X-ray, shoulder
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 73030 (CPT)
- CPT Billing Code: 73030
- Insurance Median: $406
- Cash Discount Price: $411
- vs. Medicare Baseline: 4.57x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 457% of the Medicare baseline (a markup of 357%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $22 - $86 | 25% |
| Aetna | $22 - $645 | 25% |
| Humana | $22 - $84 | 25% |
| Blue Cross Blue Shield | $49 - $169 | 55% |
| UnitedHealthcare | $75 - $512 | 84% |
| Kindful Hospice [20434] | $84 | 94% |
| Pace Of The Ozarks Contracted [320518] | $84 | 94% |
| Elara Caring Aspire Hospice [20433] | $84 | 94% |
| Cross Timbers Hospice [20098] | $84 | 94% |
| Medicare (plans) | $84 - $88 | 94% |
| Tricare | $84 | 94% |
| Mercy Hospice Okc [20252] | $84 | 94% |
| Halo Hcr Inc Hospice [20432] | $84 | 94% |
| Kindful Hospice Contracted [320434] | $84 | 94% |
| Dept Of Veteran Affairs Contracted [320106] | $84 | 94% |
| Halo Hcr Inc Hospice Contracted [320432] | $84 | 94% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $84 | 94% |
| Ambetter / Centene | $86 | 97% |
| Home State Health Plan Contracted [320187] | $86 | 97% |
| Providrs Care Network Contracted [320484] | $163 | 183% |
| Medica Contracted [320239] | $185 - $276 | 208% |
| Health Choice Contracted [320166] | $198 | 223% |
| Cigna | $242 - $248 | 272% |
| United Medical Resources Contracted [320454] | $342 - $512 | 385% |
| Imagine 360 Contracted [320494] | $406 - $607 | 457% |
| Yuzu Health Contracted [320521] | $406 - $607 | 457% |
| Mercy Benefit Admin Contracted [320251] | $406 - $607 | 457% |
| Healthlink Contracted [320179] | $406 - $607 | 457% |
| Edison Health Solutions Contracted [320502] | $406 - $607 | 457% |
| Workers Comp [20426] | $406 - $607 | 457% |
| Aither Health Contracted [320449] | $406 - $607 | 457% |
| Ebms Contracted [320493] | $406 - $607 | 457% |
| Reflect Health Contracted [320492] | $406 - $607 | 457% |
| Auxiant Contracted [320462] | $406 - $607 | 457% |
| American Healthcare Alliance Contracted [320020] | $406 - $607 | 457% |
| First Health Contracted [320128] | $431 - $645 | 485% |
Consumer Guidance & Cost Commentary
For the X-ray, shoulder procedure (CPT 73030) at Mercy Hospital Pittsburg, Inc., the facility's cash price of $411.00 is notably higher than the state average of $88.00, though it remains significantly lower than the facility's gross charge of $633.00. While commercial insurance plans like UnitedHealthcare and Aetna have negotiated rates ranging from $75 to $645, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying the cash rate directly. It is important to note that many commercial payers listed, such as Kindful Hospice and various contracted entities, have fixed negotiated rates of $84, which are lower than the cash price but still represent a substantial portion of the gross charge.
The facility's pricing is benchmarked against Medicare, which sets a fixed rate of $88.91 for this service. The facility's cash price of $411.00 represents a markup of 4.6 times the Medicare amount, which is consistent with the national average for this procedure. Commercial negotiated rates vary widely across the 36 payers represented, with some contracts reaching up to $645, while others remain fixed at $84. Patients should verify their specific plan's allowed amount before scheduling, as in-network rates do not always guarantee the lowest possible cost. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts, as paying upfront can sometimes bypass administrative fees and result in a lower final bill than the standard cash price listed.