X-ray, foot
Facility: Decatur Health
Billing Code: 73630 (CPT)
- CPT Billing Code: 73630
- Insurance Median: $200
- Cash Discount Price: $236
- vs. Medicare Baseline: 2.25x 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 225% of the Medicare baseline (a markup of 125%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $157 | 177% |
| UnitedHealthcare | $160 - $200 | 180% |
| Humana | $161 | 181% |
| Blue Cross Blue Shield | $173 | 195% |
| Aetna | $236 - $262 | 265% |
| Midlands Choice- All Plans | $236 | 265% |
| Medicaid / KanCare | $265 | 298% |
Consumer Guidance & Cost Commentary
For the X-ray of the foot (CPT 73630) at Decatur Health in Oberlin, KS, the cash median price is $236, which aligns exactly with the negotiated rates for Aetna and Midlands Choice. While the facility's gross charge is $262, patients with high-deductible plans may find paying cash directly more cost-effective than using insurance, as the commercial negotiated rates for some payers like UnitedHealthcare range from $160 to $200 but often include administrative overhead that can exceed the cash price. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can bypass the standard insurance billing cycle and reduce the final amount owed.
When evaluating the cost against federal benchmarks, the Medicare amount for this service is $88.91, which serves as the objective baseline for fair pricing. The cash median of $236 represents approximately 2.2 times the Medicare rate, a figure that falls within the typical range where commercial rates average 200% to 300% of Medicare due to administrative costs and contract dynamics. Although specific county or state average data was not provided in the source information, understanding that the Medicare rate reflects the true cost of delivery helps patients recognize that the commercial price includes additional layers of pricing structure. To ensure accuracy, patients should request an itemized bill to verify that no unbundled codes or services not rendered are included in the final charge.