CMS Price Transparency Data

CT scan, sinuses

Facility: Good Samaritan Hospital

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70486
Insurance Median: $13,044
Cash Discount Price: $22,030
vs. Medicare Baseline: 122.12x Medicare

The contracted insurance negotiated median rate for a CT scan, sinuses at Good Samaritan Hospital is $13,044. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22,030. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 122.12x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

$22,030

Average discount available for prompt cash payment at this facility.

Insurance Median

$13,044

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: $22,030 (20625%)

Insurance Median: $13,044 (12212%)

Cash: $22,030 (20625% of Medicare)

Ins. Median: $13,044 (12212% 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 12212% of the Medicare baseline (a markup of 12112%). 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	$84	79%
Physicians Medical Group	$126	118%
Blue Cross Blue Shield	$138 - $706	129%
United	$245 - $15,586	229%
Medcare Partners	$705 - $9,168	660%
Blue Shield	$1,889	1769%
Aetna	$2,044 - $5,074	1914%
Nx Health Network	$2,821 - $36,673	2641%
Sutter Select	$2,821 - $36,673	2641%
Multiplan	$3,056 - $48,897	2861%
Humana	$3,291 - $42,785	3081%
First Health	$3,573 - $61,121	3345%
Cigna	$3,761 - $48,897	3521%
Healthsmart	$3,761 - $51,953	3521%
Intercontinental Corporation	$3,761 - $48,897	3521%
Pha Pacific Health Alliance	$3,761 - $48,897	3521%
Ppo Next	$3,761 - $48,897	3521%

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 $22,030.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70486.

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 70486.
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.