CMS Price Transparency Data

X-ray, shoulder

Facility: Nemours Children's Hospital, Delaware

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $238
Cash Discount Price: $417
vs. Medicare Baseline: 2.68x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Nemours Children's Hospital, Delaware is $238. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $417. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.68x the Medicare baseline. Located in 1600 Rockland Rd Po Box 269, Wilmington, DE.

Cash / Self-Pay

$417

Average discount available for prompt cash payment at this facility.

Insurance Median

$238

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: $417 (469%)

Insurance Median: $238 (268%)

Cash: $417 (469% of Medicare)

Ins. Median: $238 (268% 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 268% of the Medicare baseline (a markup of 168%). 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
Us Family Health Plan	$13	15%
Celtic Transplant	$59 - $417	66%
Keystone First Hlth Plan	$83 - $185	93%
Tricare	$92	103%
Celtic Transplant For De First Health	$146	164%
UnitedHealthcare	$153 - $260	172%
Wellpoint Maryland	$154	173%
Kidz Partners	$158	178%
Health Partners	$162	182%
Upmc	$165	186%
Fidelis	$167	188%
Aetna	$177 - $242	199%
Blue Cross Blue Shield	$183 - $368	206%
Priority Partners John Hopkins	$205	231%
Six Degrees Health Transplant	$208	234%
Cigna	$229 - $263	258%
Great West-One Health Plan	$229 - $263	258%
Ambetter / Centene	$238	268%
Amerihealth Caritas Delaware	$238	268%
Geisinger Health Plan	$250	281%
Integra Administrative Group	$250	281%
National Transplant Network (Ntn)	$271	305%
Six Degrees Health	$271	305%
Star Healthcare Network	$271	305%
Life Trac Solid Organ And Bmt Transplant	$292	328%
First Health Network	$396	445%
Insurance Administrators Of America	$396	445%
Interlink Transplant Network	$396	445%
Multiplan	$396	445%
Preferred Healthcare	$396	445%
Private Healthcare Systems	$396	445%
Three Rivers Provider Network	$396	445%

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 $417.
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 Nemours Children's Hospital, Delaware 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.