X-ray, shoulder
Facility: Ashland Health Center
Billing Code: 73030 (CPT)
- CPT Billing Code: 73030
- Insurance Median: $195
- Cash Discount Price: $156
- vs. Medicare Baseline: 2.19x 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 219% of the Medicare baseline (a markup of 119%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $65 | 73% |
| Compalliance-All Plans | $156 | 175% |
| Health Partners Of Kansas-All Plans | $166 | 187% |
| Multiplan-All Plans | $191 | 215% |
| Medicare (plans) | $195 | 219% |
| Health Choice-All Plans | $195 | 219% |
| Aetna | $195 | 219% |
| Medica Mcare - All Plans | $195 | 219% |
| Healthy Blue Mcr Adv - All Other Plans | $195 | 219% |
| Medicaid / KanCare | $195 | 219% |
| UnitedHealthcare | $195 | 219% |
| Providers Care (Wppa)-All Plans | $292 | 328% |
Consumer Guidance & Cost Commentary
For the X-ray, shoulder procedure (CPT 73030) at Ashland Health Center in Ashland, KS, the facility's negotiated rates across all major payers, including Medicare, Blue Cross Blue Shield, and Medicaid/KanCare, are consistently $195. This amount matches the facility's median negotiated rate and the gross charge listed, indicating no variation based on insurance plan. While the cash median price is lower at $156, patients with high-deductible plans or those without insurance may find the cash price more advantageous, as paying $156 directly avoids the administrative markup inherent in insurance billing cycles. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the data does not provide a specific county or state average for comparison, so the $195 negotiated rate stands as the benchmark for in-network coverage in this location.
Patients should be aware that the $195 rate represents the contracted amount for in-network services, which includes the administrative costs of claims processing and utilization reviews. If a patient chooses to pay out-of-pocket, they should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final cost by 20% to 50% if settled upfront. Additionally, if a patient receives care from an out-of-network provider at this facility, they may encounter balance billing for the difference between the provider's full charge and the insurance allowed amount, though the No Surprises Act protects against such surprise bills for emergency and non-emergency services at in-network facilities. To ensure accuracy, patients should request an itemized bill before paying, as summary invoices can obscure unb