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 |
|---|---|---|---|---|
| Shortening of hand tendon CPT 26479 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Shortening of thigh bone CPT 27465 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Shorten radius or ulna CPT 25390 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Shorten radius & ulna CPT 25392 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Shoulder Arthroscopy (Rotator Cuff Repair) CPT 29827 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Shoulder MRI (with and without contrast) CPT 73223 | $3,598.10 | $6,542.00 | $373.86 – $392.55 | 3 |
| Shoulder MRI (with contrast) CPT 73222 | $3,148.20 | $5,724.00 | $840.06 – $882.07 | 3 |
| Shoulder MRI (without contrast) CPT 73221 | $2,954.60 | $5,372.00 | $255.69 – $268.47 | 3 |
| Shoulder prosthesis removal CPT 23334 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Shoulder prosthesis removal CPT 23335 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Shoulder X-ray CPT 73030 | $418.55 | $761.00 | $93.26 – $97.92 | 3 |
| Shuntogram nonvascular supervision & interpretation CPT 75809 | $411.40 | $748.00 | $112.03 – $117.63 | 3 |
| Sialidase enzyme assay CPT 87905 | not published | not published | $12.22 – $12.83 | 3 |
| Sialography s&i CPT 70390 | $842.05 | $1,531.00 | $255.69 – $268.47 | 3 |
| Sialolithotomy 42330 CPT 42330 | $2,498.10 | $4,542.00 | $3,552.91 – $3,730.55 | 3 |
| Sickling rbc CPT 85660 | $103.40 | $188.00 | $5.51 – $5.79 | 3 |
| Sigmoidoscopy and biopsy CPT 45331 | not published | not published | $996.56 – $1,046.39 | 3 |
| Sigmoidoscopy flex decompression 45337 CPT 45337 | not published | not published | $996.56 – $1,046.39 | 3 |
| Sigmoidoscopy for bleeding CPT 45334 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Sigmoidoscopy/submucosal injection 45335 CPT 45335 | not published | not published | $996.56 – $1,046.39 | 3 |
| Sigmoidoscopy w/ablation CPT 45346 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Sigmoidoscopy w/fb removal 45332 CPT 45332 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Sigmoidoscopy w/plcmt stent CPT 45347 | not published | not published | $6,505.69 – $6,830.97 | 3 |
| Sigmoidoscopy w/resection CPT 45349 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Sigmoidoscopy w/tumr remove CPT 45338 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Sigmoidoscopy w/ultrasound CPT 45341 | not published | not published | $996.56 – $1,046.39 | 3 |
| Sigmoidoscopy w/us guide bx CPT 45342 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Sigmoid/rmv tumor/polyp/hot bx for 45333 CPT 45333 | not published | not published | $996.56 – $1,046.39 | 3 |
| Signal avg ecg w or without ecg 93278 CPT 93278 | $181.50 | $330.00 | $63.22 – $66.38 | 3 |
| Sig w/tndsc balloon dilation CPT 45340 | not published | not published | $1,282.34 – $1,346.46 | 3 |
| Sim ang w/prs cath rad emb HCPCS C8004 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Simple cystometrogram 51725 CPT 51725 | not published | not published | $267.74 – $281.13 | 3 |
| Single energy x-ray study HCPCS G0130 | not published | not published | $112.03 – $117.63 | 3 |
| Single transfer toe-hand CPT 26553 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Sinus CT scan (with and without contrast) CPT 70488 | $2,230.80 | $4,056.00 | $187.96 – $197.36 | 3 |
| Sinus CT scan (with contrast) CPT 70487 | $2,059.20 | $3,744.00 | $187.96 – $197.36 | 3 |
| Sinus CT scan (without contrast) CPT 70486 | $1,887.60 | $3,432.00 | $112.03 – $117.63 | 3 |
| Sinus/juglr venogram s&i CPT 75860 | $4,965.40 | $9,028.00 | $3,383.62 – $3,552.80 | 3 |
| Sinusotomy maxillary sinus 31020 CPT 31020 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Sinusotomy sinus remove polyps 31032 CPT 31032 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Sinusotomy sphenoid w/wo bx 31050 CPT 31050 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Skeletal muscle relaxant 1/2 CPT 80369 | $119.90 | $218.00 | not published | 0 |
| Skin and muscle repair face CPT 15845 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Skin Biopsy CPT 11102 | $327.25 | $595.00 | $435.63 – $457.41 | 3 |
| Skin full graft 20sq cm less 15200 CPT 15200 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Skin pedicle flap arms/legs CPT 15572 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Skin pedicle flap trunk CPT 15570 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Skin split graft addl 100sq cm 15101 CPT 15101 | $2,938.10 | $5,342.00 | not published | 0 |
| Skin test unlisted antigen ea CPT 86486 | not published | not published | $30.99 – $32.54 | 3 |
| Slco1b1 gene com variants CPT 81328 | not published | not published | $174.81 – $183.55 | 3 |
| Sleep study attended CPT 95807 | not published | not published | $399.88 – $419.88 | 3 |
| Sleep Study (Polysomnography) CPT 95810 | $3,960.55 | $7,201.00 | $920.24 – $966.25 | 3 |
| Sleep study unattended CPT 95806 | $562.65 | $1,023.00 | $231.39 – $242.96 | 3 |
| Sling arm deluxe w/pad xs HCPCS A4565 | $1,030.51 | $1,873.66 | not published | 0 |
| Sling pelv split sam med HCPCS L0621 | $80.46 | $146.29 | not published | 0 |
| Sling suprapubic suburetheral HCPCS C1771 | $1,119.42 | $2,035.31 | not published | 0 |
| Slitting of prepuce CPT 54000 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Slitting of prepuce CPT 54001 | $2,196.70 | $3,994.00 | $2,240.09 – $2,352.10 | 3 |
| Slp pure tone screening CPT 92551 | $47.30 | $86.00 | not published | 0 |
| Slp stdy unatnd w/anal CPT 95801 | not published | not published | $63.22 – $66.38 | 3 |
| Small animal inoculation CPT 87003 | not published | not published | $16.84 – $17.68 | 3 |
| Small bowel endoscopy CPT 44360 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Small bowel endoscopy CPT 44364 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Small bowel endoscopy CPT 44366 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Small bowel endoscopy CPT 44369 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Small bowel endoscopy CPT 44376 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Small bowel endoscopy CPT 44378 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Small bowel endoscopy CPT 44382 | not published | not published | $971.94 – $1,020.54 | 3 |
| Small bowel endoscopy CPT 44384 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Small bowel endoscopy >2nd w/remove 44363 CPT 44363 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Small bowel endoscopy 44365 CPT 44365 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Small bowel endoscopy/biopsy CPT 44361 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Small bowel endoscopy/biopsy CPT 44377 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Small bowel endoscopy br/wa CPT 44380 | not published | not published | $971.94 – $1,020.54 | 3 |
| Small bowel endoscopy br/wa CPT 44381 | not published | not published | $2,056.34 – $2,159.15 | 3 |
| Small bowel endoscopy/stent 44370 CPT 44370 | not published | not published | $6,505.69 – $6,830.97 | 3 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $61.60 | $112.00 | $5.39 – $5.66 | 3 |
| Smear gram stain CPT 87205 | $47.85 | $87.00 | $4.27 – $4.48 | 3 |
| Smear nasal eosinophil CPT 89190 | $124.30 | $226.00 | $5.79 – $6.08 | 3 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $81.40 | $148.00 | $5.99 – $6.29 | 3 |
| Smear wet mount CPT 87210 | $50.05 | $91.00 | $5.82 – $6.11 | 3 |
| Smn1 gene full gene sequence CPT 81336 | not published | not published | $301.35 – $316.42 | 3 |
| Smn1 gen nown famil seq vrnt CPT 81337 | not published | not published | $185.20 – $194.46 | 3 |
| Smpd1 gene common variants CPT 81330 | not published | not published | $47.00 – $49.35 | 3 |
| Snrpn/ube3a gene CPT 81331 | $668.80 | $1,216.00 | $51.07 – $53.62 | 3 |
| Sodium 24 hour urine CPT 84300 | $72.05 | $131.00 | $5.06 – $5.31 | 3 |
| Sodium serum/plasma/whole blood CPT 84295 | $56.65 | $103.00 | $4.81 – $5.05 | 3 |
| Software meas of cardiac vol HCPCS G0183 | not published | not published | $93.26 – $97.92 | 3 |
| So gsap cl fr cpy nmbr&mcrst CPT 81463 | not published | not published | $1,345.31 – $1,412.58 | 3 |
| So gsap cll fr dna/dna&rna CPT 81462 | not published | not published | $1,195.83 – $1,255.62 | 3 |
| So gsap cll fr mcrstl ins CPT 81464 | not published | not published | $3,288.51 – $3,452.94 | 3 |
| So gsap dna cpy nmbr&mcrstl CPT 81458 | not published | not published | $1,046.35 – $1,098.67 | 3 |
| Somatosensory testing CPT 95927 | not published | not published | $231.39 – $242.96 | 3 |
| So neo gsap dna/dna&rna CPT 81459 | not published | not published | $2,989.55 – $3,139.03 | 3 |
| So neo gsap dna mcrstl ins CPT 81457 | not published | not published | $896.87 – $941.71 | 3 |
| Special physics consult CPT 77370 | $751.30 | $1,366.00 | not published | 0 |
| Special radiation dosimetry CPT 77331 | $233.20 | $424.00 | not published | 0 |
| Special radiation treatment CPT 77470 | $2,302.85 | $4,187.00 | not published | 0 |
| Special teletx port plan CPT 77321 | $1,095.05 | $1,991.00 | not published | 0 |
| Specific gravity body fluid CPT 84315 | $19.80 | $36.00 | $3.28 – $3.44 | 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.