▸ Hospital · OH · CCN 360134
Good Samaritan Hospital
375 DIXMYTH AVENUE, CINCINNATI, OH, 45220
362 bedsAcute Care Hospitals2
Compliance grade
A
100/100
Procedures tracked
146
of 209 target codes
Payers
17
with negotiated rates
Rates published
4,235
last crawl 2026-05-24
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychoses | MS-DRG | 885 | 17 | — | — | $12,567 | $17,341 | $36,192 |
| Psychiatric diagnostic evaluation | CPT | 90791 | 0 | $633.92 | $475.44 | — | — | — |
| Psychiatric eval with medical services | CPT | 90792 | 0 | $582.4 | $436.8 | — | — | — |
| Psychotherapy 30 minutes | CPT | 90832 | 0 | $366.24 | $274.68 | — | — | — |
| Psychotherapy 45 minutes | CPT | 90834 | 0 | $470.4 | $352.8 | — | — | — |
| Psychotherapy 60 minutes | CPT | 90837 | 0 | $519.68 | $389.76 | — | — | — |
| Crisis psychotherapy 60 minutes | CPT | 90839 | 0 | $495.04 | $371.28 | — | — | — |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 0 | $652.05 | $489.04 | — | — | — |
| ED visit level 2 | CPT | 99282 | 0 | $710 | $532.5 | — | — | — |
| ED visit level 3 | CPT | 99283 | 0 | $2,121.75 | $1,591.31 | — | — | — |
| ED visit level 4 | CPT | 99284 | 0 | $2,691 | $2,018.25 | — | — | — |
| ED visit level 5 | CPT | 99285 | 0 | $3,250 | $2,437.5 | — | — | — |
| Critical care, first hour | CPT | 99291 | 0 | $4,400 | $3,300 | — | — | — |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 0 | $403.99 | $302.99 | — | — | — |
| CT head with contrast | CPT | 70460 | 0 | $403.99 | $302.99 | — | — | — |
| CT head with and without contrast | CPT | 70470 | 0 | $403.99 | $302.99 | — | — | — |
| CT neck with contrast | CPT | 70491 | 0 | $403.99 | $302.99 | — | — | — |
| MRI brain without contrast | CPT | 70551 | 0 | $659.6 | $494.7 | — | — | — |
| MRI brain with contrast | CPT | 70552 | 0 | $659.6 | $494.7 | — | — | — |
| MRI brain with and without contrast | CPT | 70553 | 0 | $659.6 | $494.7 | — | — | — |
| Chest X-ray single view | CPT | 71045 | 0 | $289.14 | $216.86 | — | — | — |
| Chest X-ray 2 views | CPT | 71046 | 0 | $347.97 | $260.98 | — | — | — |
| Chest X-ray 3 views | CPT | 71047 | 0 | $470.61 | $352.96 | — | — | — |
| CT chest without contrast | CPT | 71250 | 0 | $403.99 | $302.99 | — | — | — |
| CT chest with contrast | CPT | 71260 | 0 | $403.99 | $302.99 | — | — | — |
| CT chest with and without contrast | CPT | 71270 | 0 | $403.99 | $302.99 | — | — | — |
| MRI chest without contrast | CPT | 71550 | 0 | $659.6 | $494.7 | — | — | — |
| MRI chest with contrast | CPT | 71551 | 0 | $699.73 | $524.8 | — | — | — |
| MRI chest with and without contrast | CPT | 71552 | 0 | $659.6 | $494.7 | — | — | — |
| Lumbosacral spine X-ray | CPT | 72100 | 0 | $502.72 | $377.04 | — | — | — |
| CT cervical spine without contrast | CPT | 72125 | 0 | $403.99 | $302.99 | — | — | — |
| CT thoracic spine without contrast | CPT | 72128 | 0 | $403.99 | $302.99 | — | — | — |
| CT lumbar spine without contrast | CPT | 72131 | 0 | $403.99 | $302.99 | — | — | — |
| MRI cervical spine without contrast | CPT | 72141 | 0 | $659.6 | $494.7 | — | — | — |
| MRI thoracic spine without contrast | CPT | 72146 | 0 | $659.6 | $494.7 | — | — | — |
| MRI lumbar spine without contrast | CPT | 72148 | 0 | $659.6 | $494.7 | — | — | — |
| MRI lumbar spine with and without contrast | CPT | 72149 | 0 | $659.6 | $494.7 | — | — | — |
| MRI cervical spine with and without contrast | CPT | 72156 | 0 | $659.6 | $494.7 | — | — | — |
| MRI lumbar spine with contrast | CPT | 72158 | 0 | $659.6 | $494.7 | — | — | — |
| CT pelvis without contrast | CPT | 72192 | 0 | $403.99 | $302.99 | — | — | — |
| CT pelvis with contrast | CPT | 72193 | 0 | $403.99 | $302.99 | — | — | — |
| Shoulder X-ray | CPT | 73030 | 0 | $450.63 | $337.97 | — | — | — |
| Humerus X-ray | CPT | 73060 | 0 | $415.46 | $311.59 | — | — | — |
| Hand X-ray 3 views | CPT | 73130 | 0 | $462.35 | $346.76 | — | — | — |
| MRI upper extremity joint without contrast | CPT | 73221 | 0 | $659.6 | $494.7 | — | — | — |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 0 | $659.6 | $494.7 | — | — | — |
| Knee X-ray 1-2 views | CPT | 73560 | 0 | $376.39 | $282.29 | — | — | — |
| Ankle X-ray 3 views | CPT | 73610 | 0 | $509.23 | $381.92 | — | — | — |
| MRI lower extremity joint without contrast | CPT | 73721 | 0 | $659.6 | $494.7 | — | — | — |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 0 | $659.6 | $494.7 | — | — | — |
| CT abdomen without contrast | CPT | 74150 | 0 | $403.99 | $302.99 | — | — | — |
| CT abdomen with contrast | CPT | 74160 | 0 | $403.99 | $302.99 | — | — | — |
| CT abdomen with and without contrast | CPT | 74170 | 0 | $403.99 | $302.99 | — | — | — |
| CT abdomen and pelvis without contrast | CPT | 74176 | 0 | $807.98 | $605.98 | — | — | — |
| CT abdomen and pelvis with contrast | CPT | 74177 | 0 | $807.98 | $605.98 | — | — | — |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 0 | $807.98 | $605.98 | — | — | — |
| MRI abdomen without contrast | CPT | 74181 | 0 | $659.6 | $494.7 | — | — | — |
| MRI abdomen with and without contrast | CPT | 74183 | 0 | $659.6 | $494.7 | — | — | — |
| Abdominal ultrasound complete | CPT | 76700 | 0 | $936.58 | $702.44 | — | — | — |
| Abdominal ultrasound limited | CPT | 76705 | 0 | $746.59 | $559.94 | — | — | — |
| Retroperitoneal ultrasound complete | CPT | 76770 | 0 | $842.11 | $631.58 | — | — | — |
| Obstetric ultrasound first trimester | CPT | 76801 | 0 | $770 | $577.5 | — | — | — |
| Obstetric ultrasound after first trimester | CPT | 76805 | 0 | $858 | $643.5 | — | — | — |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 0 | $1,155 | $866.25 | — | — | — |
| Transvaginal ultrasound | CPT | 76830 | 0 | $761.2 | $570.9 | — | — | — |
| Pelvic ultrasound complete | CPT | 76856 | 0 | $729.14 | $546.86 | — | — | — |
| Scrotal ultrasound | CPT | 76870 | 0 | $825.66 | $619.24 | — | — | — |
| Diagnostic mammography unilateral | CPT | 77065 | 0 | $368.48 | $276.36 | — | — | — |
| Diagnostic mammography bilateral | CPT | 77066 | 0 | $523.04 | $392.28 | — | — | — |
| Screening mammography bilateral | CPT | 77067 | 0 | $415.3 | $311.48 | — | — | — |
| EKG tracing only | CPT | 93005 | 0 | $222.64 | $166.98 | — | — | — |
| Transthoracic echocardiogram complete | CPT | 93306 | 0 | $2,090 | $1,567.5 | — | — | — |
| Transthoracic echocardiogram | CPT | 93307 | 0 | $1,564.31 | $1,173.23 | — | — | — |
| Stress echocardiogram | CPT | 93350 | 0 | $3,573.42 | $2,680.06 | — | — | — |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w MCC | MS-DRG | 064 | 17 | — | — | $17,400 | $24,464 | $50,113 |
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 17 | — | — | $9,525.21 | $12,545 | $27,433 |
| Intracranial hemorrhage/CVA w/o CC/MCC | MS-DRG | 066 | 17 | — | — | $6,960.55 | $8,498.54 | $20,046 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 17 | — | — | $13,872 | $19,265 | $39,952 |
| COPD w MCC | MS-DRG | 190 | 17 | — | — | $10,292 | $13,755 | $29,640 |
| COPD w CC | MS-DRG | 191 | 17 | — | — | $8,208.65 | $10,468 | $23,641 |
| COPD w/o CC/MCC | MS-DRG | 192 | 17 | — | — | $6,626.89 | $7,972.04 | $19,085 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 17 | — | — | $7,916.69 | $10,007 | $22,800 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 17 | — | — | $6,520.65 | $7,804.4 | $18,779 |
| AMI discharged alive w MCC | MS-DRG | 280 | 17 | — | — | $14,198 | $19,745 | $40,891 |
| AMI discharged alive w CC | MS-DRG | 281 | 17 | — | — | $8,807.52 | $11,413 | $25,366 |
| AMI discharged alive w/o CC/MCC | MS-DRG | 282 | 17 | — | — | $7,265.1 | $8,979.1 | $20,923 |
| Heart failure & shock w MCC | MS-DRG | 291 | 17 | — | — | $11,678 | $15,942 | $33,631 |
| Heart failure & shock w CC | MS-DRG | 292 | 17 | — | — | $8,255.87 | $10,542 | $23,777 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 17 | — | — | $6,028.81 | $7,028.31 | $17,363 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 17 | — | — | $11,050 | $14,951 | $31,823 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 17 | — | — | $7,364.26 | $9,135.56 | $21,209 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 17 | — | — | $6,029.59 | $7,029.55 | $17,365 |
| GI hemorrhage w CC | MS-DRG | 378 | 17 | — | — | $9,292.28 | $12,178 | $26,762 |
| GI hemorrhage w/o CC/MCC | MS-DRG | 379 | 17 | — | — | $6,535.6 | $7,827.99 | $18,823 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 17 | — | — | $7,709.73 | $9,680.69 | $22,204 |
| Fractures of femur w/o MCC | MS-DRG | 533 | 17 | — | — | $13,912 | $19,323 | $40,066 |
| Kidney/UTI w MCC | MS-DRG | 689 | 17 | — | — | $10,706 | $14,408 | $30,832 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 17 | — | — | $7,945.02 | $10,052 | $22,882 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 17 | — | — | $16,861 | $23,670 | $48,560 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 17 | — | — | $9,627.51 | $12,707 | $27,727 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 0 | $31.94 | $23.96 | — | — | — |
| Electrolyte panel | CPT | 80051 | 0 | $31.94 | $23.96 | — | — | — |
| Comprehensive metabolic panel | CPT | 80053 | 0 | $48.13 | $36.1 | — | — | — |
| Lipid panel | CPT | 80061 | 0 | $61.01 | $45.76 | — | — | — |
| Renal function panel | CPT | 80069 | 0 | $39.57 | $29.68 | — | — | — |
| Hepatic function panel | CPT | 80076 | 0 | $37.27 | $27.95 | — | — | — |
| Urinalysis non-automated | CPT | 81002 | 0 | $14.27 | $10.7 | — | — | — |
| Urinalysis automated | CPT | 81003 | 0 | $10.21 | $7.66 | — | — | — |
| Glucose quantitative | CPT | 82947 | 0 | $17.92 | $13.44 | — | — | — |
| Hemoglobin A1c | CPT | 83036 | 0 | $44.24 | $33.18 | — | — | — |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 0 | $76.55 | $57.41 | — | — | — |
| Complete blood count with automated differential | CPT | 85025 | 0 | $35.38 | $26.54 | — | — | — |
| Complete blood count without differential | CPT | 85027 | 0 | $29.44 | $22.08 | — | — | — |
| Urine culture bacterial | CPT | 87086 | 0 | $36.78 | $27.58 | — | — | — |
| Urine culture identification | CPT | 87088 | 0 | $36.78 | $27.58 | — | — | — |
| Tissue exam by pathologist level IV | CPT | 88305 | 0 | $162.77 | $122.08 | — | — | — |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 0 | $475 | $356.25 | — | — | — |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 0 | $2,420 | $1,815 | — | — | — |
| Upper GI endoscopy with biopsy | CPT | 43239 | 0 | $2,813 | $2,109.75 | — | — | — |
| Sigmoidoscopy diagnostic | CPT | 45330 | 0 | $2,735 | $2,051.25 | — | — | — |
| Sigmoidoscopy with biopsy | CPT | 45331 | 0 | $2,735 | $2,051.25 | — | — | — |
| Colonoscopy diagnostic | CPT | 45378 | 0 | $2,466 | $1,849.5 | — | — | — |
| Colonoscopy with biopsy | CPT | 45380 | 0 | $3,490 | $2,617.5 | — | — | — |
| Colonoscopy with polyp removal | CPT | 45385 | 0 | $3,732 | $2,799 | — | — | — |
| surgery | ||||||||
| Major small/large bowel procedures w MCC | MS-DRG | 329 | 17 | — | — | $37,747 | $54,449 | $108,710 |
| Major small/large bowel procedures w CC | MS-DRG | 330 | 17 | — | — | $20,439 | $28,943 | $58,865 |
| Major small/large bowel procedures w/o CC/MCC | MS-DRG | 331 | 17 | — | — | $14,818 | $20,659 | $42,676 |
| Laparoscopic cholecystectomy w/o CDE w MCC | MS-DRG | 418 | 17 | — | — | $14,887 | $20,760 | $42,874 |
| Laparoscopic cholecystectomy w/o CDE w CC | MS-DRG | 419 | 17 | — | — | $12,323 | $16,960 | $35,490 |
| Laparoscopic cholecystectomy w/o CDE w/o CC/MCC | MS-DRG | 420 | 17 | — | — | $28,387 | $40,655 | $81,754 |
| Major joint replacement w MCC | MS-DRG | 469 | 17 | — | — | $25,444 | $36,319 | $73,280 |
| Major joint replacement w/o MCC | MS-DRG | 470 | 17 | — | — | $16,754 | $24,293 | $48,252 |
| Hip & femur procedures except major joint w MCC | MS-DRG | 480 | 17 | — | — | $24,493 | $34,917 | $70,540 |
| Hip & femur procedures except major joint w CC | MS-DRG | 481 | 17 | — | — | $18,057 | $25,432 | $52,005 |
| Hip & femur procedures except major joint w/o CC/MCC | MS-DRG | 482 | 17 | — | — | $14,410 | $20,057 | $41,500 |
| OR procedure for obesity w MCC | MS-DRG | 619 | 17 | — | — | $24,297 | $34,628 | $69,975 |
| OR procedure for obesity w CC | MS-DRG | 620 | 17 | — | — | $14,168 | $19,701 | $40,804 |
| OR procedure for obesity w/o CC/MCC | MS-DRG | 621 | 17 | — | — | $13,445 | $18,635 | $38,722 |
| Uterine & adnexa procedures w CC/MCC | MS-DRG | 743 | 17 | — | — | $11,338 | $15,406 | $32,654 |
| Uterine & adnexa procedures w/o CC/MCC | MS-DRG | 744 | 17 | — | — | $17,700 | $24,906 | $50,976 |
| PCI single major coronary artery | CPT | 92920 | 0 | $11,860 | $8,894.87 | — | — | — |
| PCI with drug-eluting stent | CPT | 92928 | 0 | $13,498 | $10,124 | — | — | — |
| PCI bypass graft | CPT | 92937 | 0 | $24,183 | $18,137 | — | — | — |
| Left heart catheterization | CPT | 93452 | 0 | $12,250 | $9,187.81 | — | — | — |
| Coronary angiography with cath | CPT | 93455 | 0 | $11,223 | $8,417.49 | — | — | — |
| Coronary angiography with bypass cath | CPT | 93458 | 0 | $15,320 | $11,490 | — | — | — |
Payer mix (top 17)
| Payer | Codes covered | Median rate |
|---|---|---|
| Aetna | 43 | $14,834 |
| Blue Cross Blue Shield | 43 | $17,775 |
| buckeye | 43 | $14,309 |
| CareSource | 43 | $11,678 |
| Cigna | 43 | $19,665 |
| custom design benefits | 43 | $29,806 |
| essence healthcare | 43 | $11,678 |
| Humana | 43 | $11,678 |
| imagine health | 43 | $28,006 |
| medben | 43 | $33,143 |
| medical mutual of ohio | 43 | $18,054 |
| medigold | 43 | $11,678 |
| Molina | 43 | $11,678 |
| optum | 43 | $11,678 |
| oscar | 43 | $14,804 |
| UnitedHealthcare | 43 | $15,820 |
| WellCare | 43 | $12,028 |