CMS Price Transparency Data

X-ray, shoulder

Facility: San Dimas Community Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $111
Cash Discount Price: $111
vs. Medicare Baseline: 1.25x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at San Dimas Community Hospital is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 1.25x the Medicare baseline. Located in 1350 W Covina Blvd, San Dimas, CA.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $111 (125%)

Insurance Median: $111 (125%)

Cash: $111 (125% of Medicare)

Ins. Median: $111 (125% 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.

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
Aids Healthcare Foundation	$26 - $114	29%
Blue Shield Of Promise	$26	29%
Heritage Provider Network Inc	$26 - $145	29%
La Care Health Plan	$26 - $111	29%
Molina Healthcare	$26 - $111	29%
Traditional Medi-Cal	$26	29%
Blue Cross Blue Shield	$27 - $125	30%
Health Net Of Ca	$27 - $163	30%
UnitedHealthcare	$72 - $145	81%
Blue Shield Of Ca	$75 - $111	84%
Rios	$106	119%
Central Health Plan	$111	125%
Choice Physicians Network	$111	125%
Citrus Valley Physicians Group	$111	125%
Elite Health Plan	$111	125%
Health Excel Inc	$111	125%
Medicare (plans)	$111	125%
Patient Choice Health Plan	$111	125%
Primecare Medical Network	$111 - $145	125%
Renal Payer Solutions	$111	125%
Tricare	$111	125%
Brand New Day	$112 - $167	126%
Imperial Health Plan Inc	$118	133%
Aetna	$142	160%
Ca Foundation For Medical Care	$147	165%
Worker Comp	$147	165%
Employer Direct Healthcare	$156	175%

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 $111.
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 San Dimas Community 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.