X-ray, shoulder
Facility: Nmc Health
Billing Code: 73030 (CPT)
- CPT Billing Code: 73030
- Insurance Median: $140
- Cash Discount Price: $227
- vs. Medicare Baseline: 1.57x 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.
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 |
|---|---|---|
| Bluestem Pace | $8 - $84 | 9% |
| Medicaid / KanCare | $13 - $134 | 15% |
| Leading Age | $13 - $134 | 15% |
| Wppa | $14 - $353 | 16% |
| Occunet | $16 - $385 | 18% |
| Samaritan Ministries International | $17 - $417 | 19% |
| Medincrease Health Plan | $17 - $417 | 19% |
| Prime Health Services | $20 - $481 | 22% |
| Aetna | $21 - $267 | 24% |
| UnitedHealthcare | $23 - $577 | 26% |
| Cigna | $25 - $609 | 28% |
| Blue Cross Blue Shield | $140 | 157% |
Consumer Guidance & Cost Commentary
For this shoulder X-ray procedure at Nmc Health in Newton, Kansas, the cash price of $227.00 is significantly lower than the facility's negotiated rates with major payers, which range from $140 to $609 depending on the insurance plan. While the facility's cash rate is higher than the state average for this service, it remains a substantial discount compared to the gross charges listed on the hospital's chargemaster. Patients with high-deductible plans may find paying the cash price upfront more cost-effective than relying on insurance, as the negotiated rates for in-network plans often exceed the cash amount. To maximize savings, it is advisable to explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final cost.
The Medicare benchmark for this service is $88.91, which serves as a critical baseline for evaluating the facility's pricing structure. The facility's cash rate of $227.00 represents a markup of 1.6 times the Medicare amount, while the median negotiated rate across payers is $140.00. Because commercial insurance contracts often include administrative overhead and risk premiums, the negotiated rates can be higher than the cash price, even though they are lower than the gross charges. Patients should be aware that comparing their insurance allowed amount to the hospital's gross list price can be misleading; instead, the most accurate comparison is against the Medicare rate to determine if the commercial rate is fairly priced relative to the true cost of care.