CMS Price Transparency Data

Physical therapy (functional capacity test)

Facility: Good Samaritan Hospital

Billing Code: 97750 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 97750
  • Insurance Median: $73
  • Cash Discount Price: $589
  • vs. Medicare Baseline: 2.16x Medicare
The contracted insurance negotiated median rate for a Physical therapy (functional capacity test) at Good Samaritan Hospital is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $589. Compared to the federal Medicare reimbursement reference rate of $33.73, this hospital’s rate is 2.16x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.
Cash / Self-Pay
$589

Average discount available for prompt cash payment at this facility.

Insurance Median
$73

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$33.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $33.73 (100%)
Cash / Self-Pay: $589 (1746%)
Insurance Median: $73 (216%)
Cash: $589 (1746% of Medicare)
Ins. Median: $73 (216% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $33.73 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 216% of the Medicare baseline (a markup of 116%). 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
Physicians Medical Group $16 47%
Blue Cross Blue Shield $18 - $43 53%
Aetna $38 - $126 113%
Affinity Medical Group $38 - $43 113%
Alignment Health Plan $38 - $43 113%
Central Health Plan $38 - $43 113%
Clever Care Of Golden State $38 - $43 113%
Easy Choice Health Plan $38 - $43 113%
Humana $38 - $415 113%
Managed Health Network $38 - $43 113%
On Lok Senior Health $38 - $43 113%
Palo Alto Medical $38 - $56 113%
Santa Clara Family Health Plan $38 - $113 113%
Scan Health Plan $38 - $43 113%
Triwest Healthcare Alliance $38 - $43 113%
University Healthcare $38 - $43 113%
Vitality Health Plan $38 - $43 113%
Blue Shield $39 - $132 116%
Care1St Health Plan $39 - $44 116%
United $39 - $151 116%
Health Net $43 - $138 127%
Corvel Corporation $44 - $51 130%
Affinity Medical Group Comm $50 - $56 148%
Medcare Partners $54 - $89 160%
Canopy $69 - $78 205%
Bright Health $72 - $119 213%
Nx Health Network $214 - $356 634%
Sutter Select $214 - $356 634%
Multiplan $232 - $475 688%
First Health $271 - $594 803%
Cigna $286 - $475 848%
Healthsmart $286 - $504 848%
Intercontinental Corporation $286 - $475 848%
Pha Pacific Health Alliance $286 - $475 848%
Ppo Next $286 - $475 848%

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