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 |
|---|---|---|---|---|
| Trnscath tx thromblytc art/ven sbsq day CPT 37213 | $3,692.15 | $6,713.00 | $3,383.62 – $3,552.80 | 3 |
| Trnscath tx thromblytc cath rmv sbsq day CPT 37214 | $3,907.20 | $7,104.00 | $3,383.62 – $3,552.80 | 3 |
| Trnscath tx thromblytc vein ini day CPT 37212 | $3,749.35 | $6,817.00 | $3,383.62 – $3,552.80 | 3 |
| Trnsfr/rearrngmnt adjcnt tiss any area 30.1-60sqcm CPT 14301 | not published | not published | $3,797.52 – $3,987.40 | 3 |
| Trnsfr/rearrngmnt adjcnt tiss e/n/e/l dfct 10sqcm/< CPT 14060 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Trnsfr/rearrngmnt adjcnt tiss eye/nose/ear/lip 10.1-30sqcm CPT 14061 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Trnsfr/rearrngmnt adjcnt tiss sclp/arm/lg 10.1-30sqcm CPT 14021 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10.1-30sqcm CPT 14001 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Trnsfr/rearrngmnt adjcnt tiss trnk 10sqcm/< CPT 14000 | not published | not published | $2,211.05 – $2,321.60 | 3 |
| Trnsplj pd lvr&bwl cd154+cll CPT 81560 | not published | not published | $640.73 – $672.77 | 3 |
| Trnspl rej kdn mrna qpcr 139 CPT 81558 | not published | not published | $3,240.00 – $3,402.00 | 3 |
| Troponin quantitative CPT 84484 | $127.60 | $232.00 | $12.47 – $13.09 | 3 |
| Trurl dstrj prst8 tiss rf wv CPT 53854 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Tte w or without contr, cont ecg HCPCS C8930 | not published | not published | $840.06 – $882.07 | 3 |
| Tte w or without fol w/con,stres HCPCS C8928 | $2,322.10 | $4,222.00 | $840.06 – $882.07 | 3 |
| Tte w or without fol w/cont, com HCPCS C8921 | not published | not published | $840.06 – $882.07 | 3 |
| Tte w or without fol w/cont, f/u HCPCS C8922 | not published | not published | $840.06 – $882.07 | 3 |
| Tubal Ligation (Laparoscopic) CPT 58670 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Tube trach disp innr can 5 xlt HCPCS A7521 | $72.16 | $131.20 | not published | 0 |
| Tumor cell deplete of harvst CPT 38211 | not published | not published | $472.77 – $496.41 | 3 |
| Tvh >250 gms 58290 CPT 58290 | not published | not published | $7,946.52 – $8,343.84 | 3 |
| Tx closed distal humerus fx CPT 24999 | not published | not published | $264.33 – $277.55 | 3 |
| Tx closed hip disl traumatic without anes CPT 27250 | $381.15 | $693.00 | $264.33 – $277.55 | 3 |
| Tx closed tib fx proximal w/w/o manip w/skel trac CPT 27532 | $3,146.00 | $5,720.00 | $3,506.34 – $3,681.65 | 3 |
| Tx closed tib shaft fx without manip CPT 27750 | not published | not published | $264.33 – $277.55 | 3 |
| Tx contour defects >10.0 cc CPT 11954 | not published | not published | $792.00 – $831.60 | 3 |
| Tx contour defects 1.1-5.0cc 11951 CPT 11951 | not published | not published | $792.00 – $831.60 | 3 |
| Tx open art fx mcp/iphlngl jnt incl int fixtn ea CPT 26746 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Tx open dstl phlngl fx f/t internal fixation ea CPT 26765 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Tx open iphlngl jt disl internal fixation sngl CPT 26785 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Tx open nsl fx uncomp CPT 21325 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Tx open nsl sptl fx CPT 21336 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Tx phalangeal shaft fx open prox/middle ea CPT 26735 | not published | not published | $3,506.34 – $3,681.65 | 3 |
| Tx tarsal bone fx without manip 28450 CPT 28450 | not published | not published | $264.33 – $277.55 | 3 |
| Tympanic membrane repair CPT 69610 | not published | not published | $1,662.71 – $1,745.84 | 3 |
| Tympanolysis transcanal 69450 CPT 69450 | not published | not published | $3,552.91 – $3,730.55 | 3 |
| Tympanometry & reflex thresh CPT 92550 | not published | not published | $231.39 – $242.96 | 3 |
| Tympanostomy/ven tube/loc/top anes 69433 CPT 69433 | $751.85 | $1,367.00 | not published | 0 |
| Tympp antrt/mastoidotomy prosthesis torp 69637 CPT 69637 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Tympp antrt/mastoid without ossic chain recnst 69635 CPT 69635 | not published | not published | $6,343.80 – $6,660.99 | 3 |
| Tyms gene com variants CPT 81346 | not published | not published | $174.81 – $183.55 | 3 |
| U2af1 gene common variants CPT 81357 | not published | not published | $193.25 – $202.91 | 3 |
| Ua w/micro/comp poc CPT 81000 | $46.75 | $85.00 | $4.02 – $4.22 | 3 |
| Ugt1a1 gene analy common variants CPT 81350 | $779.35 | $1,417.00 | $234.00 – $245.70 | 3 |
| Ultrasound abdomen aorta screening study aaa CPT 76706 | $432.85 | $787.00 | $112.03 – $117.63 | 3 |
| Ultrasound bone density measure CPT 76977 | not published | not published | $112.03 – $117.63 | 3 |
| Ultrasound breast complete CPT 76641 | $505.45 | $919.00 | $112.03 – $117.63 | 3 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $358.60 | $652.00 | $93.26 – $97.92 | 3 |
| Ultrasound chest CPT 76604 | $517.55 | $941.00 | $112.03 – $117.63 | 3 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | $333.30 | $606.00 | $112.03 – $117.63 | 3 |
| Ultrasound dx ophth b-scan CPT 76512 | not published | not published | $112.03 – $117.63 | 3 |
| Ultrasound elastography parenchyma CPT 76981 | not published | not published | $112.03 – $117.63 | 3 |
| Ultrasound encephalogram CPT 76506 | $698.50 | $1,270.00 | $112.03 – $117.63 | 3 |
| Ultrasound exam k transpl w/doppler CPT 76776 | $904.20 | $1,644.00 | $112.03 – $117.63 | 3 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $848.10 | $1,542.00 | $112.03 – $117.63 | 3 |
| Ultrasound guidance for vascular access CPT 76937 | $239.80 | $436.00 | not published | 0 |
| Ultrasound guided needle placement supervision & interpretation CPT 76942 | $1,093.40 | $1,988.00 | not published | 0 |
| Ultrasound hips infant dynamic CPT 76885 | $711.15 | $1,293.00 | $93.26 – $97.92 | 3 |
| Ultrasound infant hips ltd without stress CPT 76886 | $677.05 | $1,231.00 | $93.26 – $97.92 | 3 |
| Ultrasound joint complete left CPT 76881 | $849.20 | $1,544.00 | $112.03 – $117.63 | 3 |
| Ultrasound joint/nonvascular extremity limited left CPT 76882 | $405.90 | $738.00 | $112.03 – $117.63 | 3 |
| Ultrasound nrv&acc strux 1xtr compre CPT 76883 | not published | not published | $112.03 – $117.63 | 3 |
| Ultrasound ob >=14wks ea addl gest CPT 76810 | $617.65 | $1,123.00 | not published | 0 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $278.30 | $506.00 | not published | 0 |
| Ultrasound pregnant uterus detailed fetal exam single/1st gestation CPT 76811 | $799.70 | $1,454.00 | $255.69 – $268.47 | 3 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $633.60 | $1,152.00 | $112.03 – $117.63 | 3 |
| Ultrasound pregnant uterus limited >= 1 fetuses CPT 76815 | $662.75 | $1,205.00 | $112.03 – $117.63 | 3 |
| Ultrasound pregnant uterus transvaginal CPT 76817 | $488.95 | $889.00 | $112.03 – $117.63 | 3 |
| Ultrasound prostate/transrectal CPT 76872 | $722.70 | $1,314.00 | $112.03 – $117.63 | 3 |
| Ultrasound retroperitoneal limited CPT 76775 | $628.10 | $1,142.00 | $112.03 – $117.63 | 3 |
| Ultrasound scrotum and contents CPT 76870 | $996.05 | $1,811.00 | $112.03 – $117.63 | 3 |
| Ultrasound spinal canal and contents CPT 76800 | $440.00 | $800.00 | $112.03 – $117.63 | 3 |
| Ultrasound transabd ea addl gest CPT 76812 | $534.05 | $971.00 | not published | 0 |
| Ultrasound transvaginal non obstetric CPT 76830 | $856.90 | $1,558.00 | $112.03 – $117.63 | 3 |
| Ultrasound trgt dyn mbubb 1st les CPT 76978 | not published | not published | $373.86 – $392.55 | 3 |
| Ultraviolet therapy CPT 97028 | not published | not published | $8.07 – $8.47 | 3 |
| Umbilical cord occlud w/us CPT 59072 | not published | not published | $326.55 – $342.88 | 3 |
| Unlistd noninvas vasc dx std CPT 93998 | not published | not published | $30.99 – $32.54 | 3 |
| Unlisted all/immlg svc/px CPT 95199 | not published | not published | $30.99 – $32.54 | 3 |
| Unlisted chemotherapy px CPT 96549 | $75.90 | $138.00 | $50.18 – $52.69 | 3 |
| Unlisted CT procedure CPT 76497 | not published | not published | $93.26 – $97.92 | 3 |
| Unlisted cv px dx nuc med CPT 78499 | not published | not published | $428.40 – $449.82 | 3 |
| Unlisted cytogenetic study CPT 88299 | not published | not published | $55.84 – $58.64 | 3 |
| Unlisted cytopathology px CPT 88199 | not published | not published | $55.84 – $58.64 | 3 |
| Unlisted dx gi procedure CPT 91299 | not published | not published | $137.89 – $144.78 | 3 |
| Unlisted endocrine px dx nuc CPT 78099 | not published | not published | $428.40 – $449.82 | 3 |
| Unlisted fetal invas px w/us CPT 59897 | not published | not published | $216.65 – $227.48 | 3 |
| Unlisted fluoroscopic px CPT 76496 | not published | not published | $93.26 – $97.92 | 3 |
| Unlisted gi px dx nuc med CPT 78299 | not published | not published | $428.40 – $449.82 | 3 |
| Unlisted gu px dx nuc med CPT 78799 | not published | not published | $428.40 – $449.82 | 3 |
| Unlisted hystsc px uterus CPT 58579 | not published | not published | $216.65 – $227.48 | 3 |
| Unlisted laparoscopic liver biopy 47379 CPT 47379 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted laparoscopic procedure 49659 CPT 49659 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted laparoscopic reduction intestine 44238 CPT 44238 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted laparoscopy procedure biliary tract 47579 CPT 47579 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted laps px appendix CPT 44979 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted laps px bladder CPT 51999 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted laps px endoc sys CPT 60659 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted laps px esoph CPT 43289 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted laps px lymphtc sys CPT 38589 | not published | not published | $6,478.50 – $6,802.42 | 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.