CMS Price Transparency Data

X-ray, shoulder

Facility: Central Florida Lake Monroe Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $1,463
Cash Discount Price: $4,064
vs. Medicare Baseline: 16.45x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Central Florida Lake Monroe Hospital is $1,463. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,064. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 16.45x the Medicare baseline. Located in 1401 W Seminole Blvd, Sanford, FL.

Cash / Self-Pay

$4,064

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,463

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: $4,064 (4571%)

Insurance Median: $1,463 (1645%)

Cash: $4,064 (4571% of Medicare)

Ins. Median: $1,463 (1645% 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 1645% of the Medicare baseline (a markup of 1545%). 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
United	$182 - $2,195	205%
Freedom Health	$234 - $351	263%
Optimum	$234 - $351	263%
Corvel Corporation	$438	493%
Prime Health	$447	503%
Careworks (Rockport Community)	$461	519%
Simply	$501 - $751	563%
Molina Healthcare	$618 - $1,561	695%
Humana	$650 - $975	731%
Evolutions	$748 - $1,122	841%
Avmed	$780 - $2,439	877%
Sunshine State Health Plan	$829 - $1,244	932%
Aetna	$975 - $1,463	1097%
Florida Health Care Plan	$1,226 - $1,839	1379%
Plotkin Health	$1,626 - $2,439	1829%
Prime Health Sheriff	$1,626 - $2,439	1829%
Multiplan	$2,438 - $4,146	2742%
Three Rivers Provider Network	$2,438 - $3,658	2742%
Ppo Next	$2,763 - $4,146	3108%
Novanet	$2,926 - $4,390	3291%

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 $4,064.
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 Central Florida Lake Monroe 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.