SAMARITAN MEDICAL CENTER — Hospital Ledger

45 CFR § 180 compliance

B · 85

This hospital published most of what § 180 requires.

●Machine-readable file published

●Gross / standard charges

●Discounted cash price

●Payer-specific negotiated rates

○Min / max negotiated charges

●Free, public, no login required

Procedures listed

1,389

Insurances with rates

CPT / HCPCS codes

Source MRF

csv ↗

Most expensive procedures (gross)

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
PX-30182693006	HC External Ethylene Glycol	$2,732	$1,776	—	—	152
PX-30182693001	HC Ethylene Glycol	$2,732	$1,776	—	—	152
PX-30182693007	HC Labcorp Ethylene Glycol	$2,732	$1,776	—	—	152
PX-30182693005	HC Quest Ethylene Glycol	$2,732	$1,776	—	—	152
PX-274L3763001	HC Ewho Rigid Without Joints Custom Fabricated Restricted Non-Mm Supply	$1,718	$1,117	—	—	156
PX-30182441004	HC Quest Chlorinated Hydrocarbons Screen	$1,643	$1,068	—	—	132
PX-30182441001	HC Chlorinated Hydrocarbons Screen	$1,643	$1,068	—	—	132
PX-30081382002	HC Quest 17135 Hla Class II Typing High Resolution One Locus Each	$1,608	$1,045	—	—	150
PX-30081382003	HC External Hla Class II Typing High Resolution One Locus Each	$1,608	$1,045	—	—	150
PX-240H2019010	HC Pros Base Rate Level 5 (>61 Units) Telehealth Restricted (Ny)	$1,316	$855	—	—	125
PX-240H2019005	HC Pros Base Rate Level 5 (>61 Units) Restricted (Ny)	$1,316	$855	—	—	125
PX-30184145003	HC Quest Procalcitonin	$1,310	$852	—	—	153
PX-240H2019004	HC Pros Base Rate Level 4 (44-60 Units) Restricted (Ny)	$1,139	$740	—	—	125
PX-240H2019009	HC Pros Base Rate Level 4 (44-60 Units) Telehealth Restricted (Ny)	$1,139	$740	—	—	125
PX-30182373003	HC Quest Carbohydrate Deficient Transferrin	$1,134	$737	—	—	153
PX-240H2019017	HC Pros Base Rate Tier 3 (44+ Units) Telehealth Restricted (Ny)	$1,121	$728	—	—	125
PX-240H2019014	HC Pros Base Rate Tier 3 (44+ Units) Restricted (Ny)	$1,121	$728	—	—	125
PX-30184597001	HC Vitamin K	$1,096	$712	—	—	153
PX-30183013006	HC External H Pylori Breath Test Urease Activity	$1,093	$710	—	—	152
PX-30183088005	HC Quest Histamine Urine	$1,060	$689	—	—	152
PX-30183088004	HC Quest Histamine	$1,060	$689	—	—	152
PX-240H2019008	HC Pros Base Rate Level 3 (28-43 Units) Telehealth Restricted (Ny)	$1,040	$676	—	—	125
PX-240H2019003	HC Pros Base Rate Level 3 (28-43 Units) Restricted (Ny)	$1,040	$676	—	—	125
PX-30183993003	HC Quest Calprotectin Fecal	$1,026	$667	—	—	153
PX-30184181006	HC Quest 90136 Protein Western Blot Mag Antibody Igm	$1,003	$652	—	—	152
PX-30184181005	HC Quest Protein Western Blot Yo Antibody	$1,003	$652	—	—	152
PX-30184181003	HC Quest Protein Western Blot Hu Antibody	$1,003	$652	—	—	152
PX-30286021020	HC Quest 90136 Antibody Identification Leukocyte Antibodies Myeloperoxidase	$969	$630	—	—	152
PX-30286021019	HC Quest 90136 Antibody Identification Leukocyte Antibodies Proteinase 3	$969	$630	—	—	152
PX-30286021005	HC Antibody Identification Leukocyte Antibodies Phenotype Neutrophil Antigen	$969	$630	—	—	152
PX-30183519058	HC Quest Radioimmunoassay Musk Antibody Quantitative	$966	$628	—	—	59
PX-30183698003	HC Quest Lipoprotein-Associated Phospholipase A2	$935	$608	—	—	151
PX-30183698001	HC Lipoprotein-Associated Phospholipase A2	$935	$608	—	—	151
PX-260C8957001	HC IV Infusion Therapy/Diagnosis Initiation Prolonged Infusion	$915	$595	—	—	139
PX-30081517002	HC Labcorp Liver Disease Immunoassay Analysis 3 Biomarkers W Serum Prognostic Algorithm	$907	$590	—	—	140
PX-30081517001	HC Quest Liver Disease Immunoassay Analysis 3 Biomarkers W Serum Prognostic Algorithm	$907	$590	—	—	140
PX-30183951003	HC External Oncoprotein Des-Gamma-Carboxy-Prothrombin	$896	$582	—	—	112
PX-30183951002	HC Quest Oncoprotein Des-Gamma-Carboxy-Prothrombin	$896	$582	—	—	153
PX-30182107002	HC Quest Afp-L3 Frac Isoform & Tot Afp	$874	$568	—	—	153
PX-30182107001	HC Afp-L3 Frac Isoform & Tot Afp	$874	$568	—	—	153
PX-30182726003	HC Quest 17568 Fatty Acids Very Long Chain	$858	$558	—	—	153
PX-30182726001	HC Fatty Acids Very Long Chain	$858	$558	—	—	153
PX-30180145004	HC External Adalimumab (Humira) Tda	$858	$558	—	—	153
PX-30180145001	HC Adalimumab (Humira) Tda	$858	$558	—	—	153
PX-30180230001	HC Infliximab (Remicade) Tda	$858	$558	—	—	153
PX-30180145007	HC Quest 36297 Adalimumab (Humira) Tda	$858	$558	—	—	153
PX-30081375002	HC Quest Hla Class II Typing Low Resolution Hla-Drb1/3/4/5 & -Dqb1	$842	$547	—	—	150
PX-30183880007	HC Labcorp Natriuretic Peptide	$820	$533	—	—	153
PX-30183880005	HC POCT Natriuretic Peptide	$820	$533	—	—	153
PX-30081372003	HC Quest Hla Class I Typing Low Resolution Complete	$816	$530	—	—	150

Showing top 50 of 1,389 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.