Home › Hospitals › St. Mary's Good Samaritan Hospital Posts prices for 37 of the 66 common shoppable procedures we track. Price file retrieved 2026-08-22.
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Procedure Cash price Gross charge × Medicare
Shoulder arthroscopy with decompression (29826) $30,141.34
—
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Knee arthroscopy with meniscectomy (29881) $16,206.34
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5.7×
Upper GI endoscopy (EGD), diagnostic (43235) $6,529.57
—
8.2×
Upper GI endoscopy (EGD) with biopsy (43239) $7,076.48
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8.9×
Diagnostic colonoscopy (45378) $5,533.16
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6.8×
Colonoscopy with biopsy (45380) $5,480.15
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5.2×
Colonoscopy with lesion removal (45385) $5,551.75
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5.3×
Laparoscopic gallbladder removal (47562) $20,167.45
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3.8×
Inguinal hernia repair (age 5+) (49505) $17,026.72
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5.4×
Cataract removal with lens insertion (66984) $8,396.15
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4.2×
CT head/brain without contrast (70450) $1,178.45
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12.9×
MRI brain without contrast (70551) $1,903.85
$2,929
9.1×
MRI brain with contrast (70552) $2,075.45
$3,193
6.8×
MRI brain without and with contrast (70553) $2,323.75
$3,575
7.6×
X-ray lower spine, 4+ views (72110) $309.40
$476
3.4×
MRI lumbar spine without contrast (72148) $1,678.95
$2,583
8.0×
CT pelvis with contrast (72193) $1,452.10
$2,234
9.4×
MRI lower-extremity joint without contrast (73721) $1,595.75
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7.6×
CT abdomen and pelvis with contrast (74177) $2,730.06
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8.9×
Ultrasound, abdomen complete (76700) $844.35
$1,299
9.2×
Ultrasound, pregnant uterus (≥14 weeks) (76805) $598
$920
6.5×
Ultrasound, transvaginal (76830) $443.30
$682
4.8×
Mammography, one breast (diagnostic) (77065) $201.50
$310
2.3×
Mammography, both breasts (diagnostic) (77066) $402.35
$619
3.6×
Mammography, screening (bilateral) (77067) $224.90
$346
2.5×
Basic metabolic panel (80048) $85.15
$131
10.1×
Comprehensive metabolic panel (80053) $139.75
$215
13.2×
Lipid panel (80061) $42.25
$65
3.2×
Renal function panel (80069) $103.35
$159
11.9×
Hepatic function panel (80076) $106.60
$164
13.0×
PSA, total (84153) $60.45
$93
3.3×
Thyroid stimulating hormone (TSH) (84443) $31.20
$48
1.9×
CBC with automated differential (85025) $52.98
$81.50
6.8×
CBC, automated (85027) $57.85
$89
8.9×
Prothrombin time (PT) (85610) $273.65
—
63.8×
Partial thromboplastin time (PTT) (85730) $33.80
$52
5.6×
Physical therapy, therapeutic exercise (per 15 min) (97110) $80.60
$124
2.8×
As a Critical Access Hospital, Medicare pays this facility about 101% of its own costs. The × Medicare column compares the cash price against that cost-based benchmark, not a standard rate.
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