Supplies, drugs & other prices at Good Samaritan Hospital
Vincennes, IN · every code in this section with a posted price and a Medicare benchmark.
71 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 2d tte w or w/o fol w/con,co (C8923) | $1,189.80 | $1,983 | 1.4× |
| Admin hepatitis b vaccine (G0010) | $42.60 | $71 | 0.9× |
| Admin influenza virus vac (G0008) | $42.60 | $71 | 0.9× |
| Admin pneumococcal vaccine (G0009) | $42.60 | $71 | 0.9× |
| Antibody treponema pallidum total & rpr ia qual (0064U) range across 2 matching MRF lines |
$38.40–$54 | $64–$90 | varies |
| Catheterize for urine spec (P9612) | $18.60 | $31 | 2.0× |
| Chemo extend iv infus w/pump (G0498) | $530.40 | $884 | 1.5× |
| Demonstrate use home inr mon (G0248) | $178.20 | $297 | 1.3× |
| Diab manage trn per indiv (G0108) | $77.40 | $129 | 1.4× |
| Diab manage trn ind/group (G0109) | $27.60 | $46 | 1.7× |
| Direct refer hospital observ (G0379) | $495.60 | $826 | 0.8× |
| Drug test def 1-7 classes (G0480) range across 38 matching MRF lines |
$84–$187.80 | $22–$313 | varies |
| Drug test def 8-14 classes (G0481) range across 4 matching MRF lines |
$121.80–$147 | $203–$245 | varies |
| Elec stim other than wound (G0283) | $93 | $155 | 7.3× |
| Hbot, full body chamber, 30m (G0277) | $480.60 | $801 | 3.3× |
| Hep c screen high risk/other (G0472) | $105.60 | $176 | 2.3× |
| Hepb screen high risk indiv (G0499) | $67.80 | $113 | 2.4× |
| Hiv combination assay (G0475) | $89.40 | $149 | 3.7× |
| Home sleep test/type 3 porta (G0399) | $418.80 | $698 | 1.8× |
| Hospital outpt clinic visit (G0463) | $108.60 | $181 | 0.8× |
| Hpv combo assay ca screen (G0476) | $140.40 | $234 | 4.0× |
| Ig paraprotein qual imprcip&ms bld/ur w/isotype (0077U) | $451.80 | $753 | 10.4× |
| Jak2 Gene Analysis Trgt Seq Alys Exons 12-15 (0027U) range across 2 matching MRF lines |
$269.40–$279 | $449–$465 | varies |
| Liver Dis 10 Assays Serum Algorithm W/Nash (0003M) | $486.60 | $811 | 1.0× |
| Mra w/cont, abd (C8900) | $1,704.60 | $2,841 | 4.6× |
| Mra w/o fol w/cont, abd (C8902) | $1,959.60 | $3,266 | 5.3× |
| Mra w/o fol w/cont, chest (C8911) | $2,182.20 | $3,637 | 5.9× |
| Mra w/o fol w/cont, lwr ext (C8914) | $1,704.60 | $2,841 | 4.6× |
| Mri w/o fol w/cont, breast, (C8908) | $2,383.80 | $3,973 | 6.5× |
| Mri w/o fol w/cont, brst, un (C8905) | $2,023.80 | $3,373 | 5.5× |
| Ncntc R-T Fluor Wnd Img 1st (0598T) | $439.80 | $733 | 1.9× |
| Njx platelet plasma (0232T) | $533.40 | $889 | 1.1× |
| Oth resp proc, group (G0239) | $158.40 | $264 | 4.0× |
| Oth resp proc, indiv (G0238) | $55.80 | $93 | 1.8× |
| Pathogen test for platelets (P9100) | $60.60 | $101 | 1.0× |
| Perc d-e cor revasc chro sin (C9607) | $12,883.20 | $21,472 | 0.7× |
| Perc d-e cor revasc t cabg s (C9604) | $8,505.60 | $14,176 | 0.7× |
| Perc d-e cor stent ather s (C9602) | $11,741.40 | $19,569 | 0.6× |
| Perc drug-el cor stent sing (C9600) | $14,181.60 | $23,636 | 1.2× |
| Perq Sacral Augmt Bilat Inj (0201T) | $6,288 | $10,480 | 0.8× |
| Perq Sacral Augmt Unilat Inj (0200T) | $6,288 | $10,480 | 0.8× |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) | $8,845.80 | $14,743 | 0.7× |
| Prgrmg dev eval ldls pm single car chamber ip (0826T) | $56.40 | $94 | 1.4× |
| Provide inr test mater/equip (G0249) | $178.20 | $297 | 1.3× |
| Psa screening (G0103) | $95.40 | $159 | 4.9× |
| Relocation pg wcs lv pacg battery component only (0862T) | $1,815.60 | $3,026 | 0.8× |
| Relocation pg wcs lv pacg transmittr compnt only (0863T) | $1,815.60 | $3,026 | 0.8× |
| Removal pg wcs lv pacing both components (0861T) | $3,910.20 | $6,517 | 1.0× |
| Revasc intra lithotrip-ather (C9766) | $13,804.20 | $23,007 | 0.7× |
| Revasc intra lithotrip-stent (C9765) | $13,804.20 | $23,007 | 0.7× |
| Revasc intravasc lithotripsy (C9764) | $8,718 | $14,530 | 0.7× |
| Revasc lith-sten-ath tib/per (C9775) | $13,804.20 | $23,007 | 0.7× |
| Revasc lithotr-ather tib/per (C9774) | $13,804.20 | $23,007 | 0.7× |
| Revasc lithotr-stent tib/per (C9773) | $13,804.20 | $23,007 | 0.7× |
| Revasc lithotrip tibi/perone (C9772) | $8,718 | $14,530 | 0.7× |
| Revasc lithotrip-stent-ather (C9767) | $13,804.20 | $23,007 | 0.7× |
| Rx Metab Advrs Trgt Seq Alys (0029U) | $524.40 | $874 | 0.7× |
| Rx metab warfarin rx response trgt seq alys (0030U) | $549.60 | $916 | 4.1× |
| Tcat insj perm 1chmbr ldls pacemaker r atrial (0823T) | $12,126.60 | $20,211 | 0.6× |
| Tcat rmvl perm 1chmbr ldls pacemaker r atrial (0824T) | $3,174 | $5,290 | 1.0× |
| Tcat rmvl&rplcmt perm 1chmbr ldls pm r atrial (0825T) | $12,126.60 | $20,211 | 0.6× |
| Therapeutic procd strg endur (G0237) | $134.40 | $224 | 4.4× |
| Tomosynthesis, mammo (G0279) | $46.20 | $77 | 3.6× |
| Tpmt and Nudt15 Genotype (0034U) | $399.60 | $666 | 0.9× |
| Trauma respons w/hosp criti (G0390) | $1,777.20 | $2,962 | 1.3× |
| Trgt gen seq alys sld orgn neo DNA 324 genes (0037U) | $3,150 | $5,250 | 0.9× |
| Trim nail(s) (G0127) | $33 | $55 | 0.5× |
| Trluml Perip Athrc Iliac Art (0238T) | $11,457 | $19,095 | 0.6× |
| Tte w or wo fol wcon,doppler (C8929) | $1,776.60 | $2,961 | 2.1× |
| Unsched dialysis esrd pt hos (G0257) | $852.90 | $1,421.50 | 1.2× |
| Wet mounts/ w preparations (Q0111) | $15 | $25 | 0.8× |
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.