CMS Price Transparency Data

MRI, brain (with and without contrast)

Facility: Good Samaritan Hospital

Billing Code: 70553 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 70553
Insurance Median: $21,861
Cash Discount Price: $32,724
vs. Medicare Baseline: 61.33x Medicare

The contracted insurance negotiated median rate for a MRI, brain (with and without contrast) at Good Samaritan Hospital is $21,861. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32,724. Compared to the federal Medicare reimbursement reference rate of $356.43, this hospital’s rate is 61.33x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

$32,724

Average discount available for prompt cash payment at this facility.

Insurance Median

$21,861

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$356.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $356.43 (100%)

Cash / Self-Pay: $32,724 (9181%)

Insurance Median: $21,861 (6133%)

Cash: $32,724 (9181% of Medicare)

Ins. Median: $21,861 (6133% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $356.43 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 6133% of the Medicare baseline (a markup of 6033%). 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	$203	57%
Physicians Medical Group	$317	89%
Blue Cross Blue Shield	$348 - $1,742	98%
United	$828 - $10,179	232%
Medcare Partners	$4,099 - $5,987	1150%
Aetna	$4,973 - $5,074	1395%
Blue Shield	$9,952	2792%
Nx Health Network	$16,396 - $23,950	4600%
Sutter Select	$16,396 - $23,950	4600%
Multiplan	$17,762 - $31,933	4983%
Humana	$19,129 - $27,941	5367%
First Health	$20,768 - $39,916	5827%
Cigna	$21,861 - $31,933	6133%
Healthsmart	$21,861 - $33,929	6133%
Intercontinental Corporation	$21,861 - $31,933	6133%
Pha Pacific Health Alliance	$21,861 - $31,933	6133%
Ppo Next	$21,861 - $31,933	6133%

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 $32,724.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 70553.

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 70553.
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.