CMS Price Transparency Data

X-ray, lower back

Facility: Good Samaritan Hospital

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72110
Insurance Median: $221
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a X-ray, lower back at Good Samaritan Hospital is $221. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.07x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$221

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Insurance Median: $221 (207%)

Ins. Median: $221 (207% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 207% of the Medicare baseline (a markup of 107%). 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	$35	33%
Physicians Medical Group	$43	40%
Blue Cross Blue Shield	$48 - $295	45%
Cigna	$156	146%
United	$245	229%
Blue Shield	$365	342%
Aetna	$4,973 - $5,074	4656%

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 $X.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72110.

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 72110.
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.