X-ray, shoulder
Facility: Wesley Medical Center
Billing Code: 73030 (CPT)
- CPT Billing Code: 73030
- Insurance Median: $798
- Cash Discount Price: $3,594
- vs. Medicare Baseline: 8.98x 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 898% of the Medicare baseline (a markup of 798%). 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 |
|---|---|---|
| First Health | $31 - $2,209 | 35% |
| Multiplan | $32 - $4,312 | 36% |
| UnitedHealthcare | $49 | 55% |
| Medicaid / KanCare | $50 | 56% |
| Aetna | $51 - $1,710 | 57% |
| Amerigroup | $51 | 57% |
| Blue Cross Blue Shield | $161 | 181% |
| United | $182 - $2,156 | 205% |
| Health Partners Of Kansas | $415 - $2,396 | 467% |
| Wppa | $417 - $834 | 469% |
| Ambetter / Centene | $431 - $862 | 485% |
| Medical Associates Health Plan | $453 - $906 | 510% |
| Preferred Health Choices | $453 - $906 | 510% |
| Spirit Aerosystems | $767 - $1,533 | 863% |
| Triwest Healthcare Alliance | $1,557 - $3,114 | 1751% |
| Usa Managed Care | $2,037 - $4,072 | 2291% |
Consumer Guidance & Cost Commentary
For this X-ray, shoulder procedure at Wesley Medical Center in Wichita, KS, the cash price is $3,594, which matches the facility's median paid amount. This rate is significantly higher than the state average, reflecting the specific negotiated or contracted rates for this service. While many commercial payers have negotiated rates ranging from $31 to $4,312 depending on the plan, patients with high-deductible plans may find the cash price more affordable if their insurance negotiated rate exceeds $3,594. It is important to note that commercial rates often include administrative costs for claims processing, which can inflate the baseline price by 20% to 40% compared to direct cash payments.
To potentially lower your out-of-pocket costs, you should inquire about "self-pay" or "prompt-pay" discounts before scheduling your visit, as hospitals often offer fee reductions of 20% to 50% for upfront payment. These discounts bypass the costly insurance billing cycle and administrative overhead, providing immediate liquidity to the facility. Additionally, since the Medicare benchmark for this service is $88.91, the commercial rates represent a substantial markup; fair pricing is typically defined as 120% to 150% of the Medicare rate, whereas commercial rates can average 200% to 300% of this baseline. Always request a full itemized bill to verify charges and avoid balance billing, as federal protections under the No Surprises Act may limit unexpected costs for out-of-network services at in-network facilities.