MedStar Good Samaritan Hospital — price list
← Hospital overviewVerified from MedStar Good Samaritan Hospital’s published price file
Includes cash prices, list prices, 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.
175 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| 2EAST MED/SURG PRIVATE Inpatient | 11001013 CDM | $1,845 | $1,808 | $1,808 – $1,845 | — | |
| 2EAST MED/SURG SEMI-PRIVATE Inpatient | 12001012 CDM | $1,845 | $1,808 | $1,808 – $1,845 | — | |
| 3EST ADMIN STEPDOWN BED Inpatient | 10041002 CDM | $357 | $350 | $350 – $357 | — | |
| 3WEST PRIVATE Inpatient | 11001039 CDM | $1,845 | $1,808 | $1,808 – $1,845 | — | |
| 3WEST SEMI-PRIVATE Inpatient | 12001038 CDM | $1,845 | $1,808 | $1,808 – $1,845 | — | |
| 3WST ADMIN STEPDOWN BED Inpatient | 10041010 CDM | $357 | $350 | $350 – $357 | — | |
| 4EAST PRIVATE Inpatient | 11001047 CDM | $1,845 | $1,808 | $1,808 – $1,845 | — | |
| 4EAST SEMI-PRIVATE Inpatient | 12001046 CDM | $1,845 | $1,808 | $1,808 – $1,845 | — | |
| 4EST ADMIN STEPDOWN BED Inpatient | 10041028 CDM | $357 | $350 | $350 – $357 | — | |
| 5 WEST SEMI-PRIVATE Inpatient | 12001053 CDM | $1,845 | $1,808 | $1,808 – $1,845 | — | |
| 5WEST PRIVATE Inpatient | 11001054 CDM | $1,845 | $1,808 | $1,808 – $1,845 | — | |
| ACUTE CARE STEP DOWN BED Inpatient | 13001052 CDM | $1,845 | $1,808 | $1,808 – $1,845 | — | |
| ADMISSION CHARGE Inpatient | 22100010 CDM | $543 | $532 | $532 – $543 | — | |
| ALLODERM CONT PRF 230 SQCM Outpatient | Q4116 HCPCS | $12,521 | $12,271 | $12,271 – $12,521 | — | |
| ALLODERM CONT PRF MD 185 SQCM Outpatient | Q4116 HCPCS | $10,077 | $9,876 | $9,876 – $10,077 | — | |
| ALLODERM TISS THK MD 48 SQCM Outpatient | Q4116 HCPCS | $5,250 | $5,145 | $5,145 – $5,250 | — | |
| ALLOGFT CRYO N/MESH 232 SQCM Outpatient | Q4433 HCPCS | $2,047 | $2,006 | $2,006 – $2,047 | — | |
| ALLOGFT MESH 12 SQCM Outpatient | Q4186 HCPCS | $3,869 | $3,791 | $3,791 – $3,869 | — | |
| ALLOGRAFT DERMA ACE 28 SQCM Outpatient | Q4126 HCPCS | $4,927 | $4,829 | $4,829 – $4,927 | — | |
| ALLOGRAFT MEN W/BRIDGE M/RT Outpatient | C1762 HCPCS | $10,648 | $10,435 | $10,435 – $10,648 | — | |
| CCU Inpatient | 21001904 CDM | $3,240 | $3,175 | $3,175 – $3,240 | — | |
| CCU (I) Inpatient | 21002001 CDM | $3,240 | $3,175 | $3,175 – $3,240 | — | |
| CCU ADMIN STEPDOWN BED Inpatient | 10041051 CDM | $357 | $350 | $350 – $357 | — | |
| DHC ADMIN STEPDOWN BED Inpatient | 10041077 CDM | $357 | $350 | $350 – $357 | — | |
| DHC SEMI-PRIVATE Inpatient | 12015301 CDM | $1,845 | $1,808 | $1,808 – $1,845 | — | |
| DRSG MATRIX BIL 1/EA 26 SQCM Outpatient | Q4104 HCPCS | $7,067 | $6,926 | $6,926 – $7,067 | — | |
| DRSG MATRIX BIL 1/EA 129 SQCM Outpatient | Q4104 HCPCS | $9,846 | $9,650 | $9,650 – $9,846 | — | |
| DRSG MATRIX BIL 5/PK 26 SQCM Outpatient | Q4104 HCPCS | $7,066 | $6,924 | $6,924 – $7,066 | — | |
| DRSG MATRIX BIL 5/PK 129 SQCM Outpatient | Q4104 HCPCS | $9,523 | $9,333 | $9,333 – $9,523 | — | |
| DRSG WND BILAYR 516.128 SQCM Outpatient | Q4104 HCPCS | $24,107 | $23,625 | $23,625 – $24,107 | — |