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 |
|---|---|---|---|---|
| Unlisted laps px ovidct ovry CPT 58679 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted laps px renal CPT 50549 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted laps px spleen CPT 38129 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted laps px testis CPT 54699 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted laps px ureter CPT 50949 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted laps px uterus CPT 58578 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlisted misc path test CPT 89240 | not published | not published | $55.84 – $58.64 | 3 |
| Unlisted mr procedure CPT 76498 | not published | not published | $93.26 – $97.92 | 3 |
| Unlisted muscskel px dx nuc CPT 78399 | not published | not published | $428.40 – $449.82 | 3 |
| Unlisted neurological dx px CPT 95999 | not published | not published | $137.89 – $144.78 | 3 |
| Unlisted nrvs sys px dx nuc CPT 78699 | not published | not published | $428.40 – $449.82 | 3 |
| Unlisted oph svc/procedure CPT 92499 | not published | not published | $30.99 – $32.54 | 3 |
| Unlisted orl service/px CPT 92700 | not published | not published | $30.99 – $32.54 | 3 |
| Unlisted procedure colon CPT 45399 | not published | not published | $996.56 – $1,046.39 | 3 |
| Unlisted procedure esophagus CPT 43499 | not published | not published | $971.94 – $1,020.54 | 3 |
| Unlisted procedure liver CPT 47399 | not published | not published | $758.85 – $796.79 | 3 |
| Unlisted procedure microbiology CPT 87999 | $2,079.55 | $3,781.00 | not published | 0 |
| Unlisted procedure pancreas CPT 48999 | not published | not published | $758.85 – $796.79 | 3 |
| Unlisted procedure rectum CPT 45999 | not published | not published | $996.56 – $1,046.39 | 3 |
| Unlisted procedure spine CPT 22899 | not published | not published | $264.33 – $277.55 | 3 |
| Unlisted px abdomen muscskel CPT 22999 | not published | not published | $264.33 – $277.55 | 3 |
| Unlisted px arthroscopy CPT 29999 | not published | not published | $264.33 – $277.55 | 3 |
| Unlisted px biliary tract CPT 47999 | not published | not published | $971.94 – $1,020.54 | 3 |
| Unlisted px casting/strpg CPT 29799 | $239.80 | $436.00 | $174.14 – $182.85 | 3 |
| Unlisted px exc pressure ulc CPT 15999 | not published | not published | $758.85 – $796.79 | 3 |
| Unlisted px foot/toes CPT 28899 | not published | not published | $264.33 – $277.55 | 3 |
| Unlisted px forearm/wrist CPT 25999 | not published | not published | $264.33 – $277.55 | 3 |
| Unlisted px hands/fingers CPT 26989 | not published | not published | $264.33 – $277.55 | 3 |
| Unlisted px leg/ankle CPT 27899 | not published | not published | $264.33 – $277.55 | 3 |
| Unlisted px male genital sys CPT 55899 | not published | not published | $267.74 – $281.13 | 3 |
| Unlisted px pelvis/hip joint CPT 27299 | $5,963.65 | $10,843.00 | $264.33 – $277.55 | 3 |
| Unlisted px small intestine CPT 44799 | $4,777.30 | $8,686.00 | $971.94 – $1,020.54 | 3 |
| Unlisted reprod med lab proc CPT 89398 | not published | not published | $55.84 – $58.64 | 3 |
| Unlisted resp px dx nuc med CPT 78599 | not published | not published | $428.40 – $449.82 | 3 |
| Unlisted spec derm svc/px CPT 96999 | not published | not published | $215.00 – $225.75 | 3 |
| Unlisted surgical path px CPT 88399 | $66.55 | $121.00 | $55.84 – $58.64 | 3 |
| Unlisted transfusion med px CPT 86999 | $36.85 | $67.00 | $30.99 – $32.54 | 3 |
| Unlisted ultrasound procedure CPT 76999 | not published | not published | $93.26 – $97.92 | 3 |
| Unlisted vasc endoscopy px CPT 37501 | not published | not published | $672.23 – $705.84 | 3 |
| Unlstd hematop ret/endo lymp CPT 78199 | not published | not published | $428.40 – $449.82 | 3 |
| Unlstd laps px mat care&dlvr CPT 59898 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unlstd laps px sprmatic cord CPT 55559 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Unsched dialysis esrd pt hos HCPCS G0257 | $733.15 | $1,333.00 | $735.47 – $772.24 | 3 |
| Upgrade pm system CPT 33214 | $13,920.50 | $25,310.00 | $11,200.55 – $11,760.58 | 3 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $4,352.15 | $7,913.00 | $373.86 – $392.55 | 3 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $3,239.50 | $5,890.00 | $373.86 – $392.55 | 3 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $3,092.65 | $5,623.00 | $255.69 – $268.47 | 3 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | $1,151.70 | $2,094.00 | $971.94 – $1,020.54 | 3 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | not published | not published | $971.94 – $1,020.54 | 3 |
| Uppr gi scope w/submuc inj CPT 43236 | not published | not published | $971.94 – $1,020.54 | 3 |
| Urachal cyst/sinus excision 51500 CPT 51500 | not published | not published | $6,478.50 – $6,802.42 | 3 |
| Urea nitrogen CPT 84520 | $82.50 | $150.00 | $3.95 – $4.15 | 3 |
| Urea nitrogen 24 hour urine CPT 84540 | $113.30 | $206.00 | $5.56 – $5.84 | 3 |
| Urea nitrogen clearance CPT 84545 | $104.50 | $190.00 | $7.20 – $7.56 | 3 |
| Urea nitrogen semi-quant CPT 84525 | not published | not published | $5.13 – $5.39 | 3 |
| Ureteral reflux study CPT 78740 | $694.10 | $1,262.00 | $428.40 – $449.82 | 3 |
| Ureter endoscopy CPT 50970 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Ureter endoscopy & biopsy CPT 50955 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Ureter endoscopy & biopsy CPT 50974 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Ureter endoscopy & catheter CPT 50972 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Ureter endoscopy & treatment CPT 50957 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Ureter endoscopy & treatment CPT 50961 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Ureter endoscopy & treatment CPT 50976 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Ureter endoscopy & treatment CPT 50980 | not published | not published | $5,745.80 – $6,033.09 | 3 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $1,093.95 | $1,989.00 | $255.69 – $268.47 | 3 |
| Urethrlys transvag with scope CPT 53500 | not published | not published | $3,777.44 – $3,966.31 | 3 |
| Urethrocystography void s&i CPT 74455 | $1,093.95 | $1,989.00 | $255.69 – $268.47 | 3 |
| Uric acid blood CPT 84550 | $97.90 | $178.00 | $4.52 – $4.75 | 3 |
| Uric acid urine CPT 84560 | $99.55 | $181.00 | $5.08 – $5.33 | 3 |
| Urinalysis glass test CPT 81020 | not published | not published | $4.70 – $4.94 | 3 |
| Urinalysis microscopic only CPT 81015 | $42.90 | $78.00 | $3.05 – $3.20 | 3 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | $25.85 | $47.00 | $2.17 – $2.28 | 3 |
| Urinalysis (with microscopy) CPT 81001 | $106.15 | $193.00 | $3.17 – $3.33 | 3 |
| Urinalysis (without microscopy) CPT 81003 | $67.65 | $123.00 | $2.25 – $2.36 | 3 |
| Urinary reflex study CPT 51792 | not published | not published | $63.22 – $66.38 | 3 |
| Urine Culture Test CPT 87086 | $99.55 | $181.00 | $8.07 – $8.47 | 3 |
| Urine flow measurement 51736 CPT 51736 | not published | not published | $142.58 – $149.71 | 3 |
| Urine pregnancy test CPT 81025 | $139.70 | $254.00 | $8.61 – $9.04 | 3 |
| Urine screen for bacteria CPT 81007 | not published | not published | $29.98 – $31.48 | 3 |
| Urography, antegrade CPT 74425 | $696.30 | $1,266.00 | $373.86 – $392.55 | 3 |
| Urography inf drip &/or bolus CPT 74410 | not published | not published | $187.96 – $197.36 | 3 |
| Use 1st target lesion CPT 76982 | not published | not published | $112.03 – $117.63 | 3 |
| U/s trtmt, not leiomyomata HCPCS C9734 | not published | not published | $13,758.17 – $14,446.08 | 3 |
| Vag hys/<250g/rmv tube/rpr entero 58263 CPT 58263 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Vag hyst incl t/o complex CPT 58291 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Vag hyst including t/o CPT 58262 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Vag hyst t/o & repair compl CPT 58292 | not published | not published | $7,946.52 – $8,343.84 | 3 |
| Vag hyst w/enterocele compl 58294 CPT 58294 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Vag hyst w/enterocele repair CPT 58270 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Vaginal bx CPT 58999 | not published | not published | $216.65 – $227.48 | 3 |
| Vaginal delivery after cesarean delivery 59612 CPT 59612 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Vaginal hysterectomy CPT 58260 | not published | not published | $5,360.72 – $5,628.75 | 3 |
| Vaginectomy partial w/nodes CPT 57109 | not published | not published | $3,468.96 – $3,642.41 | 3 |
| Valproic acid total therapeutic drug level CPT 80164 | $190.85 | $347.00 | $13.54 – $14.22 | 3 |
| Valvuloplasty aortic CPT 92986 | not published | not published | $6,099.19 – $6,404.14 | 3 |
| Valvuloplasty mitral CPT 92987 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Valvuloplasty pulmonary CPT 92990 | not published | not published | $12,370.97 – $12,989.52 | 3 |
| Vancomycin peak therapeutic drug level CPT 80202 | $234.30 | $426.00 | $13.54 – $14.22 | 3 |
| Vanomycin dna amp probe CPT 87500 | not published | not published | $35.09 – $36.84 | 3 |
| Varicella zoster antibody igg CPT 86787 | $45.10 | $82.00 | $12.88 – $13.52 | 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.