CMS Price Transparency Data

Screening mammogram (both breasts)

Facility: Good Samaritan Hospital

Billing Code: 77067 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77067
  • Insurance Median: $696
  • Cash Discount Price: $2,220
  • vs. Medicare Baseline: 5.51x Medicare
The contracted insurance negotiated median rate for a Screening mammogram (both breasts) at Good Samaritan Hospital is $696. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,220. Compared to the federal Medicare reimbursement reference rate of $126.25, this hospital’s rate is 5.51x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.
Cash / Self-Pay
$2,220

Average discount available for prompt cash payment at this facility.

Insurance Median
$696

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$126.25

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $126.25 (100%)
Cash / Self-Pay: $2,220 (1758%)
Insurance Median: $696 (551%)
Cash: $2,220 (1758% of Medicare)
Ins. Median: $696 (551% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $126.25 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 551% of the Medicare baseline (a markup of 451%). 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 $84 - $498 67%
Physicians Medical Group $88 70%
Blue Cross Blue Shield $97 - $696 77%
Blue Shield $128 - $1,119 101%
Cigna $128 - $2,096 101%
Health Net $128 101%
Aetna $131 - $5,074 104%
Affinity Medical Group $131 104%
Alignment Health Plan $131 104%
Central Health Plan $131 104%
Clever Care Of Golden State $131 104%
Easy Choice Health Plan $131 104%
Humana $131 - $1,834 104%
Managed Health Network $131 104%
On Lok Senior Health $131 104%
Palo Alto Medical $131 - $170 104%
Scan Health Plan $131 104%
Triwest Healthcare Alliance $131 104%
University Healthcare $131 104%
Vitality Health Plan $131 104%
Care1St Health Plan $134 106%
United $134 - $668 106%
Corvel Corporation $153 121%
Affinity Medical Group Comm $170 135%
Medcare Partners $226 - $393 179%
Canopy $236 187%
Nx Health Network $905 - $1,572 717%
Sutter Select $905 - $1,572 717%
Multiplan $980 - $2,096 776%
First Health $1,146 - $2,620 908%
Healthsmart $1,207 - $2,227 956%
Intercontinental Corporation $1,207 - $2,096 956%
Pha Pacific Health Alliance $1,207 - $2,096 956%
Ppo Next $1,207 - $2,096 956%

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