CMS Price Transparency Data

CT scan, pelvis

Facility: Good Samaritan Hospital

Billing Code: 72192 (CPT)

The BaseRate · fair price medium confidence
A fair price for this
$237
about 2.2× the $107 Medicare rate · typically $128–$659
modeled estimate · not a bill or quote
What this hospital charges insurers
$690
Well above the fair price
about $453 over the fair price · 6.4× Medicare
Medicare pays $107 Fair price $237 This hospital $690 Cash price $13,187 Hospital's list price $13,187

How we calculate the fair BaseRate →

How this hospital compares to other CA hospitals

Highest price of the 9 CA hospitals we have prices for — worth calling around.

Cheapest $46 Priciest $690

Black dot = this hospital, among the 9 CA hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a CT scan, pelvis is about $237 (about 2.2× the $107 Medicare rate). Good Samaritan Hospital charges insurers about $690, or about $13,187 in cash — well above the fair price. Located in San Jose, CA.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $237. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company Price range vs. Medicare
UnitedHealthcaremajor $245 - $4,963 229%
Blue Cross Blue Shieldmajor $129 - $2,362 121%
Aetnamajor $2,044 - $5,074 1914%
Cignamajor $6,678 - $15,570 6252%
Humanamajor $5,844 - $13,624 5471%
Health Net $5,009 - $11,678 4690%
+ 6 smaller / regional plans $78 - $15,570
Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Insurance Before you use insurance

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

Enter your details and press estimate to compare.

Facility Profile & Credentials

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