CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Good Samaritan Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $1,051
Cash Discount Price: $2,142
vs. Medicare Baseline: 7.75x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Good Samaritan Hospital is $1,051. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,142. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 7.75x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

$2,142

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,051

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $2,142 (1580%)

Insurance Median: $1,051 (775%)

Cash: $2,142 (1580% of Medicare)

Ins. Median: $1,051 (775% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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 775% of the Medicare baseline (a markup of 675%). 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
Physicians Medical Group	$54	40%
Blue Cross Blue Shield	$59	44%
Aetna	$197 - $493	145%
Medcare Partners	$197 - $349	145%
Santa Clara Family Health Plan	$250 - $442	184%
Health Net	$306 - $542	226%
United	$335 - $593	247%
Santa Clara Ipa Comm	$657 - $1,163	485%
Santa Clara Ipa Mcr	$657 - $1,163	485%
Nx Health Network	$788 - $1,396	581%
Sutter Select	$788 - $1,396	581%
Multiplan	$854 - $1,861	630%
Humana	$920 - $1,628	678%
First Health	$998 - $2,326	736%
Cigna	$1,051 - $1,861	775%
Healthsmart	$1,051 - $1,977	775%
Intercontinental Corporation	$1,051 - $1,861	775%
Pha Pacific Health Alliance	$1,051 - $1,861	775%
Ppo Next	$1,051 - $1,861	775%

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 $2,142.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.