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 |
|---|---|---|---|---|
| Blood typing abo CPT 86900 | $176.55 | $321.00 | $142.58 – $149.71 | 3 |
| Blood typing ag donor ea ag CPT 86902 | $211.20 | $384.00 | $384.12 – $403.32 | 3 |
| Blood typing patient serum CPT 86904 | $78.65 | $143.00 | $63.22 – $66.38 | 3 |
| Blood typing rbc ag non abo/rh ea CPT 86905 | $292.05 | $531.00 | $384.12 – $403.32 | 3 |
| Blood typing rh (d) CPT 86901 | $88.00 | $160.00 | $40.03 – $42.03 | 3 |
| Blood typing rh phenotype complete reference CPT 86906 | $94.60 | $172.00 | $40.03 – $42.03 | 3 |
| Blood volume CPT 78122 | not published | not published | $581.86 – $610.95 | 3 |
| Bone biopsy open superficial CPT 20240 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Bone Density Scan (DEXA) CPT 77080 | $538.45 | $979.00 | $112.03 – $117.63 | 3 |
| Bone imaging multiple areas CPT 78305 | not published | not published | $428.40 – $449.82 | 3 |
| Bone/joint imaging ltd area CPT 78300 | $1,383.25 | $2,515.00 | $428.40 – $449.82 | 3 |
| Bone marrow;aspiration only 38220 CPT 38220 | $1,400.30 | $2,546.00 | $1,769.88 – $1,858.38 | 3 |
| Bone marrow biopsyneedle/trocar 38221 CPT 38221 | $1,400.30 | $2,546.00 | $1,769.88 – $1,858.38 | 3 |
| Bone marrow imaging body CPT 78104 | $650.10 | $1,182.00 | $428.40 – $449.82 | 3 |
| Bone marrow imaging ltd CPT 78102 | $563.20 | $1,024.00 | $428.40 – $449.82 | 3 |
| Bone marrow imaging mult CPT 78103 | not published | not published | $428.40 – $449.82 | 3 |
| Bone/skin graft great toe CPT 20973 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Bone/skin graft metatarsal CPT 20972 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Bone survey-lead poisoning CPT 77074 | $580.80 | $1,056.00 | $112.03 – $117.63 | 3 |
| Boot walker genesis full shell 3-strap s HCPCS L4360 | $274.01 | $498.20 | not published | 0 |
| Borrelia antibody CPT 86619 | not published | not published | $13.38 – $14.05 | 3 |
| Borrelia burgdorferi (lyme disease) antibody nonspecific CPT 86618 | $456.50 | $830.00 | $17.03 – $17.88 | 3 |
| Borrelia miyamotoi amp prb CPT 87478 | not published | not published | $35.09 – $36.84 | 3 |
| (both sides) smear without diff wbc count CPT 85008 | not published | not published | $3.43 – $3.60 | 3 |
| Bowel imaging CPT 78290 | $1,629.10 | $2,962.00 | $428.40 – $449.82 | 3 |
| Brace ankle stablizing lg HCPCS L1902 | $90.58 | $164.70 | not published | 0 |
| Brace wrist classic lft sm HCPCS L3908 | $83.27 | $151.40 | not published | 0 |
| Brachioplasty 15836 CPT 15836 | not published | not published | $3,112.75 – $3,268.38 | 3 |
| Brach/thor cath 1st CPT 36215 | $1,307.90 | $2,378.00 | not published | 0 |
| Brach/thor cath 2nd CPT 36216 | $2,824.25 | $5,135.00 | not published | 0 |
| Brach/thor cath 3rd CPT 36217 | $2,339.70 | $4,254.00 | not published | 0 |
| Braf gene CPT 81210 | $1,128.60 | $2,052.00 | $175.40 – $184.17 | 3 |
| Brain flow imaging only CPT 78610 | $921.80 | $1,676.00 | $581.86 – $610.95 | 3 |
| Brain image < 4 views CPT 78600 | not published | not published | $428.40 – $449.82 | 3 |
| Brain image 4+ views CPT 78605 | $1,005.95 | $1,829.00 | $581.86 – $610.95 | 3 |
| Brain image w/flow < 4 views CPT 78601 | not published | not published | $428.40 – $449.82 | 3 |
| Brain image w/flow 4 + views CPT 78606 | $1,053.80 | $1,916.00 | $581.86 – $610.95 | 3 |
| Brain MRA (blood vessel MRI, with and without contrast) CPT 70546 | $3,102.00 | $5,640.00 | $373.86 – $392.55 | 3 |
| Brain MRA (blood vessel MRI, with contrast) CPT 70545 | not published | not published | $373.86 – $392.55 | 3 |
| Brain MRA (blood vessel MRI, without contrast) CPT 70544 | $2,946.90 | $5,358.00 | $255.69 – $268.47 | 3 |
| Brain MRI (with and without contrast) CPT 70553 | $3,729.00 | $6,780.00 | $373.86 – $392.55 | 3 |
| Brain MRI (with contrast) CPT 70552 | $3,551.90 | $6,458.00 | $373.86 – $392.55 | 3 |
| Brain MRI (without contrast) CPT 70551 | $3,374.25 | $6,135.00 | $255.69 – $268.47 | 3 |
| Brca1&2 gene full seq alys CPT 81163 | $2,624.05 | $4,771.00 | $468.00 – $491.40 | 3 |
| Brca1&2 gen ful dup/del alys CPT 81164 | not published | not published | $584.23 – $613.44 | 3 |
| Brca1 dna gene analy known fam var CPT 81215 | not published | not published | $375.25 – $394.01 | 3 |
| Brca1 gene full dup/del alys CPT 81166 | not published | not published | $301.35 – $316.42 | 3 |
| Brca1 gene full seq alys CPT 81165 | not published | not published | $282.88 – $297.02 | 3 |
| Brca2 dna gene analy full seq analy CPT 81216 | not published | not published | $185.12 – $194.38 | 3 |
| Brca2 dna gene analy known fam var CPT 81217 | not published | not published | $375.25 – $394.01 | 3 |
| Brca2 gene full dup/del alys CPT 81167 | not published | not published | $282.88 – $297.02 | 3 |
| Brcassure ashkenazi panel-sendout CPT 81212 | not published | not published | $440.00 – $462.00 | 3 |
| Brcassure comprehensive panel-sendout CPT 81162 | $4,119.50 | $7,490.00 | $1,824.88 – $1,916.12 | 3 |
| Breast Biopsy (ultrasound-guided, percutaneous) CPT 19083 | $2,335.30 | $4,246.00 | $1,769.88 – $1,858.38 | 3 |
| Breast punct aspir cyst, bil CPT 19000 | $997.70 | $1,814.00 | $758.85 – $796.79 | 3 |
| Breast reduction CPT 19318 | not published | not published | $7,115.73 – $7,471.51 | 3 |
| Breath hydrogen test 91065 CPT 91065 | not published | not published | $231.39 – $242.96 | 3 |
| Breathing response hypoxia CPT 94450 | not published | not published | $137.89 – $144.78 | 3 |
| Breath recording infant CPT 94772 | not published | not published | $399.88 – $419.88 | 3 |
| Breath test analysis c-14 CPT 78268 | $386.10 | $702.00 | $94.41 – $99.13 | 3 |
| Breath tst attain/anal c-14 CPT 78267 | $243.65 | $443.00 | $11.06 – $11.61 | 3 |
| Bronch ebus ivntj perph les 31654 CPT 31654 | $3,736.15 | $6,793.00 | not published | 0 |
| Bronch ebus samplng 1/2 node CPT 31652 | $3,956.70 | $7,194.00 | $3,995.36 – $4,195.13 | 3 |
| Bronch ebus samplng 3/> node CPT 31653 | $4,191.00 | $7,620.00 | $3,995.36 – $4,195.13 | 3 |
| Bronchial allergy tests CPT 95070 | not published | not published | $399.88 – $419.88 | 3 |
| Bronchial challenge CPT 94070 | $719.95 | $1,309.00 | $399.88 – $419.88 | 3 |
| Bronchial valve init insert CPT 31647 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Bronchial valve remov addl CPT 31649 | not published | not published | $1,907.37 – $2,002.74 | 3 |
| Bronchial valve remov init CPT 31648 | not published | not published | $3,995.36 – $4,195.13 | 3 |
| Bronchoscopy bronch stents CPT 31636 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Bronchoscopy clear airways 31645 CPT 31645 | not published | not published | $1,907.37 – $2,002.74 | 3 |
| Bronchoscopy dilate/fx repr CPT 31630 | not published | not published | $3,995.36 – $4,195.13 | 3 |
| Bronchoscopy dilate w/stent CPT 31631 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Bronchoscopy/lung bx each 31628 CPT 31628 | not published | not published | $3,995.36 – $4,195.13 | 3 |
| Bronchoscopy/needle bx each 31629 CPT 31629 | not published | not published | $3,995.36 – $4,195.13 | 3 |
| Bronchoscopy revise stent CPT 31638 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Bronchoscopy treat blockage CPT 31641 | not published | not published | $3,995.36 – $4,195.13 | 3 |
| Bronchoscopy w/biopsy(s) 31625 CPT 31625 | not published | not published | $1,907.37 – $2,002.74 | 3 |
| Bronchoscopy w/fb removal 31635 CPT 31635 | $1,960.20 | $3,564.00 | $1,907.37 – $2,002.74 | 3 |
| Bronchoscopy w/markers CPT 31626 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Bronchoscopy w/tumor excise CPT 31640 | not published | not published | $3,995.36 – $4,195.13 | 3 |
| Bronch thermoplsty 1 lobe CPT 31660 | $6,165.50 | $11,210.00 | $7,562.90 – $7,941.05 | 3 |
| Bronch thermoplsty 2/> lobes CPT 31661 | $6,738.60 | $12,252.00 | $7,562.90 – $7,941.05 | 3 |
| Bronch w/balloon occlusion CPT 31634 | not published | not published | $7,562.90 – $7,941.05 | 3 |
| Bronch w/debrdmt subgltc & uppr trach CPT 31899 | $329.45 | $599.00 | not published | 0 |
| Br punct aspir ea add, l CPT 19001 | $606.10 | $1,102.00 | not published | 0 |
| Bundled special stain group 1 microorganisms CPT 88312 | $193.05 | $351.00 | $55.84 – $58.64 | 3 |
| Bundled special stain group 2 CPT 88313 | $315.15 | $573.00 | $142.58 – $149.71 | 3 |
| Buprenorphine and metabolite - sendout CPT 80348 | $138.60 | $252.00 | not published | 0 |
| Bur rotalink 2.15mm HCPCS C1724 | $3,820.39 | $6,946.17 | not published | 0 |
| Buttock fasciotomy CPT 27027 | not published | not published | $7,775.89 – $8,164.69 | 3 |
| Buttock fasciotomy w/dbrdmt CPT 27057 | not published | not published | $1,723.15 – $1,809.31 | 3 |
| Bx arm/elbow soft tissue supf 24065 CPT 24065 | not published | not published | $1,769.88 – $1,858.38 | 3 |
| Bx bone trocar/ndl deep CPT 20225 | $2,132.35 | $3,877.00 | $1,769.88 – $1,858.38 | 3 |
| Bx breast 1st lesion mr imag CPT 19085 | $2,411.20 | $4,384.00 | $1,769.88 – $1,858.38 | 3 |
| Bx breast 1st lesion strtctc CPT 19081 | $3,166.35 | $5,757.00 | $1,769.88 – $1,858.38 | 3 |
| Bx breast add lesion mr imag CPT 19086 | $1,125.85 | $2,047.00 | not published | 0 |
| Bx breast add lesion strtctc CPT 19082 | $1,375.55 | $2,501.00 | not published | 0 |
| Bx breast add lesion Ultrasound imag CPT 19084 | $1,207.80 | $2,196.00 | not published | 0 |
| Bx breast perq without image 19100 CPT 19100 | $1,656.60 | $3,012.00 | $1,769.88 – $1,858.38 | 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.