GOOD SAMARITAN HOSPITAL (Los Angeles, CA) prices

45 CFR § 180 compliance

C · 70

This hospital published part of what § 180 requires.

●Machine-readable file published: assessment threshold met

○Gross / standard charges: below assessment threshold

○Discounted cash price: below assessment threshold

●Payer-specific negotiated rates: assessment threshold met

●Min / max negotiated charges: assessment threshold met

●Free, public, no login required: assessment threshold met

Procedures listed

23,048

Insurances with rates

CPT / HCPCS codes

12,597

Source MRF

json ↗

File last updated: 2026-09-01 (per the hospital's file)

Retrieved: 2026-10-28

Most expensive procedures (gross)

472255

$278,709

CANN W DILATOR STRGT TIP

Gross

$278,709

920215

$278,709

DVC INTRCRD VNTRC ASST

Gross

$278,709

457900

$278,019

RETRIEVER 6X25MM

Gross

$278,019

450864

$271,199

DVC REVASC 6MM 42MM

Gross

$271,199

431380

$270,628

RETRIEVER 4MM 21MM 28MM

Gross

$270,628

469330

$270,628

RETRIEVER ENDO 6X25MM

Gross

$270,628

470825

$252,903

DVC REVASC 3X20MM 200C

Gross

$252,903

461176

$252,903

DVC REVASC 4MM 180CM

Gross

$252,903

460897

$252,903

DEVICE THRMB 6X40X10MM

Gross

$252,903

803766

$243,561

Injection, polatuzumab vedotin-piiq, 1 mg

Gross

$243,561

108308

$220,826

THRMBOENDART ILIOFEM

Gross

$220,826

461371

$220,663

SYSTEM PNCG TRANSCATH

Gross

$220,663

461957

$220,663

ICD 12MM 36J ANG 51X68MM

Gross

$220,663

729970

$220,663

ICD CRD 15X47.5X60MM

Gross

$220,663

719609

$220,663

ICD CRD 7.45X6.17X0.99CM

Gross

$220,663

700126

$220,663

ICD CRD DR

Gross

$220,663

461116

$220,663

ICD CRD DR-T DF-4

Gross

$220,663

454496

$220,663

ICD DEFIB CARD 51X66MM

Gross

$220,663

460895

$220,663

ICD DEFIB CARD DF1

Gross

$220,663

471286

$220,663

ICD DR MRI IS1 DF1

Gross

$220,663

461118

$220,663

ICD DX MRI UHE

Gross

$220,663

913137

$220,663

ICD VR-T DFI

Gross

$220,663

461048

$220,663

ICD VR-T DX HM

Gross

$220,663

454748

$220,663

CRT DEFIB CARD 73X51X13

Gross

$220,663

459186

$220,663

CRT DEFIB CARD DF4

Gross

$220,663

727702

$220,663

CRT-D CRD 2.01X2.72X0.59

Gross

$220,663

465559

$220,663

CRT-D HF-T DF4

Gross

$220,663

913657

$220,663

CRT-D HF-T DF4

Gross

$220,663

461958

$220,663

CRT-P 11X19.9X46.5

Gross

$220,663

719296

$220,663

CRT-P 8.5MM 54X45MM

Gross

$220,663

467971

$220,663

CRT-P MR 15MM

Gross

$220,663

729154

$220,663

PCMKR CRD DDDR IS-2

Gross

$220,663

732511

$220,663

ICD 6.5X5.9CM 2DR

Gross

$220,663

722582

$220,663

ICD 71X40X14MM

Gross

$220,663

472148

$220,663

ICD CHAMBER 1

Gross

$220,663

455561

$220,663

ICD CRD SC78.2X65.5X15.7

Gross

$220,663

461875

$220,663

ICD DC DR-T DFI

Gross

$220,663

461289

$220,663

ICD DEFIB CARD 7.68CM

Gross

$220,663

729968

$220,663

ICD DEFIB CARD 8.25CM

Gross

$220,663

461134

$220,663

ICD DEFIB CRD 66X51X13MM

Gross

$220,663

719603

$220,663

ICD DEFIB CRD DR

Gross

$220,663

459002

$220,663

ICD DEFIC CARD 7.68CM

Gross

$220,663

457644

$220,663

ICD DUAL CHMBR 42MM

Gross

$220,663

718120

$220,663

LEAD ICD PCNG 58CM

Gross

$220,663

719470

$220,663

LEAD PCNG DUAL 60CM 7FR

Gross

$220,663

724201

$211,285

LEAD DEFIB 65CM

Gross

$211,285

727699

$211,285

LEAD DEFIB 65CM

Gross

$211,285

458907

$199,651

GENERATOR NRSTM 5 IPG

Gross

$199,651

724916

$199,651

GRAFT PRCN 11X7.5IN

Gross

$199,651

461237

$199,651

IPG NRSTM 6.68CM 5.02CM

Gross

$199,651

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
472255	CANN W DILATOR STRGT TIP	$278,709	$278,709	$41,806	$278,709	35
920215	DVC INTRCRD VNTRC ASST	$278,709	$278,709	$41,806	$278,709	35
457900	RETRIEVER 6X25MM	$278,019	$278,019	$41,703	$278,019	35
450864	DVC REVASC 6MM 42MM	$271,199	$271,199	$40,680	$271,199	35
431380	RETRIEVER 4MM 21MM 28MM	$270,628	$270,628	$40,594	$270,628	35
469330	RETRIEVER ENDO 6X25MM	$270,628	$270,628	$40,594	$270,628	35
470825	DVC REVASC 3X20MM 200C	$252,903	$252,903	$37,935	$252,903	35
461176	DVC REVASC 4MM 180CM	$252,903	$252,903	$37,935	$252,903	35
460897	DEVICE THRMB 6X40X10MM	$252,903	$252,903	$37,935	$252,903	35
803766	Injection, polatuzumab vedotin-piiq, 1 mg	$243,561	$243,561	$137	$256	12
108308	THRMBOENDART ILIOFEM	$220,826	$220,826	$33,124	$220,826	33
461371	SYSTEM PNCG TRANSCATH	$220,663	$220,663	$33,099	$220,663	24
461957	ICD 12MM 36J ANG 51X68MM	$220,663	$220,663	$33,099	$220,663	24
729970	ICD CRD 15X47.5X60MM	$220,663	$220,663	$33,099	$220,663	24
719609	ICD CRD 7.45X6.17X0.99CM	$220,663	$220,663	$33,099	$220,663	24
700126	ICD CRD DR	$220,663	$220,663	$33,099	$220,663	24
461116	ICD CRD DR-T DF-4	$220,663	$220,663	$33,099	$220,663	24
454496	ICD DEFIB CARD 51X66MM	$220,663	$220,663	$33,099	$220,663	24
460895	ICD DEFIB CARD DF1	$220,663	$220,663	$33,099	$220,663	24
471286	ICD DR MRI IS1 DF1	$220,663	$220,663	$33,099	$220,663	24
461118	ICD DX MRI UHE	$220,663	$220,663	$33,099	$220,663	24
913137	ICD VR-T DFI	$220,663	$220,663	$33,099	$220,663	24
461048	ICD VR-T DX HM	$220,663	$220,663	$33,099	$220,663	24
454748	CRT DEFIB CARD 73X51X13	$220,663	$220,663	$33,099	$220,663	24
459186	CRT DEFIB CARD DF4	$220,663	$220,663	$33,099	$220,663	24
727702	CRT-D CRD 2.01X2.72X0.59	$220,663	$220,663	$33,099	$220,663	24
465559	CRT-D HF-T DF4	$220,663	$220,663	$33,099	$220,663	24
913657	CRT-D HF-T DF4	$220,663	$220,663	$33,099	$220,663	24
461958	CRT-P 11X19.9X46.5	$220,663	$220,663	$33,099	$220,663	24
719296	CRT-P 8.5MM 54X45MM	$220,663	$220,663	$33,099	$220,663	24
467971	CRT-P MR 15MM	$220,663	$220,663	$33,099	$220,663	24
729154	PCMKR CRD DDDR IS-2	$220,663	$220,663	$33,099	$220,663	24
732511	ICD 6.5X5.9CM 2DR	$220,663	$220,663	$33,099	$220,663	24
722582	ICD 71X40X14MM	$220,663	$220,663	$33,099	$220,663	24
472148	ICD CHAMBER 1	$220,663	$220,663	$33,099	$220,663	24
455561	ICD CRD SC78.2X65.5X15.7	$220,663	$220,663	$33,099	$220,663	24
461875	ICD DC DR-T DFI	$220,663	$220,663	$33,099	$220,663	24
461289	ICD DEFIB CARD 7.68CM	$220,663	$220,663	$33,099	$220,663	24
729968	ICD DEFIB CARD 8.25CM	$220,663	$220,663	$33,099	$220,663	24
461134	ICD DEFIB CRD 66X51X13MM	$220,663	$220,663	$33,099	$220,663	24
719603	ICD DEFIB CRD DR	$220,663	$220,663	$33,099	$220,663	24
459002	ICD DEFIC CARD 7.68CM	$220,663	$220,663	$33,099	$220,663	24
457644	ICD DUAL CHMBR 42MM	$220,663	$220,663	$33,099	$220,663	24
718120	LEAD ICD PCNG 58CM	$220,663	$220,663	$33,099	$220,663	24
719470	LEAD PCNG DUAL 60CM 7FR	$220,663	$220,663	$33,099	$220,663	24
724201	LEAD DEFIB 65CM	$211,285	$211,285	$31,693	$211,285	24
727699	LEAD DEFIB 65CM	$211,285	$211,285	$31,693	$211,285	24
458907	GENERATOR NRSTM 5 IPG	$199,651	$199,651	$29,948	$199,651	24
724916	GRAFT PRCN 11X7.5IN	$199,651	$199,651	$29,948	$199,651	24
461237	IPG NRSTM 6.68CM 5.02CM	$199,651	$199,651	$29,948	$199,651	24

Showing top 50 of 23,048 priced procedures, sorted by gross charge.

Data straight from this hospital's federally-mandated machine-readable file (45 CFR § 180). The compliance grade reflects how completely the hospital published the six required data elements, not the quality of care.