CMS Price Transparency Data

CT scan, pelvis

Facility: Good Samaritan Hospital

Billing Code: 72192 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72192
Insurance Median: $6,678
Cash Discount Price: $13,187
vs. Medicare Baseline: 62.52x Medicare

The contracted insurance negotiated median rate for a CT scan, pelvis at Good Samaritan Hospital is $6,678. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,187. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 62.52x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

$13,187

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,678

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: $13,187 (12346%)

Insurance Median: $6,678 (6252%)

Cash: $13,187 (12346% of Medicare)

Ins. Median: $6,678 (6252% 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 6252% of the Medicare baseline (a markup of 6152%). 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	$78	73%
Physicians Medical Group	$117	110%
Blue Cross Blue Shield	$129 - $728	121%
United	$245 - $4,963	229%
Medcare Partners	$1,252 - $2,919	1172%
Aetna	$2,044 - $5,074	1914%
Blue Shield	$2,362	2211%
Nx Health Network	$5,009 - $11,678	4690%
Sutter Select	$5,009 - $11,678	4690%
Multiplan	$5,426 - $15,570	5080%
Humana	$5,844 - $13,624	5471%
First Health	$6,344 - $19,463	5940%
Cigna	$6,678 - $15,570	6252%
Healthsmart	$6,678 - $16,543	6252%
Intercontinental Corporation	$6,678 - $15,570	6252%
Pha Pacific Health Alliance	$6,678 - $15,570	6252%
Ppo Next	$6,678 - $15,570	6252%

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 $13,187.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72192.

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 72192.
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.