CMS Price Transparency Data

X-ray, shoulder

Facility: Kootenai Health

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $34
Cash Discount Price: $249
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Kootenai Health is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $249. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 0.38x the Medicare baseline. Located in 2003 Kootenai Health Way, Coeur D'Alene, ID.

Cash / Self-Pay

$249

Average discount available for prompt cash payment at this facility.

Insurance Median

$34

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: $249 (280%)

Insurance Median: $34 (38%)

Cash: $249 (280% of Medicare)

Ins. Median: $34 (38% 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
Coordinated Care Of Washington	$5 - $19	6%
Molina Healthcare Of Idaho	$5 - $123	6%
Molina Healthcare Of Washington	$5 - $19	6%
Magellan	$8 - $27	9%
Wellpoint	$8 - $27	9%
Aetna	$9 - $276	10%
Blue Cross Blue Shield	$9 - $299	10%
Humana	$9 - $90	10%
Pacificsource	$9 - $272	10%
Premera	$9 - $205	10%
Regence Blue Shield Of Idaho	$9 - $90	10%
UnitedHealthcare	$9 - $299	10%
Group Health/Kaiser	$13 - $324	15%
Mountain Health Co-Op	$257	289%
Cigna	$272 - $276	306%
Interwest Health	$282	317%
First Choice Health (Ameriben)	$283 - $288	318%

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 $249.
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 Kootenai Health 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.