X-ray, shoulder
Facility: Rooks County Health Center
Billing Code: 73030 (CPT)
- CPT Billing Code: 73030
- Insurance Median: $266
- Cash Discount Price: $222
- vs. Medicare Baseline: 2.99x 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 299% of the Medicare baseline (a markup of 199%). 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 |
|---|---|---|
| Tricare | $139 | 156% |
| Veterans Admin - All Plans | $139 | 156% |
| Celtic Mcr Adv | $139 | 156% |
| Blue Cross Blue Shield | $140 | 157% |
| Celtic Comm - All Other Plans | $153 | 172% |
| Preferred Benefits Admin | $266 | 299% |
| Aetna | $266 | 299% |
| UnitedHealthcare | $266 | 299% |
| Health Partners - All Plans | $281 | 316% |
| Preferred Hlthcare - All Other Plans | $281 | 316% |
| Healthy Blue Mcaid - All Plans | $296 | 333% |
Consumer Guidance & Cost Commentary
For CPT code 73030, an X-ray of the shoulder at Rooks County Health Center in Plainville, KS, the facility's cash median rate is $222.00, which is lower than the negotiated rates paid by most major insurers listed in this report. While the facility's cash price is notably lower than the gross charge of $296.00, patients with high-deductible plans may find that paying the cash rate directly is more cost-effective than relying on insurance, as the negotiated rates for payers such as Celtic Mcr Adv ($139), Blue Cross Blue Shield ($140), and Preferred Benefits Admin ($266) often exceed the cash price. It is important to note that while the facility is a Critical Access Hospital owned by a Government Hospital District, the cash rate of $222.00 is still higher than the Medicare benchmark of $88.91, indicating that the facility's pricing structure includes a markup above the federal cost baseline.
Patients should be aware that the "median negotiated" rate of $266.00 represents the average amount commercial insurers pay, which can be significantly higher than the cash option. Although the data does not provide explicit state or county average comparisons for this specific code, the wide variance in payer payments—from $139 for Tricare to $296 for Healthy Blue Mcaid—highlights how insurance contracts can result in different out-of-pocket costs depending on the plan. To minimize costs, consumers should verify their specific plan's allowed amount before scheduling and ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by