SSM Health Good Samaritan Hospital - Mt. Vernon prices. From its own published file.

SSM Health Good Samaritan Hospital - Mt. Vernon in Mount Vernon, IL publishes its standard charges as required by federal rule. Here's what it lists for common services, and how to check your bill against it.

8,540prices published

Apr 2026file last updated

$4,334cash price for ct abdomen and pelvis with contrast (list $7,880)

Common services

Service	Cash price	List price	Insurers pay
Emergency visit, moderate (level 3) `99283`	$939	$1,708	$293–$307
Emergency visit, high (level 4) `99284`	$1,451	$2,639	$447–$470
Emergency visit, highest (level 5) `99285`	$1,707	$3,104	$638–$670
Comprehensive metabolic panel `80053`	$149	$270	$10.56–$11.09
Basic metabolic panel `80048`	$107	$195	$8.46–$8.88
Complete blood count (CBC) `85025`	$81.40	$148	$7.77–$8.16
Blood draw (venipuncture) `36415`	$22.00	$40.00	$9.34–$9.81
Urinalysis `81001`	$106	$193	$3.17–$3.33
Troponin (heart test) `84484`	$128	$232	$12.47–$13.09
EKG tracing `93005`	$307	$559	$63.22–$66.38
Chest X-ray, 2 views `71046`	$391	$711	$93.26–$97.92
CT head without contrast `70450`	$1,888	$3,432	$112–$118
CT abdomen and pelvis with contrast `74177`	$4,334	$7,880	$374–$393
MRI lower back without contrast `72148`	$2,292	$4,719	$256–$268
Ultrasound, abdomen `76700`	$1,272	$2,312	$112–$118
IV push, single drug `96374`	$339	$664	$228–$239
IV fluids, first hour `96360`	$333	$652	$228–$239
Ketorolac injection, 15 mg `J1885`	—	—	$0.29–$0.30
Colonoscopy, diagnostic `45378`	—	—	$997–$1,046
Upper GI endoscopy with biopsy `43239`	—	—	$972–$1,021
Knee arthroscopy `29881`	—	—	$3,506–$3,682

Cash price: the discounted price for self-pay patients. List price: the hospital's gross charge. Insurers pay: the lowest and highest rates it lists for insurance plans. Source: SSM Health Good Samaritan Hospital - Mt. Vernon price transparency page.

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Common billing problems to look for

Billed above the posted cash priceIf you're paying yourself, ask the hospital to apply its published cash price.
Panels billed inside panelsA basic metabolic panel (80048) billed with a comprehensive one (80053) on the same day.
Duplicate linesThe same service billed twice without explanation.
No itemized billYou can ask for every line with its code, date and amount.