CMS Price Transparency Data

Diagnostic mammogram (both breasts)

Facility: Good Samaritan Hospital

Billing Code: 77066 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77066
  • Insurance Median: $820
  • Cash Discount Price: $1,739
  • vs. Medicare Baseline: 5.22x Medicare
The contracted insurance negotiated median rate for a Diagnostic mammogram (both breasts) at Good Samaritan Hospital is $820. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,739. Compared to the federal Medicare reimbursement reference rate of $156.98, this hospital’s rate is 5.22x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.
Cash / Self-Pay
$1,739

Average discount available for prompt cash payment at this facility.

Insurance Median
$820

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$156.98

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $156.98 (100%)
Cash / Self-Pay: $1,739 (1108%)
Insurance Median: $820 (522%)
Cash: $1,739 (1108% of Medicare)
Ins. Median: $820 (522% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $156.98 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 522% of the Medicare baseline (a markup of 422%). 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 $101 - $478 64%
Physicians Medical Group $108 69%
Blue Cross Blue Shield $119 - $864 76%
Blue Shield $155 - $1,104 99%
Cigna $155 - $2,013 99%
Health Net $155 - $586 99%
Aetna $159 - $5,074 101%
Affinity Medical Group $159 101%
Alignment Health Plan $159 101%
Central Health Plan $159 101%
Clever Care Of Golden State $159 101%
Easy Choice Health Plan $159 101%
Humana $159 - $1,761 101%
Managed Health Network $159 101%
On Lok Senior Health $159 101%
Palo Alto Medical $159 - $206 101%
Scan Health Plan $159 101%
Triwest Healthcare Alliance $159 101%
University Healthcare $159 101%
Vitality Health Plan $159 101%
Care1St Health Plan $162 103%
United $162 - $642 103%
Medcare Partners $169 - $377 108%
Corvel Corporation $185 118%
Affinity Medical Group Comm $206 131%
Canopy $286 182%
Nx Health Network $676 - $1,510 431%
Sutter Select $676 - $1,510 431%
Multiplan $733 - $2,013 467%
First Health $857 - $2,516 546%
Healthsmart $902 - $2,139 575%
Intercontinental Corporation $902 - $2,013 575%
Pha Pacific Health Alliance $902 - $2,013 575%
Ppo Next $902 - $2,013 575%

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