CMS Price Transparency Data

X-ray, shoulder

Facility: Virginia Gay Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $167
Cash Discount Price: $277
vs. Medicare Baseline: 1.88x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Virginia Gay Hospital is $167. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $277. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 1.88x the Medicare baseline. Located in 502 North 9Th Avenue, Vinton, IA.

Cash / Self-Pay

$277

Average discount available for prompt cash payment at this facility.

Insurance Median

$167

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: $277 (312%)

Insurance Median: $167 (188%)

Cash: $277 (312% of Medicare)

Ins. Median: $167 (188% 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
Aetna	$28	31%
Wellmark Hmo	$60	67%
Wellmark Ppo-All Other Plans	$65	73%
Medicaid / KanCare	$89 - $150	100%
UnitedHealthcare	$116 - $167	130%
Va Ccn-All Plans	$126 - $130	142%
Health Alliance Mcr Adv	$133 - $137	150%
Medical Associates-All Plans	$256 - $263	288%
Cedar Valley Community Healthcare-All Plans	$268 - $276	301%
Humana	$273 - $281	307%
Health Partners-All Plans	$290 - $298	326%
Healthsmart-All Plans	$290 - $298	326%
Corvel-All Plans	$317 - $326	357%
Health Alliance-All Other Plans	$324 - $333	364%

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 $277.
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 Virginia Gay 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.