The Good Samaritan Hospital of Cincinnati, OH
The Good Samaritan Hospital of Cincinnati, OH in Cincinnati, OH publishes cash prices for 46 common procedures listed here, from its own machine-readable price file updated Apr 1, 2026. Click a procedure to compare it with other hospitals nearby.
375 Dixmyth Avenue, Cincinnati, OH 45220 Collected Sep 23, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 HC CT Abdomen Pelvis With Con | $605.98 | $807.98 | 25% |
| CT scan of the head or brain, no contrast dye CPT 70450 HC CT Head Without Contrast | $302.99 | $403.99 | 25% |
| CT scan of the pelvis, with contrast dye CPT 72193 HC CT Pelvis With Contrast | $302.99 | $403.99 | 25% |
| CT scan of the pelvis, with contrast dye inpatient CPT 72193 HC CT Pelvis With Contrast | $302.99 | $403.99 | 25% |
| Diagnostic mammogram, both breasts both sides CPT 77066 HC Mammogram Dx Bilat With Cad | $392.28 | $523.04 | 25% |
| Diagnostic mammogram, both breasts inpatient both sides CPT 77066 HC Mammogram Dx Bilat With Cad | $392.28 | $523.04 | 25% |
| Diagnostic mammogram, one breast one side CPT 77065 HC Mammogram Dx Unilat With Cad | $276.36 | $368.48 | 25% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 HC MR Lower Ext Jnt WO Con | $494.70 | $659.60 | 25% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 HC MR Lower Ext Jnt WO&W Con | $494.70 | $659.60 | 25% |
| MRI of the brain, no contrast dye CPT 70551 HC MR Brain WO Contrast | $494.70 | $659.60 | 25% |
| MRI of the brain, with and without contrast dye CPT 70553 HC MR Brain WO&W Contrast | $494.70 | $659.60 | 25% |
| MRI of the lower back, no contrast dye CPT 72148 HC MR Spine Lumbar WO Contrast | $494.70 | $659.60 | 25% |
| MRI of the lower back, no contrast dye inpatient CPT 72148 HC MR Spine Lumbar WO Contrast | $494.70 | $659.60 | 25% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 HC US OB Transabd> 14 Weeks | $643.50 | $858.00 | 25% |
| Screening mammogram, both breasts both sides CPT 77067 HC Mammogram Scr Bilat With Cad | $311.48 | $415.30 | 25% |
| Screening mammogram, both breasts one side CPT 77067 HC Mammogram Scr Unilat With Cad | $231.01 | $308.01 | 25% |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography <6hrs | $2,672.76 | $3,563.68 | 25% |
| Sleep study in a lab (polysomnography) CPT 95810 HC Polysomnography > 6yrs Old > 6 Hrs | $3,292.30 | $4,389.74 | 25% |
| Transvaginal pelvic ultrasound CPT 76830 HC US Transvaginal | $570.90 | $761.20 | 25% |
| Transvaginal pelvic ultrasound inpatient CPT 76830 HC US Transvaginal | $570.90 | $761.20 | 25% |
| Ultrasound of the abdomen, complete CPT 76700 HC US Abdomen Complete | $702.44 | $936.58 | 25% |
| X-ray of the lower back, 4 or more views CPT 72110 HC Xr Spine Lumbosacral Min 4 Views | $595.84 | $794.45 | 25% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 HC Basic Metabolic Panel | $23.96 | $31.94 | 25% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 HC Lipid Profile | $45.76 | $61.01 | 25% |
| Complete blood count (CBC) with differential CPT 85025 HC Cbc With Differential | $26.54 | $35.38 | 25% |
| Complete blood count (CBC) with differential inpatient CPT 85025 HC Cbc With Differential | $26.54 | $35.38 | 25% |
| Complete blood count (CBC), no differential CPT 85027 HC Cbc WO Diff | $22.08 | $29.44 | 25% |
| Comprehensive metabolic panel (blood test) CPT 80053 HC Comprehensive Metabolic Panel | $36.10 | $48.13 | 25% |
| Comprehensive metabolic panel (blood test) inpatient CPT 80053 HC Comprehensive Metabolic Panel | $36.10 | $48.13 | 25% |
| Kidney function blood test panel CPT 80069 HC Renal Function Panel | $29.68 | $39.57 | 25% |
| Liver function blood test panel CPT 80076 HC Hepatic Function Panel | $27.95 | $37.27 | 25% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 HC Psa Free | $56.55 | $75.40 | 25% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 HC Psa Total | $59.38 | $79.17 | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Ptt | $20.51 | $27.35 | 25% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 HC Apc Ptt | $20.51 | $27.35 | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Istat Pt/Inr | $13.44 | $17.92 | 25% |
| Prothrombin time (PT/INR) clotting test CPT 85610 HC Prothrombin Time | $13.44 | $17.92 | 25% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 HC Tsh Hormone | $57.41 | $76.55 | 25% |
| Urinalysis with microscope exam, automated CPT 81001 HC Urinalysis With Microscopy | $10.82 | $14.43 | 25% |
| Urinalysis without microscope exam, automated CPT 81003 HC Ua Dipstick or Tablet Reagent Autom WO Microscpy | $7.66 | $10.21 | 25% |
| Urinalysis without microscope exam, automated CPT 81003 HC Urine Routine WO Micro | $7.66 | $10.21 | 25% |
| Urinalysis without microscope exam, automated inpatient CPT 81003 HC Ua Dipstick or Tablet Reagent Autom WO Microscpy | $7.66 | $10.21 | 25% |
| Urinalysis without microscope exam, manual CPT 81002 HC Urine Dip Stick | $10.70 | $14.27 | 25% |
| Urinalysis without microscope exam, manual inpatient CPT 81002 HC Urine Dip Stick | $10.70 | $14.27 | 25% |
Surgery and procedures
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Colonoscopy with polyp removal CPT 45385 HC Colonoscopy W/Lesion Removal | $2,799.00 | $3,732.00 | 25% |
| Colonoscopy with tissue sample CPT 45380 HC Colonoscopy and Biopsy | $2,617.50 | $3,490.00 | 25% |
| Colonoscopy, diagnostic CPT 45378 HC Diagnostic Colonoscopy | $1,849.50 | $2,466.00 | 25% |
| Left heart catheterization, diagnostic one side CPT 93452 HC Lt Heart Cath Includes Inj Lv | $9,187.81 | $12,250.41 | 25% |
| Left heart catheterization, diagnostic inpatient one side CPT 93452 HC Lt Heart Cath Includes Inj Lv | $9,187.81 | $12,250.41 | 25% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Njx Interlaminar Lmbr/Sac | $217.50 | $290.00 | 25% |
| Lower-back epidural injection, with imaging guidance CPT 62323 HC Esi Inj Single Lum/Sacral W Imaging | $1,587.04 | $2,116.05 | 25% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Inj Foramen Epidural L/S | $242.25 | $323.00 | 25% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Esi Transforaminal Lum/Sac | $1,575.00 | $2,100.00 | 25% |
| Lower-back nerve root steroid injection, with imaging guidance CPT 64483 HC Esi Transfrmnl Ls Same Lvl Bil | $2,362.50 | $3,150.00 | 25% |
| Lower-back nerve root steroid injection, with imaging guidance inpatient CPT 64483 HC Esi Transforaminal Lum/Sac | $1,575.00 | $2,100.00 | 25% |
| Upper endoscopy (EGD) with biopsy CPT 43239 HC Egd Biopsy Single/Multiple | $2,109.75 | $2,813.00 | 25% |
| Upper endoscopy (EGD), diagnostic CPT 43235 HC Egd Diagnostic Brush Wash | $1,815.00 | $2,420.00 | 25% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Family therapy with the patient, 50 minutes CPT 90847 HC Family Intervention W/ Patient | $109.20 | $145.60 | 25% |
| Family therapy with the patient, 50 minutes CPT 90847 HC Family Therapy With Patient | $170.94 | $227.92 | 25% |
| Family therapy with the patient, 50 minutes CPT 90847 HC Family Therapy With Patient Ph | $262.92 | $350.56 | 25% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Intervention W/ Patient | $109.20 | $145.60 | 25% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Therapy With Patient | $170.94 | $227.92 | 25% |
| Family therapy with the patient, 50 minutes inpatient CPT 90847 HC Family Therapy With Patient Ph | $262.92 | $350.56 | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 HC Family Intervention W/O Patient | $108.37 | $144.49 | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 HC Family Therapy W/O Pt | $170.94 | $227.92 | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 HC Family Education W Rn | $254.76 | $339.68 | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 HC Family Therapy W/O Pt Ph | $324.24 | $432.32 | 25% |
| Family therapy without the patient, 50 minutes CPT 90846 HC Family Education W Rn Ph | $357.00 | $476.00 | 25% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Family Intervention W/O Patient | $108.37 | $144.49 | 25% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Family Therapy W/O Pt | $170.94 | $227.92 | 25% |
| Family therapy without the patient, 50 minutes inpatient CPT 90846 HC Family Therapy W/O Pt Ph | $324.24 | $432.32 | 25% |
| Group psychotherapy session CPT 90853 HC Goal Psychothrpy Track 1&2 | $198.00 | $264.00 | 25% |
| Group psychotherapy session CPT 90853 HC Cognitive Behavior Group | $200.64 | $267.52 | 25% |
| Group psychotherapy session CPT 90853 HC Sensory Awareness Group Tx | $200.64 | $267.52 | 25% |
| Group psychotherapy session CPT 90853 HC Stress Mgmt Group | $200.64 | $267.52 | 25% |
| Group psychotherapy session CPT 90853 HC Assertive Group | $200.64 | $267.52 | 25% |
| Group psychotherapy session CPT 90853 HC Group Treatment | $210.00 | $280.00 | 25% |
| Group psychotherapy session CPT 90853 HC Stress Mgmt Group Ph | $255.36 | $340.48 | 25% |
| Group psychotherapy session CPT 90853 HC Group Psychotherapy | $281.25 | $375.00 | 25% |
| Group psychotherapy session CPT 90853 HC Cognitive Behavior Group Ph | $281.40 | $375.20 | 25% |
| Group psychotherapy session CPT 90853 HC Group Psychotherapy Ph | $281.40 | $375.20 | 25% |
| Group psychotherapy session CPT 90853 HC Assertive Group Ph | $281.40 | $375.20 | 25% |
| Group psychotherapy session CPT 90853 HC Goal Psychothrpy Track 1&2 Ph | $281.40 | $375.20 | 25% |
| Group psychotherapy session CPT 90853 HC Sensory Awareness Group Tx Ph | $281.40 | $375.20 | 25% |
| Group psychotherapy session CPT 90853 HC Intensive OP Prog (Iop) | $460.32 | $613.76 | 25% |
| Group psychotherapy session inpatient CPT 90853 HC Stress Mgmt Group | $200.64 | $267.52 | 25% |
| Group psychotherapy session inpatient CPT 90853 HC Assertive Group | $200.64 | $267.52 | 25% |
| Group psychotherapy session inpatient CPT 90853 HC Cognitive Behavior Group | $200.64 | $267.52 | 25% |
| Group psychotherapy session inpatient CPT 90853 HC Goal Psychothrpy Track 1&2 Ph | $281.40 | $375.20 | 25% |
| Group psychotherapy session inpatient CPT 90853 HC Cognitive Behavior Group Ph | $281.40 | $375.20 | 25% |
| Group psychotherapy session inpatient CPT 90853 HC Group Psychotherapy Ph | $281.40 | $375.20 | 25% |
| Group psychotherapy session inpatient CPT 90853 HC Sensory Awareness Group Tx Ph | $281.40 | $375.20 | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Cota Therapeutic Exer/Isokin Trng Each 15 Min | $93.00 | $124.00 | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Pta Ther Exer/Isokin Trng Each 15 Min | $93.00 | $124.00 | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 HC Therapeutic Exer/Isokin Trng Each 15 Min | $106.57 | $142.10 | 25% |
| Physical therapy, therapeutic exercise (15-minute unit) inpatient CPT 97110 HC Pta Ther Exer/Isokin Trng Each 15 Min | $93.00 | $124.00 | 25% |
| Psychotherapy session, 30 minutes CPT 90832 HC Indiv Therapy 16-37 Mins | $113.52 | $151.36 | 25% |
| Psychotherapy session, 30 minutes CPT 90832 HC Indiv Therapy 16-37 Mins Ph | $155.40 | $207.20 | 25% |
| Psychotherapy session, 30 minutes CPT 90832 HC Discharge Conference | $196.02 | $261.36 | 25% |
| Psychotherapy session, 30 minutes CPT 90832 HC Indiv. Psychotherapy 16 -37 Mins | $236.04 | $314.72 | 25% |
| Psychotherapy session, 30 minutes CPT 90832 HC Discharge Conference Ph | $274.68 | $366.24 | 25% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC Indiv Therapy 16-37 Mins Ph | $155.40 | $207.20 | 25% |
| Psychotherapy session, 30 minutes inpatient CPT 90832 HC Discharge Conference | $196.02 | $261.36 | 25% |
| Psychotherapy session, 45 minutes CPT 90834 HC Indiv Therapy 38-52 Mins | $184.80 | $246.40 | 25% |
| Psychotherapy session, 45 minutes CPT 90834 HC Indiv Therapy 38 - 52 Mins Ph | $274.68 | $366.24 | 25% |
| Psychotherapy session, 45 minutes CPT 90834 HC Indiv. Psychotherapy 38-52 Mins | $352.80 | $470.40 | 25% |
| Psychotherapy session, 45 minutes inpatient CPT 90834 HC Indiv Therapy 38-52 Mins | $184.80 | $246.40 | 25% |
| Psychotherapy session, 60 minutes CPT 90837 HC Indiv Therapy 53+Min | $274.56 | $366.08 | 25% |
| Psychotherapy session, 60 minutes CPT 90837 HC Indiv Therapy 53+ Min Ph | $384.72 | $512.96 | 25% |
| Psychotherapy session, 60 minutes CPT 90837 HC Indiv. Psychotherapy 53+ Mins | $389.76 | $519.68 | 25% |
| Psychotherapy session, 60 minutes inpatient CPT 90837 HC Indiv Therapy 53+ Min Ph | $384.72 | $512.96 | 25% |
Source file: https://apps.trihealth.com/static/pricing/310537486_THEGOODSAMARITANHOSPITAL_STANDARDCHARGES.csv