CMS Price Transparency Data

X-ray, shoulder

Facility: Woodlawn Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $155
Cash Discount Price: $428
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Woodlawn Hospital is $155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $428. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 1.74x the Medicare baseline. Located in 1400 E 9Th St, Rochester, IN.

Cash / Self-Pay

$428

Average discount available for prompt cash payment at this facility.

Insurance Median

$155

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: $428 (481%)

Insurance Median: $155 (174%)

Cash: $428 (481% of Medicare)

Ins. Median: $155 (174% 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
Blue Cross Blue Shield	$15 - $548	17%
Caresource Mcaid Hww	$15	17%
Mdwise Excel Hhw & Hcc	$15	17%
Mhs Mcaid Hcc	$15	17%
Mhs Mcaid Hhw	$15	17%
UnitedHealthcare	$15 - $520	17%
Aetna	$100 - $650	112%
Caresource Mcaid Hip	$100 - $150	112%
Caresource Mcr Adv	$100 - $150	112%
Humana	$100 - $531	112%
Mdwise Mcaid Excel Hip	$100 - $150	112%
Mhs Exch Mrktplce-All Other Plans	$100 - $150	112%
Mhs Mcaid Hip	$100 - $150	112%
Mhs Mcr Adv	$102 - $153	115%
Caresource Exch - All Other Plans	$130 - $196	146%
Ambetter / Centene	$133 - $200	150%
Partners Direct Health-All Plans	$310 - $465	349%
Cigna	$326 - $581	367%
Parkview Health Plans-All Plans	$342 - $513	385%
Sagamore All Other Grps - All Other Plans	$383 - $575	431%
Encore Comm-All Plans	$388 - $581	436%
Phcs/Multiplan-All Plans	$424 - $636	477%
Community Health Alliance-All Plans	$433 - $650	487%

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 $428.
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 Woodlawn 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.