Good Samaritan Hospital prices
Good Samaritan Hospital in Vincennes, IN publishes its standard charges, as every US hospital must under the federal Hospital Price Transparency Rule. Below is what its own file lists for common services, next to what it has agreed to accept from insurers.
What Good Samaritan Hospital publishes for common services
ER visit, level 3 (moderate): listed at $1,046. Insurers pay a median of $65.36, across 16 insurers.
If you were billed the list price, you may have been charged far more than insurers typically pay. See how to use these numbers below.
| Service | List price | Cash price | Insurers pay (median) |
|---|---|---|---|
| ER visit, level 1 (minor)CPT 99281, listed as "PR ED VISIT MAY NOT REQ PHYS/QHP" | $255 | $153 | $10.39$10.35 to $45.00, 16 insurers |
| ER visit, level 2 (low-moderate)CPT 99282, listed as "PR ED VISIT STRAIGHTFORWARD MDM" | $567 | $340 | $38.16$38.11 to $76.22, 16 insurers |
| ER visit, level 3 (moderate)CPT 99283, listed as "PR ED VISIT LOW MDM" | $1,046 | $628 | $65.36$64.70 to $131, 16 insurers |
| ER visit, level 4 (high)CPT 99284, listed as "PR ED VISIT MODERATE MDM" | $1,458 | $875 | $111$110 to $222, 16 insurers |
| ER visit, level 5 (critical)CPT 99285, listed as "PR ED VISIT HIGH MDM" | $2,340 | $1,404 | $162$160 to $323, 16 insurers |
| Office visit, established patient, low complexityCPT 99213, listed as "PR OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN" | - | - | $60.61$55.10 to $110, 16 insurers |
| Office visit, established patient, moderate complexityCPT 99214, listed as "PR OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN" | - | - | $89.05$80.95 to $162, 16 insurers |
| Routine venipuncture (blood draw)CPT 36415, listed as "Coll venous bld venipuncture" | $19.00 | $11.40 | $9.34$9.34 to $18.68, 16 insurers |
| Vitamin B12 injectionCPT J3420, listed as "PR VITAMIN B12 INJECTION" | $52.50 to $60.00 | $31.50 to $36.00 | - |
| Comprehensive metabolic panelCPT 80053, listed as "Comprehen metabolic panel" | $191 | $115 | $10.56$10.56 to $21.12, 22 insurers |
| Basic metabolic panelCPT 80048, listed as "Basic metabolic pnl total ca" | $124 | $74.40 | $8.46$8.46 to $16.92, 22 insurers |
| CBC with differentialCPT 85025, listed as "Complete cbc w/auto diff wbc" | $100 | $60.00 | $7.77$7.77 to $15.54, 22 insurers |
| Lipid panelCPT 80061, listed as "Lipid panel" | $216 | $130 | $13.39$13.39 to $26.78, 22 insurers |
| Hepatic function panelCPT 80076, listed as "Hepatic function panel" | $77.00 | $46.20 | $8.17$8.17 to $16.34, 22 insurers |
| X-ray, ankle, 3 viewsCPT 73610, listed as "CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS" | $415 to $675 | $249 to $405 | $34.49$7.74 to $155, 16 insurers |
| CT abdomen, without contrastCPT 74176, listed as "Ct abd & pelvis w/o contrast" | $3,069 | $1,841 | $350$160 to $3,143, 12 insurers |
| CT abdomen and pelvis, with contrastCPT 74177, listed as "Ct abd & pelvis w/contrast" | $4,099 | $2,459 | $632$167 to $3,143, 12 insurers |
| CT abdomen and pelvis, with and without contrastCPT 74178, listed as "Ct abd&plv wo cntr flwd cntr" | $4,155 | $2,493 | $751$184 to $3,143, 12 insurers |
| MRI brain, without contrastCPT 70551, listed as "Mri brain stem w/o dye" | $3,007 | $1,804 | $464$136 to $2,957, 12 insurers |
| MRI brain, with and without contrastCPT 70553, listed as "Mri brain stem w/o & w/dye" | $4,407 | $2,644 | $756$211 to $2,957, 12 insurers |
| MRI pelvis, without contrastCPT 72195, listed as "Mri pelvis w/o dye" | $2,874 | $1,724 | $827$134 to $2,957, 12 insurers |
| MRI pelvis, with and without contrastCPT 72197, listed as "Mri pelvis w/o & w/dye" | $5,068 | $3,041 | $1,101$202 to $2,957, 12 insurers |
| Complete echocardiogram with DopplerCPT 93306, listed as "PR ECHO TTHRC R-T 2D W/WOM-MODE COMPL SPEC&COLR D" | $3,046 | $1,828 | $176$63.36 to $369, 16 insurers |
| Echocardiogram, completeCPT 93307, listed as "PR ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP" | $1,578 | $947 | $122$40.07 to $294, 16 insurers |
| Electrocardiogram, routine ECG with interpretationCPT 93000, listed as "PR ECG ROUTINE ECG W/LEAST 12 LDS W/I&R" | - | - | $14.36$12.97 to $50.00, 16 insurers |
| Electrocardiogram, tracing only (technical component)CPT 93005, listed as "PR ECG ROUTINE ECG W/LEAST 12 LDS TRCG ONLY W/O I&R" | $328 | $197 | $6.35$5.53 to $29.00, 16 insurers |
| Electrocardiogram, interpretation and report onlyCPT 93010, listed as "PR ECG ROUTINE ECG W/LEAST 12 LDS I&R ONLY" | - | - | $8.01$7.45 to $22.00, 16 insurers |
| Laparoscopic cholecystectomyCPT 47562, listed as "PR LAPAROSCOPY SURG CHOLECYSTECTOMY" | - | - | $571$571 to $1,900, 16 insurers |
| Knee arthroscopy, meniscectomyCPT 29881, listed as "PR ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG" | - | - | $474$474 to $1,871, 16 insurers |
Source: Good Samaritan Hospital's standard charges file, which the hospital dated April 1, 2026. Read on October 1, 2026. View the hospital's file (a large data file). Hospitals must publish this file under 45 CFR § 180.
List price
The hospital's full charge (its "gross charge") before any discount. Few people pay it, but it is often the starting point on a bill.
Cash price
What the hospital says it accepts from patients paying without insurance.
Insurers pay
The median of the per-service rates the hospital has negotiated with insurers, shown only when at least 3 insurers report one. Your plan's rate may differ.
How to use these numbers
Uninsured or paying yourself? You can ask Good Samaritan Hospital to bill you its published cash price, and ask about financial assistance, which nonprofit hospitals must offer.
Insured, and the hospital is in your network? Your share should be based on your plan's negotiated rate, not the list price. If your bill or explanation of benefits shows the list price, ask the billing office why.
These figures summarize what the hospital publishes. They are not a quote, and they don't include separate physician bills.
Check your Good Samaritan Hospital bill for errors
The free check looks for duplicate charges, unbundling, upcoding and surprise billing. Its price comparison uses national reference pricing, separate from the hospital's published prices above.
BillMender is a document-preparation tool, not a law firm, and does not provide legal advice. We don't guarantee any outcome or dollar amount. Estimates are based on public reference pricing, not your hospital's actual contract rates.