MultiCare Good Samaritan Hospital — price list
← Hospital overviewVerified from MultiCare 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.
168 prices shown.
| Service | Code | List price | Cash price | Negotiated range | Allowed (median) | |
|---|---|---|---|---|---|---|
| Acetaminophen 160 mg/5 ml soln Inpatient | 0250 RC | $1.67 | $0.67 | $1.22 – $1.22 | — | |
| Aggregated albumin tc99m Inpatient | A9540 HCPCS | $1,035 | $414 | $611 – $756 | — | |
| Ampicillin solr Inpatient | J0290 HCPCS | $40.35 | $16.14 | $23.81 – $29.46 | — | |
| Apixaban 2.5 mg tabs Inpatient | 0250 RC | $6.38 | $2.56 | $4.66 – $4.66 | — | |
| Bipolar disorders Inpatient | 7532 APR-DRG | — | — | $1,350 – $1,350 | — | |
| Bisoprolol fumarate 5 mg tabs Inpatient | 0250 RC | $1.65 | $0.66 | $1.20 – $1.20 | — | |
| Budesonide 0.25 mg/2ml susp Inpatient | 0250 RC | $19.57 | $7.83 | $14.29 – $14.29 | — | |
| Bupivacaine 0.25 % mdv 2.5 mg/ml soln Inpatient | J0665 HCPCS | $3.05 | $1.22 | $1.80 – $2.23 | — | |
| Bupivacaine preservative free 0.25 % (pf) soln Inpatient | J0665 HCPCS | $25.25 | $10.10 | $14.90 – $18.43 | — | |
| C cs-tip micro crvd extended c4611s Inpatient | 0272 RC | $4,969 | $1,988 | $3,627 – $3,627 | — | |
| C osteopathic manip,5-6 body r Inpatient | 98927 CPT | $181 | $72.40 | $132 – $132 | — | |
| C pla2r igg ab Inpatient | 86255 CPT | $70.00 | $28.00 | $51.10 – $51.10 | — | |
| C venography, extremity bilateral Inpatient | 75822 CPT | $6,251 | $2,500 | $4,563 – $4,563 | — | |
| Calcitriol 0.25 mcg caps Inpatient | 0250 RC | $2.84 | $1.14 | $2.07 – $2.07 | — | |
| Cefepime 1 g solr 1 each vial Inpatient | J0692 HCPCS | $42.08 | $16.84 | $24.83 – $30.72 | — | |
| Cephalexin 125 mg/5ml susr Inpatient | 0250 RC | $7.52 | $3.01 | $5.49 – $5.49 | — | |
| Dapagliflozin 5 mg tabs Inpatient | 0250 RC | $43.85 | $17.54 | $32.01 – $32.01 | — | |
| Desmopressin acetate pf 4 mcg/ml soln 1 ml vial Inpatient | J2597 HCPCS | $15.51 | $6.21 | $9.15 – $11.32 | — | |
| Diatrizoate meglumine 66-10 % soln Inpatient | Q9963 HCPCS | $0.33 | $0.14 | $0.19 – $0.24 | — | |
| Dilation and curettage for non-obstetric diagnoses Inpatient | 5173 APR-DRG | — | — | $16,006 – $16,006 | — | |
| Donepezil 5 mg tabs Inpatient | 0250 RC | $1.78 | $0.72 | $1.30 – $1.30 | — | |
| Ethambutol 400 mg tabs Inpatient | 0250 RC | $5.63 | $2.26 | $4.11 – $4.11 | — | |
| Fludrocortisone 0.1 mg tabs Inpatient | 0250 RC | $3.78 | $1.52 | $2.76 – $2.76 | — | |
| Gw orth 230mm 2.5mm dhs dcs hip thrd spd pnt ns Inpatient | C1769 HCPCS | $307 | $123 | $224 – $224 | — | |
| Adap orth hfmn unv shrt os Inpatient | C1713 HCPCS | $1,048 | $419 | $618 – $765 | — | |
| Allograft thk 2-2.79mmx16x20cm Inpatient | Q4116 HCPCS | $47,518 | $19,007 | $28,036 – $34,688 | — | |
| Anch sut 1.4mm 2 iconix frc Inpatient | C1713 HCPCS | $2,835 | $1,134 | $1,673 – $2,070 | — | |
| Anch sut 8mm swivelock Inpatient | C1713 HCPCS | $2,711 | $1,084 | $1,599 – $1,979 | — | |
| Ball sapphire nc plus 4.0x12mm Inpatient | C1725 HCPCS | $720 | $288 | $425 – $526 | — | |
| Bd huml glbl unite 10mm 0 prct Inpatient | C1776 HCPCS | $5,252 | $2,101 | $3,099 – $3,834 | — |