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 |
|---|---|---|---|---|
| Specimen fat stain CPT 89125 | not published | not published | $5.88 – $6.17 | 3 |
| Speech audiometry complete CPT 92556 | not published | not published | $63.22 – $66.38 | 3 |
| Speech evaluation complex CPT 70371 | not published | not published | $255.69 – $268.47 | 3 |
| Speech recep thresh CPT 92555 | not published | not published | $63.22 – $66.38 | 3 |
| Sperm antibody test CPT 89325 | not published | not published | $10.67 – $11.20 | 3 |
| Sperm evaluation test CPT 89329 | not published | not published | $19.59 – $20.57 | 3 |
| Sperm identification CPT 89257 | not published | not published | $55.84 – $58.64 | 3 |
| Sperm isolation complex CPT 89261 | not published | not published | $55.84 – $58.64 | 3 |
| Sperm isolation simple CPT 89260 | not published | not published | $55.84 – $58.64 | 3 |
| Sperm washing 58323 CPT 58323 | not published | not published | $216.65 – $227.48 | 3 |
| Sphenoid sinus surgery CPT 31051 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Sphincteroplasty inc/prolapse adult 46750 CPT 46750 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $1,114.85 | $2,027.00 | $756.44 – $794.26 | 3 |
| Spine device implant surgery HCPCS C9757 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Spirmtry w/brnchdil inf-2 yr CPT 94012 | not published | not published | $231.39 – $242.96 | 3 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $847.55 | $1,541.00 | $399.88 – $419.88 | 3 |
| Spirometry up to 2 yrs old CPT 94011 | not published | not published | $137.89 – $144.78 | 3 |
| Spleen imaging CPT 78185 | $1,157.20 | $2,104.00 | $428.40 – $449.82 | 3 |
| Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 % CPT 15120 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Split blood or products CPT 86985 | $165.00 | $300.00 | $182.57 – $191.70 | 3 |
| Sprchoroidal spc njx rx agt CPT 67516 | not published | not published | $353.96 – $371.66 | 3 |
| Sputum specimen collection CPT 89220 | not published | not published | $182.57 – $191.70 | 3 |
| Srsf2 gene common variants CPT 81348 | not published | not published | $175.40 – $184.17 | 3 |
| Staggered spondaic word test CPT 92572 | not published | not published | $137.89 – $144.78 | 3 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $307.45 | $559.00 | $111.98 – $117.58 | 3 |
| Staph a dna amp probe CPT 87640 | $129.80 | $236.00 | $35.09 – $36.84 | 3 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $238.15 | $433.00 | $100.65 – $105.68 | 3 |
| Stem cells total count CPT 86367 | not published | not published | $77.78 – $81.67 | 3 |
| Stenger test pure tone CPT 92565 | not published | not published | $63.22 – $66.38 | 3 |
| Stenger test speech CPT 92577 | not published | not published | $399.88 – $419.88 | 3 |
| Stent/athrectomy/fem/pop/unilat 37227 CPT 37227 | $21,568.80 | $39,216.00 | not published | 0 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $10,837.20 | $19,704.00 | not published | 0 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $204.80 | $372.37 | not published | 0 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $3,783.26 | $6,878.65 | not published | 0 |
| Stent iliac/open or perc/uni/init 37221 CPT 37221 | $13,849.55 | $25,181.00 | not published | 0 |
| Stent iliac/open/perc/ea ad/ipsila 37223 CPT 37223 | $10,499.50 | $19,090.00 | not published | 0 |
| Stent/tib/peroneal/unilat/initial 37230 CPT 37230 | $18,611.45 | $33,839.00 | not published | 0 |
| Sternal debridement CPT 21627 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| St evaluate speech sound production CPT 92522 | $294.25 | $535.00 | $114.30 – $120.02 | 3 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $790.35 | $1,437.00 | $218.13 – $229.04 | 3 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $416.90 | $758.00 | $94.22 – $98.93 | 3 |
| St evaluation swallow function CPT 92610 | $232.10 | $422.00 | $56.75 – $59.59 | 3 |
| Stimulants synthetic CPT 80371 | $171.05 | $311.00 | not published | 0 |
| Storage/year embryo(s) CPT 89342 | not published | not published | $182.57 – $191.70 | 3 |
| Storage/year oocyte(s) CPT 89346 | not published | not published | $182.57 – $191.70 | 3 |
| Storage/year reprod tissue CPT 89344 | not published | not published | $182.57 – $191.70 | 3 |
| Storage/year sperm/semen CPT 89343 | not published | not published | $182.57 – $191.70 | 3 |
| Strapping of ankle and/or ft 29540 CPT 29540 | $226.60 | $412.00 | $174.14 – $182.85 | 3 |
| Strapping of chest CPT 29200 | not published | not published | $174.14 – $182.85 | 3 |
| Strapping of elbow or wrist 29260 CPT 29260 | $84.15 | $153.00 | $63.22 – $66.38 | 3 |
| Strapping of hand or finger CPT 29280 | $84.15 | $153.00 | $63.22 – $66.38 | 3 |
| Strapping of hip CPT 29520 | not published | not published | $142.58 – $149.71 | 3 |
| Strapping of knee CPT 29530 | $67.65 | $123.00 | $142.58 – $149.71 | 3 |
| Strapping of toes 29550 CPT 29550 | not published | not published | $63.22 – $66.38 | 3 |
| Strep a ag ia CPT 87430 | not published | not published | $16.81 – $17.65 | 3 |
| Strep a dna dir probe CPT 87650 | not published | not published | $20.05 – $21.05 | 3 |
| Strep a dna quant CPT 87652 | not published | not published | $41.76 – $43.85 | 3 |
| Strep b assay w/optic CPT 87802 | $107.25 | $195.00 | $12.73 – $13.37 | 3 |
| Strep b dna amp probe CPT 87653 | not published | not published | $35.09 – $36.84 | 3 |
| Streptokinase antibody CPT 86590 | not published | not published | $12.66 – $13.29 | 3 |
| Stress test pulmonary CPT 94618 | $242.55 | $441.00 | $142.58 – $149.71 | 3 |
| Stress tte complete CPT 93351 | not published | not published | $585.55 – $614.83 | 3 |
| Str markers spec anal addl CPT 81266 | not published | not published | $304.81 – $320.05 | 3 |
| Str markers specimen anal CPT 81265 | not published | not published | $233.07 – $244.72 | 3 |
| St treatment speech individual CPT 92507 | $234.85 | $427.00 | $73.52 – $77.20 | 3 |
| St treatment swallow dysfunction/oral CPT 92526 | $307.45 | $559.00 | $80.96 – $85.01 | 3 |
| Subdural tap fontanelle/sutur infant init 61000 CPT 61000 | not published | not published | $756.44 – $794.26 | 3 |
| Subq njx filling matrl 1cc/< CPT 11950 | not published | not published | $215.00 – $225.75 | 3 |
| Subq njx fil matrl 5.1-10cc CPT 11952 | not published | not published | $792.00 – $831.60 | 3 |
| Subtalar arthro w/deb CPT 29906 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Subtalar arthro w/exc CPT 29905 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Subtalar arthro w/fb rmvl CPT 29904 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Subtalar arthro w/fusion CPT 29907 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Suction lipectomy head&neck CPT 15876 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Suction lipectomy lwr extrem CPT 15879 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Suction lipectomy trunk CPT 15877 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Suction lipectomy upr extrem CPT 15878 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Sugars multiple quant CPT 84379 | not published | not published | $11.53 – $12.11 | 3 |
| Sugars single quant CPT 84378 | $44.00 | $80.00 | $11.53 – $12.11 | 3 |
| Sulfonylurea screen qn-sendout CPT 80377 | $111.10 | $202.00 | not published | 0 |
| Sup of prep of antigen # of vials 95144 CPT 95144 | not published | not published | $50.18 – $52.69 | 3 |
| Supply of digital device HCPCS G0552 | not published | not published | $142.67 – $149.80 | 3 |
| Surg dx exam anorectal CPT 45990 | $2,263.80 | $4,116.00 | $2,974.45 – $3,123.17 | 3 |
| Surgery for urethra pouch CPT 53240 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Surgery to stop leg growth CPT 27475 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Surgery to stop leg growth CPT 27477 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Surgery to stop leg growth CPT 27479 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Surgery to stop leg growth CPT 27485 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Surgical exposure prostate 55860 CPT 55860 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Surgical opening of stomach CPT 43510 | not published | not published | $971.94 – $1,020.54 | 3 |
| Surgical opening of throat CPT 42955 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Surgical pathology level 1 gross examination only CPT 88300 | $109.45 | $199.00 | $30.99 – $32.54 | 3 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $268.95 | $489.00 | $40.03 – $42.03 | 3 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $319.00 | $580.00 | $55.84 – $58.64 | 3 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $458.70 | $834.00 | $55.84 – $58.64 | 3 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $977.90 | $1,778.00 | $384.12 – $403.32 | 3 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $1,074.15 | $1,953.00 | not published | 0 |
| Surg tx anal fistula 2nd stage 46285 CPT 46285 | not published | not published | $2,974.45 – $3,123.17 | 3 |
| Susceptibility agar dilution per agent CPT 87181 | $78.65 | $143.00 | $4.75 – $4.99 | 3 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $47.30 | $86.00 | $4.75 – $4.99 | 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.