CMS Price Transparency Data

CT scan, chest (no contrast)

Facility: Good Samaritan Hospital

Billing Code: 71250 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 71250
  • Insurance Median: $3,389
  • Cash Discount Price: $22,592
  • vs. Medicare Baseline: 31.73x Medicare
The contracted insurance negotiated median rate for a CT scan, chest (no contrast) at Good Samaritan Hospital is $3,389. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22,592. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 31.73x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.
Cash / Self-Pay
$22,592

Average discount available for prompt cash payment at this facility.

Insurance Median
$3,389

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $22,592 (21152%)
Insurance Median: $3,389 (3173%)
Cash: $22,592 (21152% of Medicare)
Ins. Median: $3,389 (3173% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 3173% of the Medicare baseline (a markup of 3073%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group Contract Rate Range vs. Medicare Reference
Santa Clara Family Health Plan $79 74%
Physicians Medical Group $133 125%
Blue Cross Blue Shield $147 - $728 138%
United $245 - $5,761 229%
Aetna $2,044 - $5,074 1914%
Blue Shield $2,362 2211%
Medcare Partners $3,389 3173%
Nx Health Network $13,555 12691%
Sutter Select $13,555 12691%
Multiplan $14,685 - $18,074 13749%
Humana $15,814 14806%
First Health $17,170 - $22,592 16075%
Cigna $18,074 16922%
Healthsmart $18,074 - $19,203 16922%
Intercontinental Corporation $18,074 16922%
Pha Pacific Health Alliance $18,074 16922%
Ppo Next $18,074 16922%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 2425 Samaritan Drive, San Jose, CA 95124
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals