Good Samaritan Hospital — price list

← Hospital overviewVerified from Good Samaritan Hospital’s published price file

Includes insurance-negotiated rates. Open any row for plan-level negotiated rates. This is public hospital price transparency data, not a guaranteed estimate of your bill.

How to read these columns

List: The hospital’s full undiscounted (gross) charge — rarely what anyone actually pays.
Cash: The discounted self-pay price for paying directly, without insurance.
Negotiated: Rates agreed with insurers; open a row for plan-level detail. Your share depends on your benefits.

These are the hospital’s published reference prices, not a personalized estimate of your bill.

96 prices shown.

Service	Code	List price	Cash price	Negotiated range	Allowed (median)
Brachytx, non-str,Yttrium-90 Outpatient	2616 OTHER	—	—	—	$40,890
Cath coronary drug-delivery Outpatient	2050 OTHER	—	—	—	$35,917
Clinic Visits and Related Services Outpatient	5012 OTHER	—	—	—	$110
Cochlear Implant Procedure Outpatient	5166 OTHER	—	—	—	$87,330
Complex GI Procedures Outpatient	5331 OTHER	—	—	—	$5,515
Critical Care Outpatient	5041 OTHER	—	—	—	$2,094
Dialysis Outpatient	5401 OTHER	—	—	—	$2,452
Endo, single, urinary tract Outpatient	2040 OTHER	—	—	—	$6,865
Inj cefazolin sodium, hikma Outpatient	0788 OTHER	—	—	—	$3,155
Inj, bupivacaine liposome Outpatient	0763 OTHER	—	—	—	$12,460
Inj, glycopyrrolate, 0.1 mg Outpatient	0792 OTHER	—	—	—	$13,115
Inj, methylpred acetate 1 mg Outpatient	0790 OTHER	—	—	—	$111
Ketorolac tromethamine inj Outpatient	0764 OTHER	—	—	—	$9,504
Level 1 Abdominal/Peritoneal/Biliary and Related Procedures Outpatient	5341 OTHER	—	—	—	$10,889
Level 1 Airway Endoscopy Outpatient	5151 OTHER	—	—	—	$554
Level 1 Blood Product Exchange and Related Services Outpatient	5241 OTHER	—	—	—	$1,178
Level 1 Breast/Lymphatic Surgery and Related Procedures Outpatient	5091 OTHER	—	—	—	$9,252
Level 1 Endovascular Procedures Outpatient	5191 OTHER	—	—	—	$8,872
Level 1 ENT Procedures Outpatient	5161 OTHER	—	—	—	$1,423
Level 1 Excision/ Biopsy/ Incision and Drainage Outpatient	5071 OTHER	—	—	—	$2,494
Level 1 Gynecologic Procedures Outpatient	5411 OTHER	—	—	—	$418
Level 1 ICD and Similar Procedures Outpatient	5231 OTHER	—	—	—	$62,398
Level 1 Laparoscopy and Related Services Outpatient	5361 OTHER	—	—	—	$10,414
Level 1 Lower GI Procedures Outpatient	5311 OTHER	—	—	—	$4,158
Level 1 Musculoskeletal Procedures Outpatient	5111 OTHER	—	—	—	$480
Level 1 Nerve Injections Outpatient	5441 OTHER	—	—	—	$305
Level 1 Nerve Procedures Outpatient	5431 OTHER	—	—	—	$5,309
Level 1 Neurostimulator and Related Procedures Outpatient	5461 OTHER	—	—	—	$3,185
Level 1 Pacemaker and Similar Procedures Outpatient	5221 OTHER	—	—	—	$3,451
Level 1 Skin Procedures Outpatient	5051 OTHER	—	—	—	$1,194