X-ray, shoulder
Facility: Holton Community Hospital
Billing Code: 73030 (CPT)
- CPT Billing Code: 73030
- Insurance Median: $303
- Cash Discount Price: $341
- vs. Medicare Baseline: 3.41x 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 341% of the Medicare baseline (a markup of 241%). 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 | $139 | 156% |
| Aetna | $160 - $606 | 180% |
| UnitedHealthcare | $160 - $606 | 180% |
| Humana | $162 - $324 | 182% |
| Kansas Superior Select - All Plans | $164 - $327 | 184% |
| Preferred Health Freedom | $251 - $503 | 282% |
| Preferred Health Fn Select - All Other Plans | $251 - $503 | 282% |
| Preferred Health Professionals | $251 - $503 | 282% |
| Wppa Providers - All Plans | $288 - $575 | 324% |
| Medicaid / KanCare | $303 - $606 | 341% |
Consumer Guidance & Cost Commentary
For the X-ray, shoulder procedure (CPT 73030) at Holton Community Hospital in Holton, Kansas, the facility's cash median price is $341.00, which is lower than the state average of $454.00. While commercial insurance plans like Aetna and UnitedHealthcare have negotiated rates ranging from $160 to $606, these figures often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that while the No Surprises Act protects patients from balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, patients should still verify their specific plan details before scheduling. Additionally, because the facility is a Critical Access Hospital, patients should proactively ask about "self-pay" or "prompt-pay" discounts, which can significantly reduce the final amount owed if settled upfront.
The facility's negotiated rates average $303.00, which is lower than the gross chargemaster but still higher than the Medicare benchmark of $88.91, reflecting standard administrative costs and contract dynamics. Since Medicare rates represent a scientifically validated baseline for the true cost of care, comparing commercial rates to this benchmark reveals that the facility's pricing aligns with typical market structures rather than inflated list prices. To ensure accuracy and avoid unexpected costs, patients should request a full itemized bill rather than accepting summary invoices, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. Disputing these errors in writing with the billing supervisor is the most effective way to reduce medical debt and ensure the