ST. Mary's Good Samaritan Hospital, INC.

ST. Mary's Good Samaritan Hospital, INC. was paid $5.05M by Medicaid between Jan 2018 and Dec 2024, across 129 billing codes. Its largest line is 99283, emergency room visit (moderate) — 23% of everything it billed.

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2018	41,054	$930K
2019	38,001	$811K
2020	28,440	$492K
2021	33,797	$676K
2022	34,355	$708K
2023	39,764	$829K
2024incomplete	24,676	$609K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
99283	Emergency room visit (moderate)Emergency department visit for the evaluation and management, moderate severity	23%	19,401	17,152	$1.18M
99284	Emergency room visit (serious)Emergency department visit for the evaluation and management, high severity	13%	9,004	7,539	$648K
87636	Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B	8.3%	5,240	4,703	$420K
74177	Computed tomography, abdomen and pelvis; with contrast material	7.2%	2,341	2,001	$363K
70450	Computed tomography, head or brain; without contrast material	6.9%	2,308	1,928	$347K
99285	Emergency room visit (most serious)Emergency department visit for the evaluation and management, high severity with immediate threat to life	6.2%	5,328	4,281	$312K
99282	Emergency department visit for the evaluation and management, low to moderate severity	5.5%	4,966	4,434	$277K
71046	Radiologic examination, chest; 2 views	3.0%	6,328	5,480	$154K
96375	Therapeutic injection; each additional sequential IV push	2.1%	5,430	4,037	$106K
96374	Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance	1.8%	7,164	5,339	$91K
96365	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	1.7%	2,334	1,580	$85K
80053	Comprehensive metabolic panel	1.3%	14,454	10,715	$68K

117 more codes

93005	Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report	1.3%	6,437	$65K
96361	Intravenous infusion, hydration; each additional hour	1.3%	3,127	$64K
C9803	Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source	1.1%	5,243	$57K
85025	Blood count; complete (CBC), automated, and automated differential WBC count	1.1%	15,121	$55K
99291	Critical care, evaluation and management of the critically ill patient, first 30-74 minutes	1.0%	738	$51K
96372	Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular	<1%	4,421	$47K
83880		<1%	2,710	$43K
71045	Radiologic examination, chest; single view	<1%	2,737	$37K
74176	Computed tomography, abdomen and pelvis; without contrast material	<1%	332	$35K
87804	Infectious agent antigen detection by immunoassay; Influenza, each type	<1%	4,955	$34K
97110	Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion	<1%	1,283	$28K
94640	Pressurized or nonpressurized inhalation treatment for acute airway obstruction	<1%	2,337	$27K
80307	Drug test(s), presumptive, any number of drug classes; immunoassay	<1%	890	$25K
84484		<1%	5,069	$25K
83735		<1%	8,023	$24K
Q9967	Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	<1%	3,004	$21K
87635	Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe	<1%	765	$21K
87880	Infectious agent antigen detection by immunoassay; Streptococcus, group A	<1%	3,145	$20K
87086	Culture, bacterial; quantitative colony count, urine	<1%	4,888	$18K
U0003	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r	<1%	293	$15K
73562		<1%	315	$13K
81025		<1%	3,379	$13K
87081		<1%	3,922	$12K
99281	Emergency department visit for the evaluation and management, self-limited or minor	<1%	307	$12K
83605		<1%	2,343	$12K
83690		<1%	3,596	$12K
84443	Thyroid stimulating hormone (TSH)	<1%	1,312	$11K
87430		<1%	1,578	$11K
74018		<1%	632	$11K
96376		<1%	619	$11K
81001		<1%	7,341	$10K
96360	Intravenous infusion, hydration; initial, 31 minutes to 1 hour	<1%	331	$9K
71275	Computed tomographic angiography, chest, with contrast material	<1%	42	$8K
72125	Computed tomography, cervical spine; without contrast material	<1%	61	$8K
93306	Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete	<1%	63	$7K
73630		<1%	242	$7K
72100		<1%	204	$7K
80048	Basic metabolic panel (calcium, ionized)	<1%	1,505	$6K
87077		<1%	1,521	$6K
G0378	Hospital observation service, per hour	<1%	251	$6K
87807		<1%	777	$5K
87186		<1%	1,341	$5K
J7030	Infusion, normal saline solution , 1000 cc	<1%	4,642	$5K
97530	Therapeutic activities, direct patient contact, each 15 minutes	<1%	341	$5K
85379		<1%	930	$4K
85610		<1%	2,590	$4K
97140	Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage)	<1%	264	$4K
73610		<1%	142	$4K
87040		<1%	881	$4K
82550		<1%	1,823	$3K
81003		<1%	3,248	$3K
71250		<1%	14	$3K
71260	Computed tomography, thorax, diagnostic; with contrast material	<1%	12	$3K
73030		<1%	101	$3K
J2270	Injection, morphine sulfate, up to 10 mg	<1%	1,845	$2K
97112	Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination	<1%	173	$2K
J0696	Injection, ceftriaxone sodium, per 250 mg	<1%	2,327	$2K
J7120	Ringers lactate infusion, up to 1000 cc	<1%	2,547	$2K
36415	Collection of venous blood by venipuncture	<1%	7,782	$2K
J1885	Injection, ketorolac tromethamine, per 15 mg	<1%	3,263	$2K
J2405	Injection, ondansetron hydrochloride, per 1 mg	<1%	3,440	$2K
APT15		<1%	180	$2K
87591	Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe	<1%	148	$2K
82553		<1%	258	$2K
J0561	Injection, penicillin g benzathine, 100,000 units	<1%	20	$2K
87491	Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe	<1%	136	$2K
85730		<1%	737	$2K
86140		<1%	590	$1K
87420		<1%	251	$1K
73130		<1%	41	$1K
83036	Hemoglobin; glycosylated (A1C)	<1%	240	$1K
84439		<1%	246	$1K
82077		<1%	155	$1K
0241U	Neonatal screening for hereditary disorders, genomic sequence analysis panel	<1%	12	$1K
J1100	Injection, dexamethasone sodium phosphate, 1 mg	<1%	1,447	$1K
76705	Ultrasound, abdominal, real time with image documentation; limited	<1%	12	$964.67
77067	Screening mammography, bilateral, including computer-aided detection	<1%	22	$937.44
73110		<1%	27	$936.04
36000		<1%	29	$789.52
87400		<1%	88	$735.74
J2930	Injection, methylprednisolone sodium succinate, up to 125 mg	<1%	304	$703.28
U0005	Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2	<1%	55	$695.00
85027		<1%	239	$565.05
J3475	Injection, magnesium sulfate, per 500 mg	<1%	706	$551.35
80061	Lipid panel	<1%	167	$536.66
73502		<1%	14	$529.00
J1170	Injection, hydromorphone, up to 4 mg	<1%	480	$475.66
84702		<1%	84	$466.64
86901		<1%	71	$384.00
J1200	Injection, diphenhydramine hcl, up to 50 mg	<1%	858	$352.38
82803		<1%	18	$267.74
82306	Vitamin D; 25 hydroxy, includes fraction(s), if performed	<1%	14	$240.92
J2060	Injection, lorazepam, 2 mg	<1%	237	$228.19
86850		<1%	45	$218.51
J2550	Injection, promethazine hcl, up to 50 mg	<1%	174	$205.38
82565		<1%	80	$193.47
80320		<1%	15	$189.35
87070		<1%	33	$161.13
J2360	Injection, orphenadrine citrate, up to 60 mg	<1%	56	$138.90
86900		<1%	72	$131.37
90471	Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine	<1%	25	$88.39
84520		<1%	55	$84.08
36600		<1%	14	$80.66
85652		<1%	44	$71.20
J2765	Injection, metoclopramide hcl, up to 10 mg	<1%	67	$44.85
A9575	Injection, gadoterate meglumine, 0.1 ml	<1%	26	$43.42
87147		<1%	14	$32.44
J2272	Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg	<1%	19	$29.72
J7040	Infusion, normal saline solution, sterile (500 ml = 1 unit)	<1%	81	$28.02
J2543	Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)	<1%	21	$21.49
84100		<1%	38	$15.83
J2704	Injection, propofol, 10 mg	<1%	13	$13.00
J3010	Injection, fentanyl citrate, 0.1 mg	<1%	33	$11.50
J2250	Injection, midazolam hydrochloride, per 1 mg	<1%	60	$8.53
J7512	Prednisone, immediate release or delayed release, oral, 1 mg	<1%	40	$5.74
A9270	Non-covered item or service	<1%	3,298	$2.57
J2001	Injection, lidocaine hcl for intravenous infusion, 10 mg	<1%	15	$0.24

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.

From NPPES

Who's on the registration

Authorized officialPIERCE, STONISH (PRESIDENT & CEO)

Parent organizationST. MARY'S GOOD SAMARITAN HOSPITAL, INC.