CMS Price Transparency Data

X-ray, shoulder

Facility: Good Samaritan Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $1,788
Cash Discount Price: $3,316
vs. Medicare Baseline: 20.11x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Good Samaritan Hospital is $1,788. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,316. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 20.11x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

$3,316

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,788

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$88.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $88.91 (100%)

Cash / Self-Pay: $3,316 (3730%)

Insurance Median: $1,788 (2011%)

Cash: $3,316 (3730% of Medicare)

Ins. Median: $1,788 (2011% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $88.91 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 2011% of the Medicare baseline (a markup of 1911%). 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	$23	26%
Physicians Medical Group	$26	29%
Blue Cross Blue Shield	$28 - $197	31%
Cigna	$129 - $3,186	145%
United	$182 - $1,016	205%
Blue Shield	$229	258%
Medcare Partners	$397 - $597	447%
Health Net	$617 - $928	694%
Nx Health Network	$1,589 - $2,390	1787%
Sutter Select	$1,589 - $2,390	1787%
Multiplan	$1,722 - $3,186	1937%
Humana	$1,854 - $2,788	2085%
First Health	$2,013 - $3,983	2264%
Healthsmart	$2,119 - $3,386	2383%
Intercontinental Corporation	$2,119 - $3,186	2383%
Pha Pacific Health Alliance	$2,119 - $3,186	2383%
Ppo Next	$2,119 - $3,186	2383%
Aetna	$4,973 - $5,074	5593%

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 $3,316.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 73030.

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 73030.
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.