CMS Price Transparency Data

X-ray, shoulder

Facility: Adventist Health St Helena

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $579
Cash Discount Price: $141
vs. Medicare Baseline: 6.51x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Adventist Health St Helena is $579. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $141. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 6.51x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$141

Average discount available for prompt cash payment at this facility.

Insurance Median

$579

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: $141 (159%)

Insurance Median: $579 (651%)

Cash: $141 (159% of Medicare)

Ins. Median: $579 (651% 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 651% of the Medicare baseline (a markup of 551%). 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
Blue Shield Bh Mcr Adv	$10 - $116	11%
Blue Shield Mcr Adv	$10 - $116	11%
Kaiser Mcr Adv	$10 - $116	11%
Tricare	$10 - $116	11%
Ah Employee Health Plan - All Plans	$11 - $208	12%
Cigna	$12 - $1,631	13%
Interplan-All Plans	$12 - $1,325	13%
Kaiser-All Other Plans	$12 - $1,672	13%
Blue Shield Epn-All Other Plans	$14 - $960	16%
Blue Shield Non-Epn	$15 - $946	17%
Western Growers-All Plans	$15 - $1,081	17%
Phcs-All Plans	$22 - $1,121	25%
Medi-Cal	$26	29%
Aetna	$33 - $137	37%
Health Management Network-All Plans	$34 - $1,733	38%
Three Rivers-All Plans	$36 - $1,835	40%
Va Medi-Cal	$37	42%
UnitedHealthcare	$42 - $1,300	47%
Healthnet-All Plans	$80	90%
Va Mcr - All Other Plans	$116	130%
Blue Cross Blue Shield	$141 - $189	159%
Blue Shield Behav Hlth	$195 - $918	219%
Choicecare-All Plans	$303 - $1,427	341%
Beech Street-All Plans	$325 - $1,529	366%
Galaxy Network-All Plans	$390 - $1,835	439%

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 $141.
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 Adventist Health St Helena 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.