Visits & medical services prices at Pih Health Good Samaritan Hospital
Los Angeles, CA · every code in this section with a posted price and a Medicare benchmark.
230 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| Ablate Heart Dysrhythm Focus (93650) | $16,560 | $16,560 | 1.7× |
| Admn Sarscov2 Vacc 1 Dose (90480) | $85 | $85 | 1.6× |
| Aep neurodiagnostic i&r (92653) | $245 | $245 | 0.9× |
| Airway Inhalation Treatment (94640) range across 9 matching MRF lines |
$312–$385 | $312–$385 | varies |
| Airway resistance by oscillometry (94728) | $406 | $406 | 2.5× |
| Appl Modality 1/> Areas Ultrasound Ea 15 Min (97035) range across 10 matching MRF lines |
$173–$176 | $173–$176 | varies |
| Application on-body injector (96377) | $569 | $569 | 9.4× |
| Assessment of aphasia per hr (96105) | $542 | $542 | 5.6× |
| Behavral qualit analys voice (92524) range across 8 matching MRF lines |
$450–$505 | $450–$505 | varies |
| Brncdilat rspse spmtry pre&post-brncdilat admn (94060) | $1,558 | $1,558 | 3.2× |
| C motor evoked uppr limbs (95928) | $872 | $872 | 0.8× |
| C motor evoked upr&lwr limbs (95939) | $1,699 | $1,699 | 1.5× |
| Canalith repositioning proc (95992) | $314 | $314 | 7.7× |
| Cardiac Stress Tst,Tracing Only (93017) | $1,675 | $1,675 | 6.0× |
| Cardiopulmonary resuscitation (92950) | $1,522 | $1,522 | 5.5× |
| Cardioversion (92960) range across 4 matching MRF lines |
$2,557–$2,800 | $2,557–$2,800 | varies |
| Cath Place/Coron Angio, Img Super/Interp,R&L Hrt Cath, L Hrt Ventric (93460) | $20,654 | $20,654 | 5.0× |
| Cath Place/Coron Angio, Img Super/Interp,W Left Heart Ventriculography (93458) range across 2 matching MRF lines |
$19,028–$19,916 | $19,028–$19,916 | varies |
| Cbt 1st hour (94644) range across 2 matching MRF lines |
$383–$2,200 | $383–$2,200 | varies |
| Chemo Anti-Neopl Sq/Im (96401) | $223 | $223 | 2.4× |
| Chemo Hormon Antineopl Sq/Im (96402) | $223 | $223 | 2.4× |
| Chemo Ia Push (96420) | $457.10 | $457.10 | 1.1× |
| Chemo IV infusion addl hr (96415) | $540 | $540 | 5.8× |
| Chemo IV push addl drug (96411) | $285 | $285 | 3.1× |
| Chemother Prolong Infuse W/Pump (96416) | $1,093 | $1,093 | 2.6× |
| Chemotherapy Into Cns (96450) | $1,325 | $1,325 | 3.1× |
| Chemotherapy Unspecified (96549) | $155 | $155 | 2.6× |
| Chemotx admn IV nfs tq ea seql nfs to 1 hr (96417) | $780 | $780 | 8.4× |
| Chemotx admn IV nfs tq up 1 hr 1/1st sbst/drug (96413) | $1,150 | $1,150 | 2.7× |
| Chemotx admn IV push tq 1/1st sbst/drug (96409) | $285 | $285 | 0.7× |
| Chemotx Njx Subarachnd/Intraventr Rsvr 1/Mult (96542) | $285 | $285 | 0.7× |
| Chest Wall Manipulation (94668) | $593 | $593 | 3.5× |
| Chron Care Mgmt Srvc 20 Min (99490) | $345 | $345 | 2.6× |
| Circadian Respiratry Pattern Rec 12-24 Hr Infant (94772) | $1,132 | $1,132 | 2.4× |
| Color/duplex Doppler, complete (93975) | $2,871 | $2,871 | 9.4× |
| Complex chronic care mgmt svc 1st 60 min cal mo (99487) | $616 | $616 | 2.7× |
| Continuous Pulse Ox (94762) | $967 | $967 | 5.8× |
| Coronary Art/Grft Angio S&I (93455) | $17,111 | $17,111 | 4.1× |
| Coronary Artery Angio S&I (93454) range across 2 matching MRF lines |
$13,661–$16,703 | $13,661–$16,703 | varies |
| Cpap Ventilation Cpap Initiation&Mgmt (94660) range across 3 matching MRF lines |
$3,415–$6,000 | $3,415–$6,000 | varies |
| Cpt initial (94667) range across 2 matching MRF lines |
$430–$731 | $430–$731 | varies |
| Critical care first hour (99291) | $6,200 | $6,200 | 5.8× |
| Ctr Motor Ep Std Transcrnl Motor Stimj Lwr Limbs (95929) | $872 | $872 | 1.8× |
| Debridement Open Wound 20 Sq Cm< (97597) range across 5 matching MRF lines |
$357–$449 | $357–$449 | varies |
| Developmental tst admin phys/qhp 1st hour (96112) | $314 | $314 | 1.9× |
| Dialysis One Evaluation (90945) | $575 | $575 | 1.1× |
| Dup-scan aorta ivc iliac vascl/bpgs complete (93978) | $1,785 | $1,785 | 5.8× |
| Dup-scan lxtr art/artl bpgs compl bi study (93925) | $2,625 | $2,625 | 8.6× |
| Dup-Scan Lxtr Art/Artl Bpgs Uni/Lmtd Study (93926) range across 4 matching MRF lines |
$1,413–$1,470 | $1,413–$1,470 | varies |
| Dup-Scan Xtr Veins Complete Bilateral Study (93970) | $2,546 | $2,546 | 8.3× |
| Dup-scan xtr veins unilateral/limited study (93971) | $1,412 | $1,412 | 10.5× |
| Duplex Scan Artl Infl&Ven O/F Hemo Compl Bi Std (93985) range across 2 matching MRF lines |
$748–$1,908 | $748–$1,908 | varies |
| Duplex Scan Artl Infl&Ven O/F Hemo Compl Uni Std (93986) | $360 | $360 | 2.7× |
| Duplex Scan Hemodialysis Access (93990) | $1,137 | $1,137 | 8.5× |
| Duplex up extrem art bilat (93930) | $2,625 | $2,625 | 8.6× |
| Duplex up extrem art unilat/ltd (93931) | $1,470 | $1,470 | 10.9× |
| ECG/monitoring and analysis (93271) | $743 | $743 | 6.1× |
| Echo Congenital Complete (93303) | $2,700 | $2,700 | 3.8× |
| Echo Heart Xthoracic,Limited (93308) range across 2 matching MRF lines |
$1,350–$3,347 | $1,350–$3,347 | varies |
| Echo transesophag montr cardiac pump functj (93318) | $2,750 | $2,750 | 3.9× |
| Echo transesophageal (93312) | $2,900 | $2,900 | 4.1× |
| Eeg 41-60 Minutes (95812) | $1,392 | $1,392 | 5.0× |
| EEG awake and asleep (95819) | $873 | $873 | 3.1× |
| EEG awake drowsy (95816) | $873 | $873 | 3.1× |
| EEG cerebral death evaluation (95824) | $873 | $873 | 1.8× |
| EEG cont rec w/video by tech min 8 channels (95700) | $1,036 | $1,036 | 3.7× |
| EEG extended monitoring 61-119 minutes (95813) | $1,200 | $1,200 | 4.3× |
| Eeg Sleep Only (95822) | $1,042 | $1,042 | 3.8× |
| Eeg W/O Vid 2-12 Hr Unmntr (95705) | $1,036 | $1,036 | 3.7× |
| EEG w/o vid ea 12-26hr intmt (95709) | $1,988 | $1,988 | 4.1× |
| EEG w/o video by tech 2-12 hr intermittent mntr (95706) | $1,036 | $1,036 | 3.7× |
| EEG wo vid ea 12-26hr unmntr (95708) | $1,988 | $1,988 | 4.1× |
| Electrical Stimulation Ea 15 Min (97032) range across 9 matching MRF lines |
$204–$225 | $204–$225 | varies |
| Electrocardiogram Tracing (93005) | $614 | $614 | 8.1× |
| Electrophysiologic Follow-Up W/Pac/Rec W/Arrhyt (93624) | $13,868 | $13,868 | 1.4× |
| Electrophysiology Evaluation (93642) | $4,760 | $4,760 | 3.0× |
| Emergency Dept Visit Level 2 (99282) | $1,060 | $1,060 | 5.4× |
| Emergency Dept Visit Level 3 (99283) | $1,725 | $1,725 | 4.9× |
| Emergency Dept Visit Level 4 (99284) | $2,675 | $2,675 | 5.0× |
| Emg 3 Extremities (95863) | $950 | $950 | 5.7× |
| Emg 4 Extremities (95864) | $1,252 | $1,252 | 7.6× |
| Endomyocardial Biopsy (93505) | $5,175 | $5,175 | 1.3× |
| Ep & ablate supravent arrhyt (93653) | $27,789 | $27,789 | 0.8× |
| Ep & ablate ventric tachy (93654) | $44,509 | $44,509 | 1.3× |
| Ep Compre Electrophysiologic Arrhythmia Induction (93620) | $14,488 | $14,488 | 1.4× |
| Ep Compre Electrophysiologic W/O Arrhyt Induction (93619) | $10,350 | $10,350 | 1.0× |
| Er level 1 (99281) | $525 | $525 | 4.8× |
| Er level v (99285) | $3,925 | $3,925 | 5.1× |
| Evaluate pt use of inhaler (94664) range across 2 matching MRF lines |
$414–$420 | $414–$420 | varies |
| Evaluate Speech Production (92522) range across 15 matching MRF lines |
$450–$505 | $450–$505 | varies |
| Evaluate Swallowing Function (92610) | $626 | $626 | 7.4× |
| Evaluation of speech fluency (92521) | $505 | $505 | 3.8× |
| External Ecg Scanning Analysis Report (93226) | $2,313 | $2,313 | 30.5× |
| Extracranial Bilat Study (93880) | $2,336 | $2,336 | 7.6× |
| Extracranial Uni/Ltd Study (93882) | $895 | $895 | 6.7× |
| F-up/limited tthrc echo congenital car anomaly (93304) | $2,500 | $2,500 | 3.6× |
| Heart catheterization, both sides, with coronary and bypass graft angiography (93461) | $24,151 | $24,151 | 5.8× |
| Hemodialysis Procedure W/ Phys/Qhp Evaluation (90935) | $456 | $456 | 0.5× |
| High altitude simulation test (94452) | $450 | $450 | 2.6× |
| High Altitude Simulatj W/Phys I&R W/O2 Titration (94453) | $1,027 | $1,027 | 6.0× |
| Holter monitor recording (93225) | $1,825 | $1,825 | 10.7× |
| Icd Device Interrogate (93289) | $165 | $165 | 3.4× |
| Icd device progr eval dual (93283) | $266 | $266 | 5.5× |
| Icm Device Eval (93290) | $152 | $152 | 3.2× |
| Ilr Device Interrogate (93291) | $112 | $112 | 3.0× |
| Immunization administration (90471) range across 7 matching MRF lines |
$280–$569 | $280–$569 | varies |
| Insert/Place Heart Catheter (93503) | $5,784 | $5,784 | 2.9× |
| Intra-atrial pacing (93610) | $13,308 | $13,308 | 1.3× |
| Intracranial Complete Study (93886) | $1,311 | $1,311 | 4.3× |
| Intraventricular pacing (93612) | $5,933 | $5,933 | 0.6× |
| Iontophoresis 15 min (97033) | $204 | $204 | 10.7× |
| Irrig Drug Delivery Device (96523) | $277 | $277 | 3.7× |
| IV infusion hydration each additional hour (96361) range across 7 matching MRF lines |
$137–$475 | $137–$475 | varies |
| IV infusion hydration initial 31 min-1 hour (96360) range across 8 matching MRF lines |
$800–$1,167 | $800–$1,167 | varies |
| IV infusion ther proph addl sequential to 1 hr (96367) range across 6 matching MRF lines |
$137–$370 | $137–$370 | varies |
| IV infusion therapy prophylaxis/dx ea hour (96366) range across 7 matching MRF lines |
$137–$600 | $137–$600 | varies |
| IV push initial (96374) range across 8 matching MRF lines |
$285–$980 | $285–$980 | varies |
| L Hrt Art/Grft Angio (93459) | $23,322 | $23,322 | 5.6× |
| Lwr Xtr Vasc Stdy Bilat (93924) | $743 | $743 | 2.7× |
| Mechanical chest wall oscillation per session (94669) | $752 | $752 | 2.7× |
| Medical nutrition assmt&ivntj indiv each 15 mi (97802) | $100 | $100 | 2.7× |
| Methacholine challenge (94070) | $1,426 | $1,426 | 3.0× |
| Motion Fluoroscopy/Swallow (92611) | $1,428 | $1,428 | 15.6× |
| Muscle Test 2 Limbs (95861) | $850 | $850 | 5.0× |
| Muscle Test Nonparaspinal (95870) | $850 | $850 | 5.0× |
| Muscle Test One Limb (95860) | $551 | $551 | 3.2× |
| Needle Electromyography Cranial Nrv Muscle Bi (95868) | $1,000 | $1,000 | 3.6× |
| Needle Electromyography Cranial Nrv Muscle Uni (95867) | $850 | $850 | 3.1× |
| Needle electromyography larynx (95865) | $2,507 | $2,507 | 14.7× |
| Negative Pressure Wound Therapy Dme </= 50 Sq Cm (97605) | $387 | $387 | 1.5× |
| Negative Pressure Wound Therapy Dme >50 Sq Cm (97606) | $484 | $484 | 0.9× |
| Nerve Conduction Studies 1-2 Studies (95907) range across 2 matching MRF lines |
$257–$764 | $257–$764 | varies |
| Nerve Conduction Studies 11-12 Studies (95912) | $1,464 | $1,464 | 3.1× |
| Nerve conduction studies 13 or more studies (95913) | $1,686 | $1,686 | 3.5× |
| Nerve Conduction Studies 3-4 Studies (95908) | $870 | $870 | 3.1× |
| Nerve conduction studies 5-6 studies (95909) | $1,010 | $1,010 | 3.6× |
| Nerve conduction studies 7-8 studies (95910) | $1,148 | $1,148 | 2.4× |
| Nerve Conduction Studies 9-10 Studies (95911) | $465 | $465 | 1.0× |
| Neuromuscular Junct Tstg Ea Nrv Any 1 Meth (95937) | $571 | $571 | 3.5× |
| Neuromuscular Reeducation (97112) range across 8 matching MRF lines |
$191–$204 | $191–$204 | varies |
| Newborn resuscitation (99465) | $918 | $918 | 1.1× |
| Oral Function Therapy (92526) | $480 | $480 | 5.7× |
| Oral Speech Device Eval (92597) | $521 | $521 | 7.3× |
| Orthc/Prostc Mgmt Sbsq Enc (97763) | $158 | $158 | 3.2× |
| Orthotics Mgmt & Trainj Initial Enctr Ea 15 Mins (97760) | $204 | $204 | 4.4× |
| Ot Contrast Bath Ea 15 Min (97034) | $75 | $75 | 5.3× |
| Ot eval high complexity (97167) range across 9 matching MRF lines |
$378–$618 | $378–$618 | varies |
| Ot Eval Low Complex (97165) range across 7 matching MRF lines |
$288–$533 | $288–$533 | varies |
| Ot Eval Moderate Complexity (97166) range across 7 matching MRF lines |
$378–$533 | $378–$533 | varies |
| Ot manual therapy 15 min (97140) | $204 | $204 | 7.4× |
| Ot Re-Eval Est Plan Care (97168) range across 5 matching MRF lines |
$158–$225 | $158–$225 | varies |
| Outpatient Cardiac Rehab W/Cont Ecg Monitoring (93798) | $380 | $380 | 2.3× |
| Outpatient Cardiac Rehab W/O Cont Ecg Monitor (93797) range across 7 matching MRF lines |
$139–$554 | $139–$554 | varies |
| Pentamidine Aersl Inhalation Pneumocystis/Proph (94642) | $383 | $383 | 1.4× |
| Peripheral arterial disease rehab per session (93668) | $178 | $178 | 2.3× |
| Perq transcath closure pda (93582) range across 2 matching MRF lines |
$7,437–$10,537 | $7,437–$10,537 | varies |
| Perq Transcath Cls Aortic (93591) unusually low: confirm this is the full procedure |
$10,624 | $10,624 | 0.5× |
| Perq Transcath Cls Mitral (93590) unusually low: confirm this is the full procedure |
$10,537 | $10,537 | 0.4× |
| Perq Trluml C Angioplasty 1 Maj C Art&/Branches (92920) range across 3 matching MRF lines |
$10,351–$14,801 | $10,351–$14,801 | varies |
| Perq Trluml Revsc Chrnc Tot Occls 1 C Art Antgrd (92943) range across 3 matching MRF lines |
$22,771–$41,305 | $22,771–$41,305 | varies |
| Phlebotomy therapeutic (99195) | $351 | $351 | 2.1× |
| Plethysmography (94726) | $487 | $487 | 1.0× |
| Pm device eval in person (93288) | $216 | $216 | 4.5× |
| Pm device progr eval dual (93280) range across 2 matching MRF lines |
$266–$365 | $266–$365 | varies |
| Pm device progr eval multi (93281) | $126 | $126 | 2.6× |
| Pm Device Progr Eval Sngl (93279) range across 2 matching MRF lines |
$266–$361 | $266–$361 | varies |
| Pm/Icd Remote Tech Serv (93296) | $179 | $179 | 3.7× |
| Prgrmng Dev Eval Implantable in Persn 1 Ld Dfb (93282) | $266 | $266 | 5.5× |
| Prq Card Angio/Athrect 1 Art (92924) | $22,771 | $22,771 | 1.5× |
| Prq Card Stent W/Angio 1 Vsl (92928) range across 5 matching MRF lines |
$22,771–$41,305 | $22,771–$41,305 | varies |
| Prq Card Stent/Ath/Angio (92933) range across 3 matching MRF lines |
$31,051–$66,068 | $31,051–$66,068 | varies |
| Prq Revasc Byp Graft 1 Vsl (92937) | $22,771 | $22,771 | 1.5× |
| Prq Tcat Clsr Cgen Ventr Septal Dfct W/Implt (93581) unusually low: confirm this is the full procedure |
$7,437 | $7,437 | 0.3× |
| Pt Eval High Complex (97163) range across 12 matching MRF lines |
$314–$618 | $314–$618 | varies |
| Pt eval low complex 20 min (97161) range across 6 matching MRF lines |
$288–$530 | $288–$530 | varies |
| Pt Eval Mod Complex (97162) range across 6 matching MRF lines |
$378–$530 | $378–$530 | varies |
| Pt gait training 15 min (97116) range across 7 matching MRF lines |
$191–$204 | $191–$204 | varies |
| Pt mechanical traction (97012) | $175 | $175 | 12.2× |
| Pt Re-Eval Est Plan Care (97164) | $388 | $388 | 5.8× |
| Pulm function test by gas (94727) | $841 | $841 | 3.0× |
| Pulmonary service/procedure (94799) range across 4 matching MRF lines |
$199–$643 | $199–$643 | varies |
| Pulmonary Stress Testing (94618) | $613 | $613 | 3.6× |
| R Hrt Art/Grft Angio (93457) | $22,080 | $22,080 | 5.3× |
| R hrt coronary artery angio (93456) | $20,355 | $20,355 | 4.9× |
| R&L Hrt Cath W/Ventriclgrphy (93453) | $13,800 | $13,800 | 3.3× |
| Rem Interrog Scrms <30 D Phys/Qhp (93298) | $190 | $190 | 4.0× |
| Remote 30 Day Ecg Rev/Report (93270) | $494 | $494 | 10.3× |
| Respiratory flow volume loop (94375) range across 2 matching MRF lines |
$430–$608 | $430–$608 | varies |
| Rhythm Ecg 1-3 Leads Tracing Only W/O I&R (93041) range across 2 matching MRF lines |
$242–$278 | $242–$278 | varies |
| Right Heart Cath (93451) | $7,866 | $7,866 | 1.9× |
| Right ventricular recording (93603) | $13,308 | $13,308 | 8.5× |
| Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess (97602) | $314 | $314 | 1.2× |
| Rx sp-genratj augmnt&comunicaj dev 1st hr (92607) | $499 | $499 | 4.1× |
| Self Care Mngment Training (97535) range across 13 matching MRF lines |
$191–$204 | $191–$204 | varies |
| Short-latency somatosens ep std upr limbs (95925) | $1,057 | $1,057 | 3.8× |
| Somatosensory Testing (95938) | $3,000 | $3,000 | 2.7× |
| Speech sound lang comprehen (92523) | $505 | $505 | 2.2× |
| Spirometry (94010) | $775 | $775 | 2.8× |
| Ssep lower limbs (95926) | $1,057 | $1,057 | 3.8× |
| Standardized Cognitive Performance Testing (96125) | $521 | $521 | 5.1× |
| Stress Tte Only (93350) | $2,950 | $2,950 | 4.2× |
| Surfactant Admin Thru Tube (94610) | $950 | $950 | 3.4× |
| Ther Ivntj Cog Funcj Cntct 1st 15 Minutes (97129) | $175 | $175 | 7.8× |
| Ther Ivntj Ea Addl 15 Min (97130) | $88 | $88 | 4.2× |
| Ther/Proph/Diag Inj Sc/Im (96372) range across 10 matching MRF lines |
$85–$531 | $85–$531 | varies |
| Ther/Proph/Diag Iv Inf Init (96365) range across 7 matching MRF lines |
$1,085–$1,510 | $1,085–$1,510 | varies |
| Therapeutic Activities (97530) range across 15 matching MRF lines |
$191–$204 | $191–$204 | varies |
| Tilt table test with heart rhythm and blood pressure monitoring (93660) | $2,950 | $2,950 | 6.1× |
| Transcath Closure of Asd (93580) unusually low: confirm this is the full procedure |
$10,537 | $10,537 | 0.4× |
| Transtelephonic Rhythm Strip Pacemaker Eval (93293) | $325 | $325 | 6.8× |
| Tte w/doppler, complete (93306) | $3,300 | $3,300 | 4.7× |
| Tte W/O Doppler Complete (93307) | $2,500 | $2,500 | 8.1× |
| Tx atrial fib pulm vein isol (93656) | $27,602 | $27,602 | 0.8× |
| Tx Speech Lang Voice Commj &/Auditory Proc Ind (92507) | $499 | $499 | 6.6× |
| Tx Speech Language Voice Commj Auditry 2/>Indiv (92508) | $158 | $158 | 6.6× |
| Tx/Pro/Dx Inj New Drug Addon (96375) range across 7 matching MRF lines |
$285–$735 | $285–$735 | varies |
| Unlisted cardiovascular service/procedure (93799) range across 2 matching MRF lines |
$242–$574 | $242–$574 | varies |
| Unlisted otorhinolaryngological service (92700) | $571 | $571 | 15.3× |
| Upr/L Xtremity Art 2 Levels (93922) | $1,207 | $1,207 | 7.1× |
| Upr/Lxtr Art Stdy 3+ Lvls (93923) range across 3 matching MRF lines |
$817–$1,412 | $817–$1,412 | varies |
| Valvuloplasty aortic valve (92986) | $18,777 | $18,777 | 2.6× |
| Valvuloplasty mitral valve (92987) range across 2 matching MRF lines |
$6,760–$18,777 | $6,760–$18,777 | varies |
| Valvuloplasty pulmonary valve (92990) | $18,777 | $18,777 | 1.3× |
| Veeg 2-12 hr unmonitored (95711) | $1,036 | $1,036 | 3.7× |
| Veeg by tech ea incr 12-26 hr intermittent mntr (95715) | $1,988 | $1,988 | 4.1× |
| Vent Mgmt Inpat Init Day (94002) range across 4 matching MRF lines |
$6,250–$6,730 | $6,250–$6,730 | varies |
| Ventilation Assist & Mgmt Inpatient Ea Sbsq Da (94003) range across 4 matching MRF lines |
$5,700–$6,730 | $5,700–$6,730 | varies |
| Visual Evoked Potential Test (95930) | $1,214 | $1,214 | 4.4× |
| Vital capacity, total (94150) | $231 | $231 | 1.4× |
| Wheelchair Mgmt Ea 15 Min (97542) range across 2 matching MRF lines |
$158–$225 | $158–$225 | varies |
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.