X-ray, shoulder
Facility: Hiawatha Community Hospital
Billing Code: 73030 (CPT)
- CPT Billing Code: 73030
- Insurance Median: $592
- Cash Discount Price: $760
- vs. Medicare Baseline: 6.66x 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 666% of the Medicare baseline (a markup of 566%). 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 | $133 - $140 | 150% |
| Aetna | $281 - $614 | 316% |
| UnitedHealthcare | $281 - $653 | 316% |
| Humana | $284 | 319% |
| Ambetter / Centene | $337 | 379% |
| Oscar - All Plans | $570 | 641% |
| Centrus Health Direct - All Plans | $570 | 641% |
| Preferred Hlth - All Plans | $684 | 769% |
| Cigna | $722 | 812% |
| Wppa Providrs Care - All Plans | $722 | 812% |
| Midlands Choice - All Plans | $737 | 829% |
| Multiplan - All Plans | $737 | 829% |
| Healthy Blue Mcaid - All Plans | $760 | 855% |
Consumer Guidance & Cost Commentary
For the X-ray, shoulder procedure (CPT 73030) at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $760.00, which matches the facility's gross charge. This cash rate is significantly higher than the state average for this service, though specific county averages were not provided in the data. While commercial insurance plans like Blue Cross Blue Shield and Aetna negotiate rates ranging from $133 to $653, these negotiated amounts often exceed the cash price for patients with high-deductible plans. In such cases, paying cash directly can be more cost-effective than relying on insurance, provided the patient qualifies for a self-pay or prompt-pay discount. Patients should contact the hospital directly to confirm if a prompt-pay discount is available, as paying upfront can sometimes bypass the administrative overhead and administrative markups inherent in the insurance billing cycle.
The facility's negotiated rates vary widely across payers, with the lowest allowed amount being $133 and the highest at $760. Notably, the median negotiated rate across all payers is $592.00, while the median amount paid by insurers is $570.00. When comparing these commercial rates to the Medicare benchmark of $88.91, the facility's pricing reflects a significant markup, a common practice in the healthcare industry where commercial rates often range from 200% to 300% of the Medicare rate. If you receive a bill from this facility, it is advisable to request an itemized billing audit to ensure no errors, unbundled codes, or services not rendered are included, as over 80% of