CMS Price Transparency Data

X-ray, shoulder

Facility: Fishermen's Community Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $259
Cash Discount Price: $645
vs. Medicare Baseline: 2.91x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Fishermen's Community Hospital is $259. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $645. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.91x the Medicare baseline. Located in 3301 Overseas Hwy, Marathon, FL.

Cash / Self-Pay

$645

Average discount available for prompt cash payment at this facility.

Insurance Median

$259

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: $645 (725%)

Insurance Median: $259 (291%)

Cash: $645 (725% of Medicare)

Ins. Median: $259 (291% 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 291% of the Medicare baseline (a markup of 191%). 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
Amerigroup	$34 - $51	38%
Medicaid / KanCare	$34 - $56	38%
UnitedHealthcare	$34 - $992	38%
Sunshine State	$36 - $54	40%
Wellcare	$36 - $54	40%
Aetna	$37 - $760	42%
Vista	$37 - $55	42%
Blue Cross Blue Shield	$166 - $992	187%
Leon Medical	$208	234%
Medica Health Plan	$208	234%
Medicare (plans)	$208 - $281	234%
Humana	$227	255%
Avmed	$229 - $821	258%
Cigna	$237 - $794	267%
Non Contracted	$364	409%
International	$645	725%
Amerihealth	$744	837%
Dimension Health Plan	$744 - $893	837%
Affordable	$893	1004%
Phcs	$893	1004%
Quality Health	$893	1004%

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 $645.
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 Fishermen's 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.