CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: Good Samaritan Hospital

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72148
  • Insurance Median: $5,024
  • Cash Discount Price: $22,183
  • vs. Medicare Baseline: 20.61x Medicare
The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at Good Samaritan Hospital is $5,024. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $22,183. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 20.61x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.
Cash / Self-Pay
$22,183

Average discount available for prompt cash payment at this facility.

Insurance Median
$5,024

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)
Cash / Self-Pay: $22,183 (9100%)
Insurance Median: $5,024 (2061%)
Cash: $22,183 (9100% of Medicare)
Ins. Median: $5,024 (2061% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 2061% of the Medicare baseline (a markup of 1961%). 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 $117 48%
Physicians Medical Group $181 74%
Blue Cross Blue Shield $200 - $1,053 82%
United $518 - $5,657 212%
Medcare Partners $3,327 1365%
Blue Shield $4,970 2039%
Aetna $4,973 - $5,074 2040%
Nx Health Network $13,310 5460%
Sutter Select $13,310 5460%
Multiplan $14,419 - $17,746 5915%
Humana $15,528 6370%
First Health $16,859 - $22,183 6916%
Cigna $17,746 7280%
Healthsmart $17,746 - $18,855 7280%
Intercontinental Corporation $17,746 7280%
Pha Pacific Health Alliance $17,746 7280%
Ppo Next $17,746 7280%

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