X-ray, foot
Facility: Lmh
Billing Code: 73630 (CPT)
- CPT Billing Code: 73630
- Insurance Median: $189
- Cash Discount Price: $176
- vs. Medicare Baseline: 2.13x 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 213% of the Medicare baseline (a markup of 113%). 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 |
|---|---|---|
| UnitedHealthcare | $49 - $622 | 55% |
| Blue Cross Blue Shield | $49 - $606 | 55% |
| Humana | $88 | 99% |
| Cigna | $88 - $625 | 99% |
| Medicare (plans) | $88 | 99% |
| Haskell Indian Health Services | $88 | 99% |
| Allwell | $89 | 100% |
| Ambetter / Centene | $136 | 153% |
| Aetna | $298 - $777 | 335% |
| Non Contracted | $374 - $749 | 421% |
| First Health | $435 - $871 | 489% |
Consumer Guidance & Cost Commentary
For this X-ray of the foot at Lmh in Lawrence, KS, the cash price of $176.00 is significantly lower than the facility's gross charge of $702.00. While the Medicare benchmark of $88.91 serves as the objective baseline for evaluating pricing fairness, the cash rate is approximately double the Medicare amount, which aligns with the typical range where commercial rates can be 200% to 300% of Medicare. Patients with high-deductible plans may find this cash price advantageous if their insurance negotiated rates exceed $176.00, as paying out-of-pocket could result in immediate savings compared to the administrative costs and higher allowed amounts often seen in commercial contracts.
When comparing to payer-specific data, the facility's negotiated rates vary widely, ranging from $88 at Humana and Medicare to $777 at Aetna, with a median negotiated amount of $189.00. It is important to note that being in-network does not guarantee the lowest possible price, as different insurers have distinct contract ceilings that can be substantially higher than the cash rate. To maximize savings, patients should verify their specific plan's allowed amount before scheduling and inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% by bypassing the costly insurance claims processing cycle.