CMS Price Transparency Data

X-ray, lower back

Facility: Good Samaritan Hospital of Suffern

Billing Code: 72110 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 72110
  • Insurance Median: $281
  • Cash Discount Price: $2,089
  • vs. Medicare Baseline: 2.63x Medicare
The contracted insurance negotiated median rate for a X-ray, lower back at Good Samaritan Hospital of Suffern is $281. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,089. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.63x the Medicare baseline. Located in 255 Lafayette Avenue, Suffern, NY.
Cash / Self-Pay
$2,089

Average discount available for prompt cash payment at this facility.

Insurance Median
$281

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%)
Cash / Self-Pay: $2,089 (1956%)
Insurance Median: $281 (263%)
Cash: $2,089 (1956% of Medicare)
Ins. Median: $281 (263% 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 263% of the Medicare baseline (a markup of 163%). 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
Emblem $92 - $196 86%
Mvp Gold (McR) $130 122%
Medicare (plans) $130 - $139 122%
Hamaspik (McR) $130 122%
Tricare $130 122%
Aetna $131 - $145 123%
Affinity By Molina McR $136 127%
Emblem Select Care (Exchange) $137 128%
Cigna $155 - $1,462 145%
Beacon Exchange $156 146%
Emblem Ghi/Hip PPO $162 152%
Mvp Exchange $165 154%
Beacon Commercial $169 158%
Blue Cross Blue Shield $278 - $1,718 260%
Self-Pay $308 288%
Mvp Hmo/Ppo $321 301%
Geisinger Health Commercial/Exchange $429 402%
Self-Pay - Cc 50% $1,044 977%
Cdphp $1,044 977%
Oxford Commercial $1,244 1165%
Oxford Exchange $1,351 1265%
UnitedHealthcare $1,351 - $1,589 1265%
Magnacare Standard $1,462 1369%
Multiplan $1,567 1467%
PHCS $1,567 1467%
Emblem Ghi/Hip Hmo/Epo/Pos $1,671 1564%
First Health $1,776 1663%
Magnacare Preferred $1,880 1760%
Mvp $18,190 - $21,438 17030%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 255 Lafayette Avenue, Suffern, NY 10901
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals