X-ray, shoulder
Facility: Decatur Health
Billing Code: 73030 (CPT)
- CPT Billing Code: 73030
- Insurance Median: $208
- Cash Discount Price: $246
- vs. Medicare Baseline: 2.34x 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 234% of the Medicare baseline (a markup of 134%). 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 | $164 | 184% |
| UnitedHealthcare | $166 - $208 | 187% |
| Humana | $168 | 189% |
| Blue Cross Blue Shield | $181 | 204% |
| Midlands Choice- All Plans | $246 | 277% |
| Aetna | $246 - $273 | 277% |
| Medicaid / KanCare | $276 | 310% |
Consumer Guidance & Cost Commentary
For this X-ray, shoulder service at Decatur Health in Oberlin, Kansas, the cash price is $246, which matches the state average for this procedure. While commercial insurance plans like UnitedHealthcare and Aetna negotiate rates ranging from $164 to $276, these amounts 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 commercial rates include administrative costs for claims processing and contract management, which can inflate the baseline price by 20% to 40% compared to direct cash payments. If you are self-paying, ask the hospital specifically about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if settled upfront, bypassing the costly insurance billing cycle.
The facility's negotiated rates are significantly higher than the Medicare benchmark of $88.91, reflecting the standard markup in commercial healthcare pricing. Since Medicare rates represent a scientifically validated cost baseline, comparing your commercial rate to this figure reveals that the negotiated amounts are well above the true cost of delivery. If you receive a bill after using insurance, ensure it is an itemized statement showing specific CPT codes rather than a broad summary, as over 80% of hospital bills contain errors such as double-billing or unbundled charges. If you encounter a surprise balance bill from an out-of-network provider, do not pay immediately; instead, dispute the charge with your insurer and request a No Surprises Act audit to protect your rights.