CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: Good Samaritan Hospital

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $6,296
Cash Discount Price: $15,782
vs. Medicare Baseline: 58.95x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at Good Samaritan Hospital is $6,296. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,782. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 58.95x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

$15,782

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,296

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: $15,782 (14776%)

Insurance Median: $6,296 (5895%)

Cash: $15,782 (14776% of Medicare)

Ins. Median: $6,296 (5895% 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 5895% of the Medicare baseline (a markup of 5795%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

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

Billing Status

Remaining Deductible ($)

Your Coinsurance 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	$132	124%
Blue Cross Blue Shield	$145 - $713	136%
United	$245 - $5,373	229%
Medcare Partners	$1,574 - $3,161	1474%
Aetna	$2,044 - $5,074	1914%
Blue Shield	$2,362	2211%
Nx Health Network	$6,296 - $12,642	5895%
Sutter Select	$6,296 - $12,642	5895%
Multiplan	$6,821 - $16,857	6386%
Humana	$7,346 - $14,749	6878%
First Health	$7,976 - $21,071	7467%
Cigna	$8,395 - $16,857	7860%
Healthsmart	$8,395 - $17,910	7860%
Intercontinental Corporation	$8,395 - $16,857	7860%
Pha Pacific Health Alliance	$8,395 - $16,857	7860%
Ppo Next	$8,395 - $16,857	7860%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $15,782.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72131.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Good Samaritan Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72131.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.