X-ray, hand
Facility: Holton Community Hospital
Billing Code: 73130 (CPT)
- CPT Billing Code: 73130
- Insurance Median: $272
- Cash Discount Price: $246
- vs. Medicare Baseline: 3.06x 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 306% of the Medicare baseline (a markup of 206%). 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 | $135 | 152% |
| UnitedHealthcare | $143 - $541 | 161% |
| Aetna | $143 - $541 | 161% |
| Humana | $145 - $290 | 163% |
| Kansas Superior Select - All Plans | $146 - $292 | 164% |
| Preferred Health Fn Select - All Other Plans | $225 - $449 | 253% |
| Preferred Health Professionals | $225 - $449 | 253% |
| Preferred Health Freedom | $225 - $449 | 253% |
| Wppa Providers - All Plans | $257 - $514 | 289% |
| Medicaid / KanCare | $270 - $541 | 304% |
Consumer Guidance & Cost Commentary
For the X-ray of the hand (CPT 73130) at Holton Community Hospital, the cash median price is $246.00, which is notably lower than the facility's gross charge of $328.00. While the hospital is a Critical Access Hospital in Holton, KS, and operates as a voluntary non-profit, the negotiated rates vary significantly by insurer, ranging from a low of $135 with Blue Cross Blue Shield to a high of $541 with UnitedHealthcare and Aetna. Because commercial negotiated rates often include administrative overhead and contract ceilings, the cash price can sometimes be the most economical option for patients with high-deductible plans who have not yet met their out-of-pocket maximum. It is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed.
When evaluating the cost against federal benchmarks, the Medicare amount for this service is $88.91. The facility's cash median of $246.00 represents a markup of approximately 3.1 times the Medicare rate, which aligns with the typical range where fair pricing is often defined as 120% to 150% of Medicare, though commercial contracts frequently average between 200% and 300%. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is crucial to verify your specific plan's deductible status before scheduling, as you may still be responsible for the full negotiated rate if your deductible has not been met. Always request a detailed, itemized bill to