Visits & medical services prices at Good Samaritan Regional Hlth Center
Mount Vernon, IL · every code in this section with a posted price and a Medicare benchmark.
225 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Acupunct W/Stimul 15 Min (97813) | $37.95 | $69 | 1.2× |
| Admn Sarscov2 Vacc 1 Dose (90480) | $50.05 | $91 | 1.1× |
| Aep Hearing Status Deter Broadband Stimuli I&R (92651) | $303.05 | $551 | 1.3× |
| Airway Inhalation Treatment (94640) range across 3 matching MRF lines |
$68.20–$78.65 | $124–$143 | varies |
| Appl modality 1+ areas lllt po pain reduction (97037) | $72.05 | $131 | 1.8× |
| Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) range across 2 matching MRF lines |
$152.90–$161.15 | $278–$293 | varies |
| Application on-body injector (96377) | $75.90 | $138 | 1.5× |
| Basic vestibular evaluation (92540) | $765.60 | $1,392 | 3.3× |
| Behavral qualit analys voice (92524) range across 4 matching MRF lines |
$220–$307.45 | $400–$559 | varies |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) | $847.55 | $1,541 | 2.1× |
| C motor evoked uppr limbs (95928) | $1,328.80 | $2,416 | 1.4× |
| Caloric vestibular test w/rec bi monothermal (92538) | $432.85 | $787 | 1.9× |
| Caloric Vstblr Test W/Rec (92537) | $910.80 | $1,656 | 6.6× |
| Canalith repositioning proc (95992) | $71.50 | $130 | 1.8× |
| Car seat/bed test 60 min (94780) | $71.50 | $130 | 1.8× |
| Cardiac Stress Tst,Tracing Only (93017) | $1,749.55 | $3,181 | 7.6× |
| Cardiopulmonary resuscitation (92950) range across 2 matching MRF lines |
$601.70–$691.90 | $1,094–$1,258 | varies |
| Cardioversion (92960) range across 2 matching MRF lines |
$1,131.35–$1,300.75 | $2,057–$2,365 | varies |
| Cardioversion elective internal (92961) | $1,970.65 | $3,583 | 2.8× |
| Caregiver Training Strategies&Tq Ea Addl 15 Min (97551) | $55 | $100 | 2.1× |
| Cath Place/Coron Angio, Img Super/Interp,R&L Hrt Cath, L Hrt Ventric (93460) | $18,790.75 | $34,165 | 5.4× |
| Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) | $17,069.80 | $31,036 | 4.9× |
| Cbt 1st hour (94644) range across 2 matching MRF lines |
$144.65–$166.10 | $263–$302 | varies |
| Chemo Anti-Neopl Sq/Im (96401) | $340.45 | $619 | 4.4× |
| Chemo Hormon Antineopl Sq/Im (96402) | $253 | $460 | 3.3× |
| Chemo IV infusion addl hr (96415) | $170.50 | $310 | 2.2× |
| Chemo IV push addl drug (96411) | $375.65 | $683 | 4.9× |
| Chemother Prolong Infuse W/Pump (96416) | $568.70 | $1,034 | 1.6× |
| Chemotherapy Into Cns (96450) | $685.85 | $1,247 | 1.9× |
| Chemotherapy Unspecified (96549) | $75.90 | $138 | 1.5× |
| Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) | $211.20 | $384 | 2.7× |
| Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) | $445.50 | $810 | 1.3× |
| Chemotx admn IV push tq 1/1st sbst/drug (96409) | $435.60 | $792 | 1.2× |
| Chest Wall Manipulation (94668) | $35.20 | $64 | 0.2× |
| Color/duplex Doppler, complete (93975) | $1,188 | $2,160 | 4.6× |
| Color/duplex Doppler, limited (93976) | $1,060.40 | $1,928 | 9.5× |
| Cont gluc mntr physician/qhp provided equiptment (95250) | $381.70 | $694 | 2.7× |
| Continuous Pulse Ox (94762) | $448.25 | $815 | 3.3× |
| Coronary Art/Grft Angio S&I (93455) | $10,800.90 | $19,638 | 3.1× |
| Coronary Artery Angio S&I (93454) | $7,769.30 | $14,126 | 2.2× |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) range across 2 matching MRF lines |
$167.20–$288.20 | $304–$524 | varies |
| Cpt initial (94667) | $57.75 | $105 | 0.4× |
| Critical care first hour (99291) | $2,988.15 | $5,433 | 3.4× |
| Ctr Motor Ep Std Transcrnl Motor Stimj Lwr Limbs (95929) | $1,281.50 | $2,330 | 3.2× |
| Debridement Open Wound 20 Sq Cm< (97597) range across 3 matching MRF lines |
$382.80–$440.55 | $696–$801 | varies |
| Dialysis One Evaluation (90945) | $484 | $880 | 1.1× |
| Dup-scan aorta ivc iliac vascl/bpgs complete (93978) | $1,397.55 | $2,541 | 5.5× |
| Dup-scan aorta ivc iliac vascl/bpgs uni/lmtd (93979) | $869 | $1,580 | 7.8× |
| Dup-Scan Artl Infl&Ven O/F Pen Vsl Compl (93980) | $991.65 | $1,803 | 8.9× |
| Dup-scan lxtr art/artl bpgs compl bi study (93925) | $1,636.80 | $2,976 | 6.4× |
| Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) | $782.10 | $1,422 | 7.0× |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) | $1,442.10 | $2,622 | 5.6× |
| Dup-scan xtr veins unilateral/limited study (93971) | $721.60 | $1,312 | 6.4× |
| Duplex Scan Artl Infl&Ven O/F Hemo Compl Bi Std (93985) | $376.20 | $684 | 1.5× |
| Duplex Scan Artl Infl&Ven O/F Hemo Compl Uni Std (93986) | $188.10 | $342 | 1.7× |
| Duplex Scan Hemodialysis Access (93990) | $415.80 | $756 | 3.7× |
| Duplex up extrem art bilat (93930) | $852.50 | $1,550 | 3.3× |
| Duplex up extrem art unilat/ltd (93931) | $659.45 | $1,199 | 5.9× |
| Echo Congenital Complete (93303) | $1,018.60 | $1,852 | 1.7× |
| Echo Heart Xthoracic,Limited (93308) | $701.25 | $1,275 | 2.7× |
| Echo r-t 2d w/probe placement only (93313) | $871.20 | $1,584 | 1.5× |
| Echo transesophageal (93312) | $2,119.15 | $3,853 | 3.6× |
| Eeg 41-60 Minutes (95812) | $592.90 | $1,078 | 2.6× |
| EEG awake and asleep (95819) | $999.35 | $1,817 | 4.3× |
| EEG awake drowsy (95816) | $999.35 | $1,817 | 4.3× |
| EEG cerebral death evaluation (95824) | $699.05 | $1,271 | 1.7× |
| EEG cont rec w/video by tech min 8 channels (95700) | $372.90 | $678 | 1.6× |
| EEG extended monitoring 61-119 minutes (95813) | $1,224.30 | $2,226 | 5.3× |
| Eeg W/O Vid 2-12 Hr Unmntr (95705) | $372.90 | $678 | 1.6× |
| EEG wo vid ea 12-26hr unmntr (95708) | $928.95 | $1,689 | 2.3× |
| EKG signal averaged (93278) | $181.50 | $330 | 2.9× |
| Electrical Stimulation Ea 15 Min (97032) | $133.65 | $243 | 9.1× |
| Electrocardiogram Tracing (93005) | $307.45 | $559 | 4.9× |
| Electroconvulsive Therapy (90870) | $655.05 | $1,191 | 0.7× |
| Emergency Dept Visit Level 2 (99282) | $598.40 | $1,088 | 3.6× |
| Emergency Dept Visit Level 3 (99283) | $939.40 | $1,708 | 3.2× |
| Emergency Dept Visit Level 4 (99284) | $1,451.45 | $2,639 | 3.2× |
| Endomyocardial Biopsy (93505) | $2,781.90 | $5,058 | 0.8× |
| Er level 1 (99281) | $341 | $620 | 3.8× |
| Er level v (99285) | $1,707.20 | $3,104 | 2.7× |
| Evaluate pt use of inhaler (94664) | $101.20 | $184 | 0.4× |
| Evaluate Speech Production (92522) | $294.25 | $535 | 2.6× |
| Evaluate Swallowing Function (92610) | $232.10 | $422 | 2.7× |
| Evaluation of speech fluency (92521) range across 4 matching MRF lines |
$350.90–$416.90 | $638–$758 | varies |
| External ECG rec>48hr<7d recording (93242) | $940.50 | $1,710 | 23.5× |
| External ECG rec>7d<15d recording (93246) | $89.10 | $162 | 2.2× |
| External Ecg Scanning Analysis Report (93226) | $864.05 | $1,571 | 13.7× |
| Extracranial Bilat Study (93880) | $1,229.25 | $2,235 | 4.8× |
| Extracranial Uni/Ltd Study (93882) | $443.30 | $806 | 4.0× |
| F-up/limited tthrc echo congenital car anomaly (93304) | $711.15 | $1,293 | 1.2× |
| Flexible endoscopic eval swallow c/v rec (92612) | $401.50 | $730 | 2.0× |
| Gastroesophag Reflx Test W/Intrluml Imped Eltrd (91037) | $355.30 | $646 | 1.5× |
| Gastroesophag reflx test w/telemtry ph eltrd (91035) | $524.15 | $953 | 0.6× |
| Group Therapeutic Procedures (97150) range across 8 matching MRF lines |
$59.40–$89.10 | $108–$162 | varies |
| Heart catheterization, both sides, with coronary and bypass graft angiography (93461) | $17,981.70 | $32,694 | 5.2× |
| Hemodialysis Procedure W/ Phys/Qhp Evaluation (90935) | $566.50 | $1,030 | 0.8× |
| Holter monitor recording (93225) | $933.90 | $1,698 | 6.6× |
| Ilr Device Interrogate (93291) | $26.95 | $49 | 0.9× |
| Immunization administration (90471) | $84.15 | $153 | 1.1× |
| Insert/Place Heart Catheter (93503) | $2,125.20 | $3,864 | 1.3× |
| Intracranial Complete Study (93886) | $525.80 | $956 | 2.1× |
| Iontophoresis 15 min (97033) | $122.65 | $223 | 6.4× |
| Irrig Drug Delivery Device (96523) | $167.20 | $304 | 2.6× |
| IV infusion hydration each additional hour (96361) range across 2 matching MRF lines |
$87.45–$100.10 | $159–$182 | varies |
| IV infusion hydration initial 31 min-1 hour (96360) range across 2 matching MRF lines |
$333.30–$383.35 | $606–$697 | varies |
| IV infusion ther proph addl sequential to 1 hr (96367) range across 2 matching MRF lines |
$123.20–$142.45 | $224–$259 | varies |
| IV infusion therapy prophylaxis/dx ea hour (96366) range across 2 matching MRF lines |
$117.15–$134.75 | $213–$245 | varies |
| IV push initial (96374) range across 2 matching MRF lines |
$339.35–$390.50 | $617–$710 | varies |
| L Hrt Art/Grft Angio (93459) | $18,909 | $34,380 | 5.4× |
| Lwr Xtr Vasc Stdy Bilat (93924) | $996.05 | $1,811 | 4.3× |
| Mechanical chest wall oscillation per session (94669) | $128.70 | $234 | 0.5× |
| Med Nutr Ther, Subsq, Indiv, Ea 15 Min (97803) | $46.20 | $84 | 1.5× |
| Medical nutrition assmt&ivntj indiv each 15 mi (97802) | $55 | $100 | 1.5× |
| Medical nutrition therapy grp2/ indiv ea 30 mi (97804) | $38.50 | $70 | 2.3× |
| Methacholine challenge (94070) | $719.95 | $1,309 | 1.8× |
| Motility study esophagus (91010) | $880.55 | $1,601 | 2.2× |
| Motion Fluoroscopy/Swallow (92611) range across 5 matching MRF lines |
$330–$416.90 | $600–$758 | varies |
| Multiple Sleep Latency Test (95805) | $1,523.50 | $2,770 | 1.7× |
| Muscle Test 2 Limbs (95861) | $236.50 | $430 | 1.7× |
| Nasopharyngoscopy (92511) | $305.80 | $556 | 1.4× |
| Neg Pressure Wound Therapy Non Dme </= 50 Sq Cm (97607) range across 2 matching MRF lines |
$374.55–$1,245.75 | $681–$2,265 | varies |
| Neg Pressure Wound Therapy Non Dme >50 Sq Cm (97608) range across 2 matching MRF lines |
$374.55–$579.70 | $681–$1,054 | varies |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) | $237.60 | $432 | 1.1× |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) | $231 | $420 | 0.5× |
| Nerve Conduction Studies 1-2 Studies (95907) | $218.35 | $397 | 0.9× |
| Nerve Conduction Studies 11-12 Studies (95912) | $1,113.20 | $2,024 | 2.8× |
| Nerve conduction studies 13 or more studies (95913) | $663.30 | $1,206 | 1.7× |
| Nerve Conduction Studies 3-4 Studies (95908) | $371.80 | $676 | 1.6× |
| Nerve conduction studies 5-6 studies (95909) | $557.15 | $1,013 | 2.4× |
| Nerve conduction studies 7-8 studies (95910) | $690.80 | $1,256 | 1.7× |
| Nerve Conduction Studies 9-10 Studies (95911) | $1,728.10 | $3,142 | 4.3× |
| Neuromuscular Reeducation (97112) | $100.10 | $182 | 3.1× |
| Newborn resuscitation (99465) | $868.45 | $1,579 | 1.2× |
| Nitric oxide expired gas determination (95012) | $53.90 | $98 | 1.3× |
| Nonphysician Telephone Assessment 11-20 Min (98967) | $106.15 | $193 | 4.2× |
| Nonphysician Telephone Assessment 21-30 Min (98968) | $160.60 | $292 | 4.6× |
| Nonphysician Telephone Assessment 5-10 Min (98966) | $50.60 | $92 | 3.7× |
| Oral Function Therapy (92526) range across 5 matching MRF lines |
$198–$307.45 | $360–$559 | varies |
| Orthc/Prostc Mgmt Sbsq Enc (97763) range across 2 matching MRF lines |
$103.40–$112.75 | $188–$205 | varies |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) range across 2 matching MRF lines |
$78.10–$102.85 | $142–$187 | varies |
| Ot Contrast Bath Ea 15 Min (97034) range across 2 matching MRF lines |
$50.05–$56.65 | $91–$103 | varies |
| Ot eval high complexity (97167) | $342.65 | $623 | 3.4× |
| Ot Eval Low Complex (97165) | $263.45 | $479 | 2.6× |
| Ot Eval Moderate Complexity (97166) | $265.10 | $482 | 2.6× |
| Ot manual therapy 15 min (97140) | $131.45 | $239 | 4.7× |
| Ot paraffin bath (97018) range across 2 matching MRF lines |
$68.20–$71.50 | $124–$130 | varies |
| Ot Re-Eval Est Plan Care (97168) | $239.25 | $435 | 3.5× |
| Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) | $240.90 | $438 | 1.7× |
| Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) | $143.55 | $261 | 0.6× |
| Perq Trluml C Angioplasty 1 Maj C Art&/Branches (92920) | $11,829.95 | $21,509 | 1.9× |
| Perq Trluml Revsc Chrnc Tot Occls 1 C Art Antgrd (92943) | $11,485.10 | $20,882 | 0.9× |
| Phlebotomy therapeutic (99195) | $190.85 | $347 | 1.3× |
| Phys/qhp svcs op pulm rehab w/cont oximtry mntr (94626) | $84.15 | $153 | 1.3× |
| Phys/qhp svcs op pulm rehab wo cont oximtry mntr (94625) | $84.15 | $153 | 1.3× |
| Physical Performance Test (97750) | $94.05 | $171 | 2.8× |
| Plethysmography (94726) | $533.50 | $970 | 1.3× |
| Pm device eval in person (93288) | $64.90 | $118 | 1.6× |
| Polysom 6/>Yrs Sleep W/Cpap 4/> Addl Param Attnd (95811) | $4,520.45 | $8,219 | 4.9× |
| Polysom <6 yrs 4/> paramtrs (95782) | $5,689.75 | $10,345 | 6.2× |
| Polysom <6 Yrs Sleep W/Cpap/Bilvl Vent 4/> Param (95783) | $5,667.75 | $10,305 | 6.2× |
| Prq Card Angio/Athrect 1 Art (92924) | $13,410.10 | $24,382 | 1.1× |
| Prq Card Stent W/Angio 1 Vsl (92928) | $15,936.80 | $28,976 | 1.3× |
| Prq Card Stent/Ath/Angio (92933) | $20,326.90 | $36,958 | 1.0× |
| Prq Revasc Byp Graft 1 Vsl (92937) | $11,818.40 | $21,488 | 1.0× |
| Psych diag eval w/med srvcs (90792) | $316.80 | $576 | 1.7× |
| Psychiatric diagnostic evaluation (90791) | $293.70 | $534 | 1.5× |
| Pt Eval High Complex (97163) | $345.40 | $628 | 3.5× |
| Pt eval low complex 20 min (97161) | $228.80 | $416 | 2.3× |
| Pt Eval Mod Complex (97162) | $250.25 | $455 | 2.6× |
| Pt gait training 15 min (97116) | $92.95 | $169 | 3.2× |
| Pt group caregiver training (97552) | $71.50 | $130 | 3.2× |
| Pt mechanical traction (97012) | $132.55 | $241 | 9.2× |
| Pt Re-Eval Est Plan Care (97164) | $185.35 | $337 | 2.7× |
| Pulm function test by gas (94727) | $326.70 | $594 | 1.4× |
| Pulmonary service/procedure (94799) range across 4 matching MRF lines |
$156.20–$334.40 | $284–$608 | varies |
| Pulmonary Stress Testing (94618) | $242.55 | $441 | 1.7× |
| Pure Tone Audiometry Air (92552) | $145.75 | $265 | 1.0× |
| R Hrt Art/Grft Angio (93457) | $8,908.90 | $16,198 | 2.6× |
| R hrt coronary artery angio (93456) | $5,012.70 | $9,114 | 1.4× |
| R&L Hrt Cath W/Ventriclgrphy (93453) | $5,684.80 | $10,336 | 1.6× |
| Remote 30 Day Ecg Rev/Report (93270) | $779.35 | $1,417 | 19.5× |
| Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) | $254.10 | $462 | 4.0× |
| Right Heart Cath (93451) | $5,432.35 | $9,877 | 1.6× |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) | $268.95 | $489 | 1.3× |
| Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) range across 4 matching MRF lines |
$263.45–$350.90 | $479–$638 | varies |
| Self Care Mngment Training (97535) range across 3 matching MRF lines |
$71.50–$100.65 | $130–$183 | varies |
| Short-latency somatosens ep std upr limbs (95925) | $691.90 | $1,258 | 3.0× |
| Sinusoidal Vertical Axis Rotational Testing (92546) | $317.35 | $577 | 2.3× |
| Sleep study unattended (95806) | $562.65 | $1,023 | 2.4× |
| Slp caregiver training 1st 30 min (97550) | $63.25 | $115 | 1.2× |
| Slp Stdy Unatnd W/Hrt Rate/O2 Sat/Resp/Slp Time (95800) | $265.65 | $483 | 1.1× |
| Somatosensory Testing (95938) | $1,113.20 | $2,024 | 1.2× |
| Speech sound lang comprehen (92523) range across 8 matching MRF lines |
$483.45–$790.35 | $879–$1,437 | varies |
| Spirometry (94010) | $317.35 | $577 | 1.4× |
| Ssep lower limbs (95926) | $795.30 | $1,446 | 3.4× |
| Standardized Cognitive Performance Testing (96125) | $238.15 | $433 | 2.3× |
| Stress Tte Only (93350) | $2,215.95 | $4,029 | 3.8× |
| Subq Infusion Additional Pump Infusion Site (96371) range across 2 matching MRF lines |
$89.10–$102.85 | $162–$187 | varies |
| Temp transcutaneous pacing (92953) range across 2 matching MRF lines |
$594.55–$684.20 | $1,081–$1,244 | varies |
| Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) | $97.90 | $178 | 4.4× |
| Ther Ivntj Ea Addl 15 Min (97130) | $62.70 | $114 | 3.0× |
| Ther Px 1/> Areas Each 15 Minutes Massage (97124) | $94.05 | $171 | 3.2× |
| Ther Sp-Genratj Dev Prgrmg&Modificaj (92609) | $286.55 | $521 | 2.8× |
| Ther/Proph/Diag Inj Ia (96373) range across 2 matching MRF lines |
$205.70–$236.50 | $374–$430 | varies |
| Ther/Proph/Diag Inj Sc/Im (96372) range across 2 matching MRF lines |
$137.50–$158.40 | $250–$288 | varies |
| Ther/Proph/Diag Iv Inf Init (96365) range across 2 matching MRF lines |
$375.10–$431.20 | $682–$784 | varies |
| Therapeutic Activities (97530) | $107.25 | $195 | 3.1× |
| Tilt table test with heart rhythm and blood pressure monitoring (93660) | $880 | $1,600 | 2.2× |
| Tobacco Use Cessation Intensive >10 Minutes (99407) | $53.35 | $97 | 1.3× |
| Tobacco Use Cessation Intermediate 3-10 Minutes (99406) | $53.35 | $97 | 1.3× |
| Transcranial Doppler Stdy Intracranial Art Lmtd (93888) | $350.35 | $637 | 3.1× |
| Tte w/doppler, complete (93306) | $2,501.95 | $4,549 | 4.3× |
| Tte W/O Doppler Complete (93307) | $1,005.95 | $1,829 | 3.9× |
| Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) | $234.85 | $427 | 3.1× |
| Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) range across 4 matching MRF lines |
$85.25–$127.60 | $155–$232 | varies |
| Tx/Pro/Dx Inj New Drug Addon (96375) range across 2 matching MRF lines |
$177.65–$204.05 | $323–$371 | varies |
| Tympanometry (92567) | $72.60 | $132 | 1.8× |
| Unlisted cardiovascular service/procedure (93799) range across 2 matching MRF lines |
$3,270.30–$3,787.85 | $5,946–$6,887 | varies |
| Upr/L Xtremity Art 2 Levels (93922) | $495 | $900 | 3.5× |
| Upr/Lxtr Art Stdy 3+ Lvls (93923) | $831.05 | $1,511 | 3.6× |
| Vent Mgmt Inpat Init Day (94002) | $479.60 | $872 | 0.7× |
| Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) | $435.60 | $792 | 0.7× |
| Vital capacity, total (94150) | $156.20 | $284 | 1.1× |
| Wheelchair Mgmt Ea 15 Min (97542) | $97.35 | $177 | 3.1× |
| Whirlpool Therapy (97022) | $115.50 | $210 | 7.4× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.