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 |
|---|---|---|---|---|
| Susceptibility mic per plate CPT 87186 | $86.35 | $157.00 | $8.65 – $9.08 | 3 |
| Suscept studies macrobroth dilution ea CPT 87188 | $36.30 | $66.00 | $6.64 – $6.97 | 3 |
| Suspension of testis CPT 54620 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Svc venogram s&i CPT 75827 | $1,746.80 | $3,176.00 | $1,686.89 – $1,771.24 | 3 |
| Sweat collection by iontophoresis CPT 89230 | $225.50 | $410.00 | $55.84 – $58.64 | 3 |
| Sympathectomy supfc palmar CPT 64823 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Synthetic sentence id test CPT 92576 | not published | not published | $40.03 – $42.03 | 3 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $79.20 | $144.00 | $4.40 – $4.62 | 3 |
| System pacing micra av HCPCS C1786 | $10,195.78 | $18,537.78 | not published | 0 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $14,188.91 | $25,798.01 | not published | 0 |
| T3 (triiodothyronine) free CPT 84481 | $27.50 | $50.00 | $16.94 – $17.79 | 3 |
| T3 (triiodothyronine) total CPT 84480 | $187.55 | $341.00 | $14.18 – $14.89 | 3 |
| T4 (thyroxine) free CPT 84439 | $161.70 | $294.00 | $9.02 – $9.47 | 3 |
| T4 (thyroxine) total CPT 84436 | $251.35 | $457.00 | $6.87 – $7.21 | 3 |
| Tacrolimus therapeutic drug level CPT 80197 | $236.50 | $430.00 | $13.73 – $14.42 | 3 |
| Target gsa panel hmtlmph neop CPT 81450 | not published | not published | $759.53 – $797.51 | 3 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $6,590.65 | $11,983.00 | $2,919.60 – $3,065.58 | 3 |
| Target gsa panel organ neop CPT 81445 | not published | not published | $597.91 – $627.81 | 3 |
| Tattooing/intraderm 6.1-20.0 sq cm 11921 CPT 11921 | not published | not published | $792.00 – $831.60 | 3 |
| Tbp gene detc abnor alleles CPT 81344 | not published | not published | $137.00 – $143.85 | 3 |
| Tbs techl calculation only CPT 77091 | not published | not published | $93.26 – $97.92 | 3 |
| Tbs techl prep&transmis data CPT 77090 | not published | not published | $93.26 – $97.92 | 3 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $225.50 | $410.00 | $100.00 – $105.00 | 3 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $310.20 | $564.00 | $61.98 – $65.08 | 3 |
| Tc-99m exame autol wbc diag per dose HCPCS A9569 | $3,581.05 | $6,511.00 | not published | 0 |
| Tc-99m exametazime diag HCPCS A9521 | $2,493.70 | $4,534.00 | not published | 0 |
| Tc-99m fanolesomab diag HCPCS A9566 | $2,422.20 | $4,404.00 | not published | 0 |
| Tc-99m labeled rbc HCPCS A9560 | $561.00 | $1,020.00 | not published | 0 |
| Tc-99m maa HCPCS A9540 | $129.25 | $235.00 | not published | 0 |
| Tc-99m mebrofenin HCPCS A9537 | $169.95 | $309.00 | not published | 0 |
| Tc-99m medronate HCPCS A9503 | $113.85 | $207.00 | not published | 0 |
| Tc-99m mertiatide HCPCS A9562 | $818.40 | $1,488.00 | not published | 0 |
| Tc-99m pentetate dtpa HCPCS A9539 | $90.75 | $165.00 | not published | 0 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | $261.25 | $475.00 | not published | 0 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $151.80 | $276.00 | not published | 0 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $792.00 | $1,440.00 | not published | 0 |
| Tc-99m succimer (dmsa) HCPCS A9551 | $390.50 | $710.00 | not published | 0 |
| Tc-99m sulfur colloid HCPCS A9541 | $216.15 | $393.00 | not published | 0 |
| Tc-99m tilmanocept diag HCPCS A9520 | $886.60 | $1,612.00 | not published | 0 |
| Tca peel dermal 15789 CPT 15789 | not published | not published | $792.00 – $831.60 | 3 |
| Tcd emboli detect w/inj CPT 93893 | not published | not published | $112.03 – $117.63 | 3 |
| Tcd emboli detect without inj CPT 93892 | not published | not published | $112.03 – $117.63 | 3 |
| T-cell depletion of harvest CPT 38210 | not published | not published | $472.77 – $496.41 | 3 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $192.50 | $350.00 | $46.98 – $49.33 | 3 |
| T cells absolute cd 4 count CPT 86361 | $102.30 | $186.00 | $26.78 – $28.12 | 3 |
| T cells total count CPT 86359 | $158.40 | $288.00 | $37.73 – $39.62 | 3 |
| Tcranial magn stim tx deli CPT 90868 | not published | not published | $231.39 – $242.96 | 3 |
| Tcranial magn stim tx plan CPT 90867 | not published | not published | $231.39 – $242.96 | 3 |
| Tcran magn stim redetemine CPT 90869 | not published | not published | $231.39 – $242.96 | 3 |
| Team conf w/pat by hc prof CPT 99366 | $199.10 | $362.00 | not published | 0 |
| Tee w or without fol w/cont,cong HCPCS C8926 | not published | not published | $840.06 – $882.07 | 3 |
| Tee w or without fol w/cont, mon HCPCS C8927 | not published | not published | $840.06 – $882.07 | 3 |
| Telehealth original site facility fee HCPCS Q3014 | $42.90 | $78.00 | not published | 0 |
| Telethx isodose plan cplx CPT 77307 | $1,617.00 | $2,940.00 | not published | 0 |
| Telethx isodose plan simple CPT 77306 | $470.80 | $856.00 | not published | 0 |
| Temperature gradient studies CPT 93740 | not published | not published | $137.89 – $144.78 | 3 |
| Tendon lengthening CPT 26476 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Tendon lngth upr a/e ea tdn CPT 24305 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Tendon shortening CPT 26477 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Tendon transfer with graft CPT 26492 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Tenodesis biceps tdn at elbw CPT 24340 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Tenolysis extensor tendon hand/finger each CPT 26445 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Tenolysis triceps CPT 24332 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Tenoplasty elbow to sho 1 CPT 24320 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Tenosynovectomy radic 26145 CPT 26145 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Tenotomy hip flexor open CPT 27005 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Tenotomy length/rls abductor hallucis musc 28240 CPT 28240 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Tenotomy open tndn flxr toe sgl tndn spx CPT 28232 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Tert gene targeted seq alys CPT 81345 | not published | not published | $185.20 – $194.46 | 3 |
| Test for chlorohydrocarbons CPT 82441 | not published | not published | $6.01 – $6.31 | 3 |
| Test for porphobilinogen CPT 84106 | not published | not published | $5.82 – $6.11 | 3 |
| Test for urine cystines CPT 82615 | not published | not published | $9.55 – $10.03 | 3 |
| Testicular imaging w/vasc flow CPT 78761 | $862.40 | $1,568.00 | $428.40 – $449.82 | 3 |
| Testosterone response panel CPT 80414 | not published | not published | $51.64 – $54.22 | 3 |
| Test pathogen(s) for platelets reference HCPCS P9100 | $113.85 | $207.00 | $63.22 – $66.38 | 3 |
| Test stress cardiovascular tracing only CPT 93017 | $1,749.55 | $3,181.00 | $231.39 – $242.96 | 3 |
| Test urine for lactose CPT 83633 | not published | not published | $11.25 – $11.81 | 3 |
| Test urine for porphyrins CPT 84119 | not published | not published | $13.36 – $14.03 | 3 |
| Test urine urobilinogen CPT 84578 | not published | not published | $4.47 – $4.69 | 3 |
| Tgfbi gene common variants CPT 81333 | not published | not published | $137.00 – $143.85 | 3 |
| Tgsap hl neo 5-50 rna alys CPT 81451 | not published | not published | $759.53 – $797.51 | 3 |
| Tgsap so/hl 51/< rna alys CPT 81456 | not published | not published | $2,919.60 – $3,065.58 | 3 |
| Tgsap so neo 5-50 rna alys CPT 81449 | not published | not published | $597.91 – $627.81 | 3 |
| Thaw cryoprsvrd reprod tiss CPT 89354 | not published | not published | $182.57 – $191.70 | 3 |
| Thawing cryopresrved embryo CPT 89352 | not published | not published | $182.57 – $191.70 | 3 |
| Thawing cryopresrved oocyte CPT 89356 | not published | not published | $182.57 – $191.70 | 3 |
| Thawing cryopresrved sperm CPT 89353 | not published | not published | $55.84 – $58.64 | 3 |
| Thaw preserved stem cells CPT 38208 | not published | not published | $472.77 – $496.41 | 3 |
| Theophylline therapeutic drug level CPT 80198 | $194.70 | $354.00 | $14.14 – $14.85 | 3 |
| Therapeutic procd strg endur HCPCS G0237 | $86.35 | $157.00 | $30.99 – $32.54 | 3 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $55.00 | $100.00 | $25.85 – $27.14 | 3 |
| Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes CPT 97803 | $46.20 | $84.00 | $22.59 – $23.72 | 3 |
| Therapy photodnmc lght dstr lsn skn by staff rx per day CPT 96567 | not published | not published | $215.00 – $225.75 | 3 |
| Ther fx nasal inf turbinate CPT 30930 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Ther nma rdctj intus/obstrcj CPT 74283 | not published | not published | $187.96 – $197.36 | 3 |
| Ther/proph/diag inj ia CPT 96373 | $236.50 | $430.00 | $227.94 – $239.33 | 3 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $1,646.15 | $2,993.00 | $672.23 – $705.84 | 3 |
| Thoracoscopy diagnostic 32601 CPT 32601 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Thoracoscopy w/bx med space CPT 32606 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Thoracoscopy wbx sac CPT 32604 | not published | not published | $11,391.13 – $11,960.68 | 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.