr HCPCS G0145 | not published | not published | $26.49 – $27.81 | 3 |
| Scr c/v cyto,thinlayer,rescr HCPCS G0143 | $124.30 | $226.00 | $27.05 – $28.40 | 3 |
| Screen cerv/vag thin layer HCPCS G0123 | not published | not published | $20.26 – $21.27 | 3 |
| Screening Colonoscopy (average risk) HCPCS G0121 | not published | not published | $996.56 – $1,046.39 | 3 |
| Screening Colonoscopy (high risk) HCPCS G0105 | not published | not published | $996.56 – $1,046.39 | 3 |
| Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations HCPCS G0328 | $45.10 | $82.00 | $18.05 – $18.95 | 3 |
| Screening hepatitis b non-obstetric high risk HCPCS G0499 | not published | not published | $28.27 – $29.68 | 3 |
| Screening hepatitis c antibody high risk HCPCS G0472 | not published | not published | $46.35 – $48.67 | 3 |
| Screening HIV antigen/antibody combination assay HCPCS G0475 | not published | not published | $24.08 – $25.28 | 3 |
| Screening Mammogram CPT 77067 | $348.15 | $633.00 | $92.07 – $96.67 | 3 |
| Screening prostate cancer PSA HCPCS G0103 | $200.20 | $364.00 | $19.31 – $20.28 | 3 |
| Screen pap by tech w md supv HCPCS P3000 | $288.20 | $524.00 | $18.54 – $19.47 | 3 |
| Screw cortex 2.0 x 10mm HCPCS C1713 | $12,452.29 | $22,640.52 | not published | 0 |
| Sc ther infusion reset pump CPT 96371 | $102.85 | $187.00 | $77.16 – $81.01 | 3 |
| Sedimentation rate erythrocyte automated CPT 85652 | $61.60 | $112.00 | $2.70 – $2.84 | 3 |
| Select picture audiometry CPT 92583 | not published | not published | $63.22 – $66.38 | 3 |
| Self-meas bp pt educaj/train CPT 99473 | not published | not published | $30.99 – $32.54 | 3 |
| Semen analysis HCPCS G0027 | not published | not published | $6.50 – $6.82 | 3 |
| Semen analysis presence/motility CPT 89321 | not published | not published | $12.05 – $12.65 | 3 |
| Semen analysis w/count CPT 89310 | $118.25 | $215.00 | $8.61 – $9.04 | 3 |
| Sensorimotor examination CPT 92060 | not published | not published | $63.22 – $66.38 | 3 |
| Sensorineural acuity lvl tst CPT 92575 | not published | not published | $40.03 – $42.03 | 3 |
| Sept9 promoter methylation analysis CPT 81327 | $347.60 | $632.00 | $192.00 – $201.60 | 3 |
| Sequestrectomy olecrn proces CPT 24138 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Sequestrectomy radial h/n CPT 24136 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Sequestrectomy shft/dstl hum CPT 24134 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Serial casting application 97139app CPT 97139 | $112.75 | $205.00 | not published | 0 |
| Serpina1 gene CPT 81332 | not published | not published | $43.65 – $45.83 | 3 |
| Sertraline (zoloft) - sendout CPT 80332 | $117.15 | $213.00 | not published | 0 |
| Set radiation therapy field CPT 77280 | $1,008.70 | $1,834.00 | not published | 0 |
| Set radiation therapy field CPT 77290 | $1,778.15 | $3,233.00 | not published | 0 |
| Sex chromatin identification CPT 88130 | not published | not published | $17.98 – $18.88 | 3 |
| Sex chromatin identification CPT 88140 | not published | not published | $7.99 – $8.39 | 3 |
| Sex transformation f to m CPT 55980 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Sex transformation m to f CPT 55970 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Sf3b1 gene common variants CPT 81347 | not published | not published | $193.25 – $202.91 | 3 |
| Sgmdsc w/band ligation CPT 45350 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Shave sgl skin lsn f/e/e/n/l/m 0.5cm/< CPT 11310 | not published | not published | $215.00 – $225.75 | 3 |
| Shave sgl skin lsn f/e/e/n/l/m 0.6-1.0cm CPT 11311 | not published | not published | $215.00 – $225.75 | 3 |
| Shave sgl skin lsn f/e/e/n/l/m 1.1-2cm CPT 11312 | not published | not published | $435.63 – $457.41 | 3 |
| Shave sgl skin lsn f/e/e/n/l/m >2cm CPT 11313 | not published | not published | $435.63 – $457.41 | 3 |
| Shave sgl skin lsn s/n/h/f/g 0.5cm/< CPT 11305 | not published | not published | $215.00 – $225.75 | 3 |
| Shave sgl skin lsn s/n/h/f/g 0.6-1.0 cm CPT 11306 | not published | not published | $215.00 – $225.75 | 3 |
| Shave sgl skin lsn s/n/h/f/g 1.1-2cm CPT 11307 | not published | not published | $215.00 – $225.75 | 3 |
| Shave sgl skin lsn s/n/h/f/g >2cm CPT 11308 | not published | not published | $435.63 – $457.41 | 3 |
| Shave sgl skin lsn t/a/l 0.5cm/< CPT 11300 | not published | not published | $435.63 – $457.41 | 3 |
| Shave sgl skin lsn t/a/l 0.6-1.0cm CPT 11301 | $177.65 | $323.00 | $215.00 – $225.75 | 3 |
| Shave sgl skin lsn t/a/l 1.1-2.0cm CPT 11302 | $189.20 | $344.00 | $215.00 – $225.75 | 3 |
| Shigella antibody CPT 86771 | not published | not published | $24.48 – $25.70 | 3 |
| Sho arthrs dx +- synovial bx CPT 29805 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Sho arthrs srg bicp tenodsis CPT 29828 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Sho arthrs srg capsulorraphy CPT 29806 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Sho arthrs srg compl synvct CPT 29821 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Sho arthrs srg lmtd dbrdmt CPT 29822 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Sho arthrs srg lss&rescj ads CPT 29825 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Sho arthrs srg prtl synvct CPT 29820 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Sho arthrs srg rmvl loose/fb CPT 29819 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Sho arthrs srg rpr slap les CPT 29807 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Sho arthrs srg xtnsv dbrdmt CPT 29823 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Shoe heel pad & depress for HCPCS L3480 | $77.64 | $141.17 | not published | 0 |
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.